Osteoporosis Flashcards
What is osteoporosis?
Reduction in bone density
How does osteoporosis appear on an x-ray?
Osteopenia (reduction in bone density)
What investigation is used to diagnose osteoporosis?
DEXA scan
How does the DEXA scan work?
The femoral neck is scanned and the T-score is calculated
What is considered a normal T score?
More than -1
What is considered osteopenia on a DEXA scan?
T score -1 to -2.5
What is considered osteoporosis on a DEXA scan?
T score LESS than -2.5
What is considered severe osteoporosis on a DEXA scan?
T score less than -2.5 + a fracture
What are the risk factors for osteoporosis?
Age
Post-menopausal women
Reduced mobility
Low BMI
Low calcium or Vit D
Alcohol and smoking
CKD
Long term corticosteroids
Certain medications
What medications increase the risk of of osteoporosis?
Long term corticosteroids
SSRIs
PPIs
Anti-epileptics
Anti oestrogens
Why are post menopausal women at risk of osteoporosis?
Oestrogen is protective
It stimulates osetoblast activity so when its production ceases there will overall be more osteoclast activity
What treatment can you offer to post menopausal women to help prevent osteoporosis?
Selective Oestrogen Receptor Modulator (SERM)
Raloxifene or Tamoxifen
What is the alternate use of tamoxifen?
What is its down side?
Treats Breast cancer
But increases risk for endometrial cancer
What investigations would you do for a patient who you think might have osteoporosis?
What scoring system would you use to determine likelihood of osteoporosis?
Vitamin D
Serum calcium
ALP
Thyroid function
Testosterone (men)
WHO FRAX score
What is the use of the WHO FRAX score?
Measures 10year risk of a major osteoporotic hip fracture
Can be used to guide whether to start treatment for osteoporosis before a DEXA scan
What patients can you start osteoporosis. Treatment for without a DEXA scan?
If they had a vertebral fracture
What patients should you question osteoporosis?
Long term corticosteroids
Previous fragility fracture
50+ with risk factors
Women 65+
Men 75+
What are lifestyle modifications that can be done for osteoporosis?
Inc physical activity
Healthy weight
Smoking cessation
Alcohol reduction
Increase calcium intake
Improve vitamin D intake
How much calcium should a patient aim for in a day?
1000mg
How many units of vitamin D does a patient need?
400-800 IU
What is the first line medical treatment for osteoporosis?
Bisphosphonates
How do bisphosphonates work?
Reduces osteoclast activity
What are the side effects of bisphosphonates?
Oesophagitis
Osteonecrosis of the jaw
Osteonecrosis. Of the external auditory canal
Atypical
How must oral bisphosphonates be taken?
Empty stomach with full glass of water
Should remain upright for 30mins before moving to reduce risk of GORD and oesophagitis
What are the 2 main bisphosphonates used for osteoporosis?
Alendronate
Zolendronic acid
What dose of alendronic acid does a patient take and how often?
70mg once weekly
How much zolendronic acid is given to a patient?
How is it taken?
How frequently is it given?
5mg
IV
Once yearly
What are some specialist medications that can be given to treat osteoporosis if bisphosphonates aren’t suitable?
Denosumab
Rommosozumab
HRT
Raloxifene
Strontium ranelate
What is an adverse effect of strontium. Ranelate?
Increases risk of VTE and MI
How does Raloxifene differ to tamoxifen?
What are its adverse effects?
It doesn’t stimulate receptors in the uterus so doesn’t increase the risk of endometrial cancer.
Increases its risk of VTE
Why are patients at risk of osteoporosis with CKD?
Kidneys unable to activate vitamin D
Means poor absorption of calcium in the gut (renal bone disease)
