Osteoporosis Flashcards
What are risk factors for osteoporosis?
Increasing age Female gender Premature menopause Corticosteroid use Smoking Alcohol Low BMI Family history Asians, Caucasians DM, hyperthryoid Multiple myeloma Lymphoma
What tools can be used to screen for osteoporosis? What should these be used?
FRAX: Hx of glucocorticoid use Rheumatoid arthritis Alcohol excess Hx of parental hip fracture Low BMI Current smoking ---> arrange DEXA scan if FRAX shows intermediate result
QFracture - estimates 10 year risk of fragility facture
Women 65+ and men 75+
Younger patients with risk factors
Patients who have sustained a fragility fracture
What drugs can worsen osteoporosis?
Glucocorticoids SSRIs Antiepileptics PPIs Glitazones Long term heparin therapy
What investigations in osteoporosis?
Exclude diseases that mimic osteoporosis - osteomalacia, myeloma
Identify cause of osteoporosis and contributing factors
Assess risk fo subsequent fracutre
FBC ESR CRP Calcium Albumin U&E - creatinine, phosphate LFT - ALP TFT Bone profile: calcium, albumin, phosphate, magnesium and ALP
DEXA scan
PTH, vitamin D
What should you do if low risk, intermediate risk and high risk on FRAX?
low: reassure and give lifestyle advice
Intermediate: Offer bone mineral density testing
High risk: Offer bone protection treatment
What are interpretation of the results of DEXA scan?
T score: based on bone mass of young reference population
> -1 = normal
-1.0 to -2.5 = osteopenia
< -2.5 = osteoporosis
Z score adjusted for age gender and ethnicity
What is indication for treatment”?
Fragility fractures
Confirmed osteoporosis T
What is management for osteoporosis?
First line: Alendronic acid (bisphosphonate)
If not tolerated: risedronate, etidronate
Vitamin D and calcium
What can be taken if bisphosphonates are not tolerated?
Raloxifene - selective oestrogen receptor modulator
- reduces bone loss and increases bone density
Increased riskof VTE
May worse menopause symtpoms
Strontium ranelate
- increases deposition of new bone and inhibits osteoclasts
Increased risk of CVD and VTE
How do bisphosphonates work?
Inhibit osteoclasts
Indications for bisphosphonates?
Prevention and treatment of osteoporosis
Hypercalcaemia
Paget’s disease
Pain from bone metastases
What adverse effects of bisphosphonates
Oesophageal: oesophagitis, ulcers
Osteonecrosis of the jaw
Increased risk to atypical stress fracture of proximal femur
What counselling for bisphosphonates?
Swallow whole with whole glass of water
Take sitting up or standing
Tak eon empty stomach
Take at least 30 minutes before breakfast or other oral medications
Stay upright for 30 minutes after raking tablet
Once weekly
