Osteoporosis Flashcards
osteoporotic fractures
occur without major trauma
osteoporosis is a reduction in
bone mass
osteoporosis is defined as a bone mineral density (BMD)…
more than 2.5 standard deviations below the young adult mean value
values between 1 and 2.5 SDs below the young adult mean are termed
osteopenia
BMD- dependent risk factors for osteoporosis
female caucasian / asian hypogonadism immobilisation chronic liver disease chronic renal disease COPD GI disease low dietary calcium intake vit D deficieny drugs (corticosteroids, heparin, ciclosporin, anticonvulsants) endocrine disease (cushings, hyperthyroidism hyperparathyroidism) DM
BMD-independent risk factors for osteoporosis
inc age previous fragility fracture FHx Low BMI smoking alcohol abuse glucocorticoid therapy high burn turnover inc risk of falling RA
clinical features osteoporosis
symptoms of osteoporosis are the result of fractures which typically occur at 4 sites:
thoracic and lumbar vertebrae (may lead to loss of height)
proximal femur
distal radius
investigations osteoporosis
dual energy x-ray absorptiometry (DXA) = gold standard in measuring bone density
Xray - fractures, not osteopenia
calcium, phosphate and alkaline phosphatase are normal
management osteoporosis: new vertebral fracture
bed rest 1-2w strong analgesia muscle relaxants (eg diazepam) subcut calcitonin pamidronate (bisphosphonate)
lifestyle changes osteoporosis
stop smoking decrease alcohol calcium intake 700-1000mg/d vit D 400-800w/d regular weight bearing exercise elderly = physio and home safety assessment
pharmacological intervention osteoporosis
First line = bisphosphonates - inhibit osteoclast activity and hence bone resporption
Raloxifene - selective oestrogen-receptor modulator (SERM), activates oestrogen receptors on bone but not endometrium
Recombinant human parathyroid peptide and PTH stimulate bone formation
glucocortocoid induced osteoporosis
oral corticosteroids = inc risk of fracture at hip and spine
reduce dose to minimum
calcium and vit D supplements
