Osteoporosis Flashcards
Definition of Osteoporisis
Decreased bone mass + Architectural deterioration causing increased risk of pathological fractures
What gender is more at risk for osteoporosis
Female
What is the usual first presentation for osteoporosis
a fracture, as it is asymptomatic
What type of fractures occur most commonly in osteoporosis
Wrist
Hand
Vertebrae
What is a Colles Fracture
A fracture that occurs when you fall on an outstretched hand
What is the best investigation for bone density and how do you interpret it
DEXA Scan
Gives a T score, >2.5 SD of regular adult = osteoporosis
What is a T score
Comparison of measured bone mass to a 30-year-old adult of the same sex
What is a Z score
Comparison of bone mass to the average bone mass of a healthy person of the same age and gender
When would you use a Z score over a T score
When the patient is below 50 §
Is osteoporosis is suspected, what investigations should be done
U+E (Renal function) Bone Profile Vit D levels TFT Bone turnover Multiple Myeloma screeen (ESR, Serum Immunoglobins, protein electrophoresis, Urinary bence jones protein) DEXA Scan
Why is renal function important in measuring bone density
Kidneys are responsible for Vit D metabolism
What are some drugs that may cause osteoporosis
Steroids Anti-sex hormones (finasteride, Gosrelin) Lithium Anti-convulsants Heparin
What endocrine disorders lead to osteoporosis
Cushings
Acromegaly
Hypopituitarism
Prolactinoma
What inflammatory conditions lead to osteoporosis
Rheumatoid Arthiritis
Ankylosing Spondylitis
IBD
Deficiency in what nutrients cause an increased risk of osteoporosis
Vit D
Ca2+
What conditions cause a nutritional deficiency
Malabsorption Syndrome
Diarrhoea
Coeliacs
IBD
What genetic conditions may cause osteoporosis
Marfans
Osteogenesis Imperfectica
Turners syndrome
Osteoporosis risk factors
- FHx
- Smoking
- Excess Alcohol
- Steroids + osteoporitic drugs
- Low Oestrogen, seen in amenorrhoea (no periods 6+ months), Late Menarche, Early Menopause
- Immobility
- Inflammatory conditions like RA, ankylosing spond etc
- Gastrectomy
What lifestyle modifications can be made to treat osteoporosis
Increase Calcium intake
Weight-bearing Exercise
Smoking Cessation
Decrease Alcohol consumption if excessive
What equipment is available for people with
osteoporosis
Hip protectors
What medications are available for treating osteoporosis
Vit D Calcium ion supplementation Bisphosphonates (e.g. alendronic acid 70mg ow) Selective oestrogen receptor modulators (Raloxefine) Strontium HRT Testosterone PTH
What’s required for bisphosphonate therapy to start
Normal Vitamin D levels
Side effects of Bisphosphonates
GORD
Jaw Necrosis
Renal Toxicity
What is the treatment pathway for osteoporosis
- Lifestyle advice + Bisphosphonates + Ca + Vit D supplementation
- Hormone replacement (if deficient), Oestrogen receptor modulation + Supplementation OR Denosumab (mAB) + Supplementation
