Osteoporosis Flashcards
What is primary OP?
Age related
What is secondary Op?
Caused by other conditions or drugs
What becomes more likely if trabecular bone is affected?
Crush fractures of the vertebrae (hence little old ladies)
What becomes more likely if cortical bone is affected? Which can be esp dangerous if it affects where?
Long bone fractures, especially the femoral head fracture which can be lethal
Which sex is more likely to be affected?
Women (also have increased risk of fracture as they loose more trabeculae with age whereas the number in men remains more stable)
What are the risk factors for developing primary OP?
FMH, drinking more than 4 units of alcohol a day, RA, bmi below 22 (the normal level), prolonged immobility and untreated menopause
What is the acronym for secondary OP?
SHATTERED
What does ‘shattered’ stand for?
Steroids, hyperparathyroidism/hyperthyroidism/hypercalciuria, alcohol and tobacco use, thin (BMI less than 22), testosterone levels reduced, early menopause, renal or liver failure, erosive/inflammatory bone disease (RA), dietary calcium low/malabsorption/diabetes t1
Investigations are?
XR, dexa scan, bloods UE, FBC, investigations for any secondary cause suspected eg GFR and LFTs
Which bone do they scan with a dexa?
The hip
What is bone mineral density measured in?
G/cm2
What is the T score?
The number of standard deviations from the youthful healthy average
Each increase in T score multiplies the risk of fracture by what amount?
2.6 times
With reference to T score what is osteopenia? What should you do?
-1 to -2.5 at risk of developing osteoporosis, offer lifestyle advice
What is osteoporosis with reference to t score? What should you do?
A score below -2.5 offer lifestyle advice and treatment
If diagnosed with OP what should you do in 2 years?
Repeat dexa
When should you do a dexa scan?
Low trauma fracture, women older than 65 with a risk factor or younger with 2 rfs, prior to prendisalone treatment, men or women with osteopenia with low trauma vertebral fracture, bone and bone remodelling conditions
When do you not need to do a dexa scan?
Pre-treatment for Women over 75 with: low trauma fracture, RA, alcoholism or positive FMH
What is osteoporosis?
Skeletal disease characterised by low bone mass and micro-deterioration of bone tissue resulting in bone weakness and susceptibility to fracture
WhT scoring system is used to estimate the risk of fracture in the next 10 years?
The FRAX scoring system
What lifestyle measures can be taken?
Quit smoking, reduce alcohol, weight bearing exercise, balance exercises, calcium and vitamin d rich diet, home based fall prevention program
What is the 1st line treatment for OP?
Alendronic acid (bisphosphosphonate) and used for prevention in long term steroid use.
How must you take alendronic acid?
Sat upright, before food with lots of water, remain upright and don’t eat or take other meds for 30 mins
What are the side effects of alendronic acid?
Dysphagia, strictures and rarely jaw osteonecrosis
What might you give supplement wise?
Calcium, vitamin D
If intolerant to bisphosphosphonates the. What should you give?
Sodium ranelate
What preventative measure for women going into menopause can be given?
HRT
What does HrT increase the risk of?
Breast cancer
What treatment is given to hypo gonadal me Not?
Testosterone to increase trabecular interconnections
What treatment can be used like HrT with less risk of breast cancer?
Raloxifene
How does prendisalone cause osteoporosis (SIOP)?
Direct osteoblast inhibition, enhances bone resorption, inhibits Ca absorption, increases loss by inhibiting calciferol release by interstitial cells, inhibits sex hormones
Is mineralization decreased in OP?
No there is only bone loss
