Osteoporosis Flashcards
Ostoporosis RISK FACTORS
Diet- low in calcium
Low BMI < 19
Lack of exercise
Inadequate exposure to sunlight
SAD and excessive coffee intake
Medications: glucocorticoids, anticonvulsants (phenothiazines), GnRh, aromatase inhibitors (Letrozole, Anastrozole, Exemestane), heparin, Depo, thiazolidinedions (glitazones), PPI’s
Medical conditions: hyperthyroidism, hyperparathyroidism, chronic liver or renal disorders, rheumatoid arthritis, coeliac disease
Menopause
Family history
Ostoporosis First Investigation
25 hydroxy Vitamin D
Ostoporosis Best Investigation
DEXA Scan (Don’t take Ca 24 hours before)
- T-score:
> -1: Normal, - 0.9 to -2.4: Osteopenia
< -2.5: Osteoporosis - Z score: ≤ -2: Investigation for underlying causes
Osteoporosis CRITERIA FOR TREATMENT
Any man or woman with spine or hip fractures after minimal trauma even if the T score is more than -2.5. Treatment may be initiated without confirmation of low bone mineral density.
No fracture but score < or equal to -2.5 if risk factors are present
Osteoporosis due to secondary causes
Treatment with medications has to be started along with Calcium and Vitamin D supplementation
1200- 1500 mg/day of calcium
800- 2000 IU/day of Vitamin D
Notes: Medications increase bone density in the hip approximately by 1-3% and in the spine by 4-8% over 3-4 years
Osteoporosis FIRST-LINE Treatment
- Bisphosphonates
- Alendronate
- Risedronate
- Zoledronic Acid - Denosumab
- Strontium ranelate
- Raloxifene
- MHT
Osteoporosis SECOND-LINE Treatment
Teriparatide:
- Is a recombinant parathyroid hormone.
- Stimulates bone-forming cells.
- Only if other treatments fail.
- Given as daily injections subcutaneously for 18 months.
INDICATIONS: > 1 symptomatic new fracture after 12 months of biphosphonate or if T score is ≤-3
Osteoporosis FIRST-LINE Treatment: BISPHOSPHONATES Zoledronic Acid
Annual infusion for a maximum of 3 years.
Used if patients have Oesophagitis.
Vitamin D levels should be corrected to 50nmol/L before starting the treatment.
Osteoporosis FIRST-LINE Treatment: Denosumab
- Monoclonal antibody against osteoclast.
- Given as 6 monthly injections subcutaneously for 36 months.
- No gastrointestinal side effects.
- But increases hypocalcemia.
Osteoporosis FIRST-LINE Treatment: Strontium ranelate
Given orally 2 grams/day.
Should not be given with calcium supplements.
Reserved for severe osteoporosis because can cause MI
- Contraindications:
- DVT
- Prolonged immobilisation
Osteoporosis FIRST-LINE Treatment: Raloxifene
- Selective estrogen receptor modulator
- Oestrogen-like effect on bone but antagonistic for uterus and breast.
- Can be considered as second-line treatment for postmenopausal women with osteoporosis at risk of breast cancer.
- Reduces risk of vertebral fractures.
Osteoporosis FIRST-LINE Treatment: MHT
In peri or postmenopausal women with osteoporosis associated with other menopausal symptoms
OSTEOPENIA CRITERIA FOR TREATMENT
T score between -1 and -2.5 without minimal trauma fracture
Treat with calcium and Vitamin D supplementation and lifestyle modifications:
1200- 1500 mg/day of calcium
800- 2000 IU/day of Vitamin D
Osteoporosis Treatment Follow-up
Repeat DEXA in 2 years.
Every year if medication is changed, termination of the treatment or high-risk patient.
Osteopenia Follow-up
Repeat DEXA every 2 - 5 years
Osteoporosis Treatment: BISPHOSPHONATES General Features
- Decrease bone loss and increase mineral density.
- Measure Vit D and RFT before starting the treatment.
- Useful for vertebral & non-vertebral fractures.
- Contraindicated in pregnancy because it’s teratogenic.
- Side Effects: GI discomfort, oesophagitis, and jaw necrosis
