osteoporosis Flashcards

1
Q

what is it?

A

A metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk

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2
Q

what is risk of fracture related to?

A

age, BMD, Falls, bone turnover

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3
Q

aetiology?

A
1-	Endocrine causes 
	Thyrotoxicosis
	Hyper and hypoparathyroidim
	Cushings
	Hyperprolactinaemia
	Hypopituitarism
	Early menopause

2- Rheumatic causes
 Rheumatoid arthritis
 Ankylosing spondylitis
 Polymyalgia rheumatica

3- GI causes

 Inflammatory diseases: UC and crohns
 Liver diseases: Primary Biliary Cholangitis , Congenital Adrenal Hyperplasia, Alcoholic cirrhosis, Viral cirrhosis( hep C)
 Malabsorption: chronic pancreatitis, coeliac disease, whipples disease, short gut syndromes and ischaemic bowel

Medications
	Steroids
	PPI
	Enzyme inducting antiepileptic medications
	Aromatase inhibitors
	GnRH inhibitors
	Warfarin
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4
Q

how to prevent osteoporosis?

A

 Minimise risk factors
 Ensure good calcium and Vitamin D status
 Falls prevention strategies
 Medications

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5
Q

when is treatment recommended?

A

-Recommended after DXA scan predicts 10% risk of fracture within the next 10 years in Scotland

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6
Q

treatment ?

A
1--Bisphosphonates- first choice
2-Denosumab anti-RANK 
3- Teriparatide
4- HRT 
5- Testosterone 
6- SERMS
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7
Q

risk factors

A
SHATTERED 
Steroids
Hyperthyroidism/ parathyroidism/ calcinuria 
Alcohol and tobacco use
Testosterone decrease
Thin BMI<19 
Renal/liver failure
Erosive/ inflammatory bone disease
Dietary Ca 2+ deficiency
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8
Q

Presentation

A
  • If trabecular bone involved: crushed vertebrae e.g. short old ladies
  • If cortical bone involved: long bones involved e.g. long femur neck fracture
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9
Q

Risks of bisphosphonates

A
  • If nitrogen containing inhibit osteoclasts
  • Must have adequate renal function
  • Must have adequate calcium and vitamin D status
  • Good dental health and hygiene – need to advise dentist on use of bisphosphonates
Side effects:
Oesophagitis
Iritis/uveitis
ONJ?
Atypical femoral shaft fractures?
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10
Q

Investigations

A

XRAY

DEXA SCAN

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11
Q

How to read a DEXA scan

A
  • T score is the number of standard deviations the BMD is from the youthful average
  • Each decrease of 1 is equivalent to a 2.6 fold increase risk

T score
>0 : TMD is better than references
- Referred when FRAX/ QSCAN greater than 10% over next 10 years
-0 to -1
– 1 to -2.5 : osteopenia. Risk of osteoporotic fracture
–2.5 or worse : osteoporosis

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