Osteoporosis Flashcards
What is osteoporosis?
A skeletal condition characterized by low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture
What are the non-modifiable risk factors for osteoporosis?
- Advanced age (>65 years)
- Female gender
- Caucasian or South Asian
- Family history of osteoporosis
- History of low trauma fracture.
What are the modifiable risk factors for osteoporosis?
- Low body weight (58 kg or BMI <21)
- Premature menopause (age <45)
- Calcium/vitamin D deficiency
- Inadequate physical activity
- Cigarette smoking
- Excessive alcohol intake (>3 drinks/day)
- Iatrogenic factors (e.g., corticosteroids, aromatase inhibitors).
How is osteoporosis diagnosed?
Dual energy x-ray absorptiometry (DEXA) of the lumbar spine and hip is gold standard
What does a T-score of -2.5 or less indicate?
Osteoporosis.
What is the T-score range for normal bone mineral density (BMD)?
T-score ≥ -1.
What is osteopenia defined by in terms of T-score?
T-score between -1 and -2.5.
What does a Z-score less than -2 indicate?
It should prompt evaluation for causes of secondary osteoporosis.
What can plain radiographs indicate in relation to osteoporosis?
They lack sensitivity but rib fractures or vertebral compression fractures without trauma history should prompt evaluation for osteoporosis.
What is the first-line treatment for osteopenia?
Risk modification: weight-bearing exercise, vitamin D3 supplementation, limiting alcohol, and smoking cessation.
What are the first-line treatments for osteoporosis?
- Vitamin D (400-800 IU) and calcium supplementation (at least 1000mg)
- Oral bisphosphonates or IV if oral not tolerated
What are the second-line treatments for osteoporosis?
- Denosumab
- Teriparatide.
True or False: Regular weight-bearing exercise helps to prevent osteoporosis.
True.
What are some secondary causes of osteoporosis?
- Coeliac disease
- Eating disorders
- Hyperparathyroidism
- Hyperthyroidism
- Multiple myeloma; causes low BMD and vertebral fractures
What should patients be reassured about regarding oral bisphosphonates?
Serious side effects are very rare
* Reflux and oesophageal erosions
* Atypical fractures (e.g., atypical femoral fractures)
* Osteonecrosis of the jaw (regular dental checkups are recommended before and during treatment)
* Osteonecrosis of the external auditory canal
How does osteoporosis in men compare to women?
It is less common, and secondary causes should be excluded.
Fill in the blank: Hypogonadism may be treated with _______.
Testosterone.
What is a T-score
Number of SDs from the mean bone density of persons of same gender at age of peak density (25)
What is the Z score
comparison of the patient’s
BMD with an age- & gender-matched population
What advice would you give to a patient who has been started on oral bisphosphonates
- take on an empty stomach and other drugs/food should be avoided for 30 mins afterwards to maximise gut absorption
- swallow whole with water and avoid bending down for 30 mins to reduce chances of indigestion
Give 2 contraindications of bisphosphonates
Achalasia
Poor swallow
What may be prescribe in the event that bisphosphonates are contraindicated or not tolerated
IV zolendronic acid
Denosumab
how do bisphosphonates work and give 3 examples
interfere with the way osteoclasts attach to bone, reducing activity and reabsorption of bone
* Alendronate 70 mg once weekly (oral)
* Risedronate 35 mg once weekly (oral)
* Zoledronic acid 5 mg once yearly (intravenous)
how should treatment with bisphosphonates be monitored
reassess treatment after 3-5 years
- repeat DEXA and stop treatment if the T-score is > -2.5
- treatment should be continued in high risk pt
what blood test results would you expect to see in osteoporosis
normal ALP,calcium, phosphate and PTH
what is Paget’s disease
disease of increased but uncontrolled bone turnover
- primarily a disorder of osteoclasts: ↑↑ osteoclastic resorption, ↑ osteoblastic activity
what are the most commonly affected areas of Paget’s disease
- skull
- spine
- pelvis
- long bones of lower extremities e.g. femur
what are predisposing factors of Paget’s disease
- increasing age
- male sex
- northern latitude
- family history
what are clinical features of Paget’s disease
only 5% of patients are symptomatic
* older male with bone pain and an isolated raised ALP
* bone pain (e.g. pelvis, lumbar spine, femur)
* classical, untreated features: bowing of tibia, bossing of skull
what are appropriate investigations for Paget’s disease
- bloods
- x-ray
- bone scintigraphy
what are blood test results of Paget’s disease
- raised ALP
- calcium + phosphate typically normal (↑Ca2+ associated with prolonged immobilisation)
what are x-ray findings of Paget’s disease
- osteolysis in early disease –> mixed lytic/sclerotic lesions later
- skull: thickened vault, osteoporosis circumscripta
what is involved in the management of Paget’s disease
- bisphosphonates either oral risedronate or IV zoledronate
- calcitonin used less commonly
what are complications of Paget’s disease
- deafness (cranial nerve entrapment)
- bone sarcoma (1% if affected for > 10 years)
- fractures
- skull thickening
- high-output cardiac failure
a patient has been diagnosed with PMR and started on prednislone 15mg OD - what is the most appropriate approach to bone protection
start oral aledronate + ensure calcium and vitamin D replete
Bone protection for patients who are going to take long-term steroids should start immediately
what are the NICE guidelines for patients >65 starting long term corticosteroids therapy
co-prescribe bisphosphonates to prevent glucocorticoid induced osteoporosis
give examples of medications that may worsen osteoporosis
- glucocorticoids
- SSRI
- anti-epileptic
- PPIs
