Osteoporosis Flashcards
Osteoporosis: Identifying Risk
Who is at risk?
Average risk:
• Postmenopausal women (aged ≥45 years)
• Men aged ≥50 years
Increased risk:
• Aged >60 years for men and >50 years for women plus any of:
– family history of fragility fracture
– smoking
– high alcohol intake (>4 standard drinks per day for men and >2 for women)
– vitamin D deficiency <50 nmol (screening for vitamin D not indicated just for risk assessment)*
– low body weight (body mass index [BMI] <20kg/m2)
– recurrent falls
– low levels of physical activity†
– immobility (to the extent that person
cannot leave their home or cannot do
any housework)
• Medical conditions and medications
that may cause secondary osteoporosis including:
– endocrine disorders
(eg hypogonadism, Cushing syndrome, hyperparathyroidism, hyperthyroidism)
– premature menopause
– anorexia nervosa or amenorrhea for
>12 months (unrelated to pregnancy)
before 45 years of age
– inflammatory conditions (eg rheumatoid arthritis)
– malabsorption (eg coeliac disease)
– chronic kidney or liver disease
– multiple myeloma and monoclonal
gammopathies
– human immunodeficiency virus (HIV)
and its treatment
– Type 1 and type 2 diabetes mellitus
– drugs, especially corticosteroids
(eg 7.5 mg for >3 months) used for immunosuppression including as part of chronic anti-rejection therapy in organ or bone marrow transplant, anti-epileptic, aromatase inhibitors, anti-androgen, excessive thyroxine, possibly selective serotonin reuptake inhibitors (SSRIs)
High Risk:
• Patients aged >45 years who have sustained a low-trauma fracture
• Postmenopausal women, and older men with a vertebral fracture. Such fractures should be ruled out if clinically suspected (eg from loss of height >3 cm, kyphosis, back pain)
Actions based on risk
Average; preventative advice
Increased: DXA and mx, ix for causes of secondary osteoporosis
High: DXA, Ix for cause, Start Osteoporesis therapy
Preventive interventions
Assessment of risk factors
history, paying particular attention to the risk factors above plus:
• vertebral deformity (if has occurred within 5–10 years, this creates an equivalent risk to any other fragility fracture)
• loss of height (>3 cm) and/or thoracic kyphosis (consider lateral spine X-ray for vertebral deformity)
Preventive actions;
- daily dietary calcium intake t(1000 mg for adult men until 70 years of age and women until 50 years of age, 1300 mg after this age; prevention of bone loss [I, A] but not for fracture prevention [III-2, D])
- healthy lifestyle (eg smoking cessation and limiting alcohol intake)
- Education and psychosocial support for risk factor modification
- Falls reduction strategies: Falls (I, A), and fracture risk reduction (Practice Point)
- Encourage regular weight-bearing and resistance exercise for the prevention of falls (I, A), bone loss (I, A) and fracture risk reduction (I, C)
- Advise on appropriate sun exposure levels (which minimise the risk of skin cancer) as a source of vitamin D
- Discuss absolute risk of fracture BMD
What makes you think osteoporosis as a GP?
- No history of trauma fracture, = other risk factors present = do BMD;
- Medications; HIV treatment, Steroids > 3m, anti-epileptics, SSRIs
- Non-modifiable; fhx, early menopause, over 70, recurrent falls
- Endocrine: T1dm, T2DM, hyperthyroidism, primary hyperparathyroidism, CLD, CKD
- Other Diseases; Major depression, MM, Breast cancer, prostate cancer, Major depression
- Low BMI, malabsorption disorders - History of minimal trauma fracture + over 50 = rx as oesteoporesis
BMD results
T-score;
- T-score, the number of standard deviations above or below the mean for a healthy 30-year-old adult of the same sex and ethnicity as the patient
Osteopenia = t-score -1 to -2.5 = Mx risk Osteoporesis = T < -2.5 = pharm + mx risk
Preventative actions;
- Calcium 1300 mg/day
- Vitamin D > 50 nmol/L
- Weight Bearing Exercise 30 min3-5 times/ week
- Falls prevention
- Repeat BMD in 2-5 y
