Osteoporosis Flashcards
What are the risk factors of osteoporosis?
- Menopause
- 50+ men
- LT glucocorticoid
- Elderly, parenteral hx of hip fractures
- Low BMI, smoking, no exercise, excess alcohol
- Vit D + calcium deficiency
- Diabetes, RA
What is the treatment for osteoporosis?
- First line: oral bisphosphonate (alendronic acid and risedronate)
- Menopause (<60 years and menopausal symptoms): if high risk can use HRT
Medication examples:
- Calcitriol (synthetic vitamin D3)
- Denosumab
- HRT (oestrogen, tibolone, raloxifene)
When would you use prevention for osteoporosis?
pt on long term glucocorticoid
- High risk: large doses (>7.5mg daily prednisolone)
- Men 70+ AND previous fragility fracture
- Women 70+ OR previous fragility fracture
Bisphosphonate: MOA
slows bone resorption by adsorbing onto hydroxyapatite crystals
Bisphosphonate: drugs
- Alendronic acid (5 years)
- Risedronate (5 years)
- Ibandronic acid (IV or orally)
- Zoledronic acid (IV most potent; highest risk of jaw osteonecrosis)
Alendronic acid: administration
- Swallow whole with plenty of water
- Standing or sitting
- Empty stomach at least 30 min before breakfast (or another oral med)
- Stand or sit upright for 30 min
Risedronate: administration
- Leave 2H gap btw food + drink, calcium products, antacids, iron or minerals
- Stand or sit upright for 30 min – avoid at bed time or before rising
Bisphosphonate: side effect
Oesophageal reaction
- Counsel: report symptoms of oesophageal irritation (dysphagia, new worsening heartburn, pain swallowing or retrosternal pain)
Atypical femoral fractures
- MHRA: report hip, thigh, groin pain
Osteonecrosis of jaw
- MHRA: routine dental check ups + good oral hygiene
- Report oral symptoms (dental mobility pain, swelling, ulcers
Osteonecrosis of auditory canal
- MHRA: report ear symptoms (ear pain or discharge, chronic infections, cholesteatoma)
