Osteoporosis Flashcards
Bone+ joint disorder
What is osteoporosis?
A bone defect characterised by reduced bone mineral density and increased porosity
What are the types of osteoporosis?
Type I (Post-menopausal)
= Exacerbated bone loss after menopause
Type II (Senile)
= Bone loss due to ageing
Secondary Osteoporosis
= Caused by conditions like steroids, alcohol, and chronic diseases.
What are the risk factors for osteoporosis?
(1) Steroid use
(2) Alcohol
(3) Smoking
(4) Low estrogen
(5) Early menopause
(6) Low calcium, inactivity
(7) Chronic diseases
(8) Vitamin D deficiency
What is the SHATTERED acronym for osteoporosis?
S: Steroid use
H: Hyperthyroidism
hyperparathyroidism
A: Alcohol, smoking
T: Thin (BMI<22) Testosterone deficiency
E: Early menopause
R: Renal/liver failure
E: Erosive bone disease
D: Diabetes
What is the pathophysiology of osteoporosis?
Bone resorption (osteoclast activity) exceeds bone formation (osteoblast activity)
= leading to decreased bone density and increased fragility
What is the gold standard for diagnosing osteoporosis?
DEXA scan (T ≤ -2.5)
What is the first-line pharmacological treatment for osteoporosis?
Oral bisphosphonates
(eg, alendronic acid, risedronate)
for T-score ≤ -2.5
What supplements should be given if calcium or vitamin D is deficient?
Calcium and/or vitamin D supplements
How do bisphosphonates work?
Reduce osteoclastic resorption of bone
What are the common side effects of bisphosphonates?
Oesophagitis, dysphagia
What are second-line treatments if bisphosphonates are not tolerated?
- Zoledronic acid
(IV, annual) - Denosumab
(monoclonal antibody reducing osteoclast activity)
What is Teriparatide used for?
Stimulate bone growth in severe osteoporosis, reducing fracture risk
What is the FRAX tool used for?
Assesses the 10-year osteoporotic fracture risk, helping determine the need for treatment
What is the T-score range for osteopenia?
T-score between -1.0 and -2.5 indicates osteopenia
Osteopenia meaning?
low bone density
What T-score defines severe osteoporosis?
T-score of -2.5 or lower with a fragility fracture defines severe osteoporosis
What is the primary prevention strategy for osteoporosis?
Building peak bone mass through \
(1) exercise
(2) healthy diet (high in calcium and vitamin D)
(3) sunlight exposure
What are the side effects of bisphosphonates?
(1) Oesophageal ulcers
(2) Atrial fibrillation
(3) osteonecrosis of the jaw
(4) Atypical stress fractures.
What is a commonly used supplement in osteoporotic patients?
Calcium + Vitamin D
How is osteoporosis diagnosed on a bone density scan?
(1) Osteoporosis is diagnosed when patients have a T-score of less than 2.5 standard deviations below the mean.
(2) A score of between -1 and -2.5 indicates osteopenia
What is the main bone protection therapy following a vertebral fracture?
Bisphosphonates
What is the mechanism of action of bisphosphonates?
They are incorporated into osteoclast cells and interfere with cell function, causing cells to be non-functional and apoptose
Bone [Blank] occurs at a greater rate than bone [Blank] in osteoporosis?
Bone Resorption occurs at a greater rate than bone formation in osteoporosis.
A T score of less than [Blank] on dual-energy x-ray absorptiometry (DEXA) scan indicates osteoporosis?
-2.5
Why should patients sit up before taking bisphosphonates?
Reduce the risk of developing an oesophageal ulcer
What is the first line of medical treatment to treat osteoporosis?
Bisphosphonates are first line and tend to be given weekly
Which subgroup of osteoporosis patients can get raloxifene?
Postmenopausal women
Which organ is mainly responsible for excretion of bisphosphonates?
Kidneys
[Blank] activity exceeds [Blank] activity in osteoporosis?
- Osteoclast
- Osteoblast
What is the FRAX tool used for osteoporosis?
Provides a 10-year risk of osteoporotic fracture, which helps decide when to offer bisphosphonates:
(1) Low risk - Bisphosphonates not yet needed
(2) Medium risk - Perform DEXA to decide if bisphosphonates are needed
(3) High risk - Bisphosphonates needed
Bone mineral density is [Blank] in osteoporosis?
Low
How do bisphonates work?
They inhibits osteoclast activity
Which site is most commonly affected by osteoporotic fractures?
Vertebral fractures
What is the mechanism of action of Raloxifene?
Raloxifene binds to oestrogen receptors and exerts the same protective action that oestrogen performs on bones by inhibiting osteoclastic action
Which patients at risk of osteoporosis should be assessed using a FRAX score?
(1) All women aged over 65 should be assessed and men aged over 75
(2) Younger patients if they have risk factors eg, a previous fragility fracture or frequent use of oral corticosteroids
At which sites do osteoporotic fractures usually occur?
Hip
Vertebrae
Wrist
Which organ is mainly responsible for excretion of bisphosphonates?
Kidneys
After suffering two fractures, one of the distal radius and one of the neck of the femur, a 90-year-old woman is started on alendronate acid.
Which is the most likely side effect she would experience?
Oesophageal irritation
Osteonecrosis of the jaw is a severe side effect of which drug?
bisphosphonates
An 86-year-old female has confirmed osteoporosis on her FRAX score. Her GP wants to start her on alendronic acid for bone protection.
Which of her past medical conditions would be a contraindication to this therapy?
Known anatomical abnormalities
= eg, oesophageal stricture
A 73-year-old woman underwent a DEXA scan and her T score is -3.5. After a discussion with the GP, it is decided to start her on a weekly tablet to protect her bones.
What is the mechanism of action of this medication?
Inhibition of osteoclasts
Bisphosphonates are known to cause oesophagitis if not taken correctly. Therefore, how should you take these sorts of drugs? and what advice do you give her?
(1) Take the medicine on an empty stomach first thing in the morning before breakfast and remain upright for at least 30 minutes after taking it
(2) She needs to have regular dental checkups
Osteoporosis is defined as being greater than 2.5 standard deviations below the average bone density.
Which method of screening is the best suited to giving an initial assessment of osteoporosis risk in a General Practice setting?
FRAX
What is the initial test for osteoporosis and what confirms the diagnosis?
Initial test
= FRAX score
Confirmatory test
= DEXA scan
What blood results are raised in those with osteoporosis?
Alkaline phosphate
= ALP
What is the first-line treatment for those with osteoporosis where bisphosphonates are contradicted (eg, in chronic kidney disease)
Denosumab
