Osteoporosis Flashcards
What is osteoporosis?
Progressive bone disease that results in low bone mass. It is measures by bone mineral density
Do corticosteroids make osteoporosis worse?
Yes, they can cause osteoporosis
What are some risk factors of osteoporosis
Post menopausal women
Men over 50
Long term corticosteroid use
Age
Less vitamin C and D intake
Lack of exercise and physical activity
Alcohol
Low BMI
What can you do to improve osteoporosis
Increase exercise
Stop smoking
Maintain normal BMI
Reduce alcohol
Increase Vitamin C and D
What are the drugs involved in treatment
Bisphosphonates
HRT
Raloxifene
Strontium
What is the treatment for post menopausal osteoarthritis
Alendronic acid or Risedronate
What if alendronic acid and risedronate are contraindicated in post menopausal women
Ibandronic acid
Denosumab
Raloxifene
What is the first line treatment in men
Alendronic acid
Risedronate
If the osteoporosis is due to glucocorticoid therapy then what should you do after the glucocorticoid therapy has stopped?
Review the need to continue bone protection
How do the bisphosphonates work?
Absorbed into the hydroxyapatite crystals in the bone, slowing both their rate of dissolution and reducing rate of bone turnover
What is the MHRA advice for bisphosphonates
1) Atypical femoral fracture - report any thigh pain, hip or groin pain during treatment
2) Osteonecrosis of the jaw - jaw bone starved of blood - maintain good check ups
3) Osteonecrosis of the external auditory canal - report any ear pain or discharge from the ear or ear infection
Side effects of alendronic acid
Oesophageal reactions
Stop and seek medical advice if any new symptoms like dysphagia, heartburn and pain on swallowing
Counselling on how to take alendronic acid
Take ONCE a week
Swallow whole
Take doses with lots of water
Take whilst sitting or standing
Take on empty stomach at least 30 mins before breakfast or any meal
Stand or sit upright for at least 30 mins after administration
What is used in severe osteoporosis for men and post menopausal women at increased risk of fractures when other treatments are contraindicated
Stontium
Should strontium be initiated by specialist
Yes
Contraindications of strontium
Cerebrovascular disease
DVT
Ischaemic Heart disease
Immobilisation
Uncontrolled hypertension
What drug does not help with the vasomotor symptoms of menopause
Raloxifene
When is HRT used for osteoporosis
In young menopausal women who are at high risk of fractures
Why is HRT not used in older women
Risk of cardiovascular disease and cancer
What HRT do you give to women with a uterus
COMBINED HRT - oestrogen and progesterone
REDUCES CHANCES OF ENDOMETRIAL CANCER
Can also give tibolone
What do you give to women without a uterus
Oestrogen only
What do you give women with endometriosis
Combined HRT
