Osteoporosis Flashcards
Which of group of patient is most likely to be affected by osteoporosis?
Post menopausal women
How quickly does osteoporosis occurs in post menopausal women?
5-10 years after menopause and at 65 years old, women are 3-5 times more susceptible of fracture.
List 5 modifiable risk factors for osteoporosis?
Smoking Low physical activity Low calcium intake Lack of vitamin D alcohol intake > 2 SD per day high caffiene intake > 4 cups per day.
List 5 non modifiable risk factors for OP?
female age late menarche early menopause family history
List 5 medical causes of osteoporosis?
Diabetes Chronic disease ie RA Steroid usage Immobility Coeliac disease Anorexia Endocrine disorders
What is the role of calcium in osteoporosis management?
recommended daily intake 1200 to 1300mg daily
500ml of milk give roughly 1000mg of calcium.
Not used as sole therapy
What is the first line therapy in the treatment of post menopausal osteoporosis?
Bisphosphonates
Oral bisphosphonates are well absorbed orally? True of false?
False
They are poorly absorbed and can lead to oesophagitis.- particularly alendronate.
What is the recommended time period of treatment with bisphosphonates?
Not clear yet. Approximately 5 years.
What is the mechanism of action of bisphosphonates?
inhibiting action of osteoclasts. Inhibit bone resorption.
When would you consider a dental assessment before starting a patient with bisphosphonates?
Poor dental hygiene peridontal disease chemo and radiotherapy anaemia steroid treatment
Outline your advice about the risk of osteonecrosis of the jaw in patient starting bisphosponates?
Risk of osteonecrosis of the jaw in non cancer patients is 1 in 10000 to 1 in 100000.
Risk of osteonecrosis in cancer patients on high dosage is 1-2 percent.
Most risk in cancer patients and those who have had immunosuppresive therapt ie prednisolone.
If a patient going for a dental procedure on bisphonate, what is your advice?
If less than 4 years of treatment, then probably ok to do dental procedure.
If more than 4 years of treatment or on steroid therapy, then withhold bisphosphonates for 2 months and don’t start until bone healed.
How would yoiu interpret the z score and T score in a BMD test?
T score used to diagnosis osteoporosis - ie -2.5 SD less than the 30 year old.
Z score used to screen for medical causes - SD from aged matched person.
What lifestyle advice would you offer in a patient with suspected menopause?
Breast screen in women between 50-69 years old. Smoking Alcohol weight gain physical activity Calcium and Vitamin D.
