Osteoporosis Flashcards
key risk factors for osteoporosis
Female Underweight RA Glucocorticoids Alcohol Parental hip fracture Smoking
FUR GAPS
investigations for osteoporosis
CRP, FBC, U+Es, LFTs
bone profile + TFTs
DEXA
exclude mimicks (osteomalaica, myeloma) identify causes (incl hyperthyroid)
osteoporosis - DEXA score
BMD 2.5 SDs or more below that of an average young subject from the same race and sex
management of osteoporosis
1° - alendronate
women - vitamin D + calcium
falls risk assessment
smoking + alcohol
why can’t some tolerate alendronate? what given instead? what given if can’t tolerate bisphosphonates?
25% can’t tolerate - upper GI problems
instead - risedronate/etidronate
can’t tolerate bisphosphonates - strontium ranelate, raloxifene
SEs bisphosphonates
oesophagitis + ulcers
osteonecrosis of jaw
atypical stress fractures of proximal femoral shaft
acute phase response - fever, myalgia, arthralgia
how to take bisphosphonates
swallow whole with plenty water
sitting upright/standing + for 30min after
on empty stomach at least 30min before breakfast
what does FRAX calculate?
10 year risk of developing an osteoporosis-related fracture
DEXA score for osteopaenia
BMD 1 SD below that of an average young subject from the same race and sex
normal t score
> -1
what is the relevance of the T score in a DEXA?
T-score - based on bone mass of young reference population
T score of -1 = bone mass of one SD below that of young reference population
FRAX score - what age group is it for?
age 40-90
FRAX - factors assessed
age + sex weight + height previous fracture + parental fracture current smoking + alcohol glucocorticoids RA + secondary osteoporosis BMD - optional but improves accuracy
when would you arrange a DEXA scan based on FRAX score?
if it shows an intermediate result
management based on FRAX score without BMD
low - reassure + lifestyle
intermediate - BMD test to determine need for treatment
high - bone protection treatment
