osteoporosis Flashcards
what is it?
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
what is risk of fracture related to?
age, BMD, Falls, bone turnover
aetiology?
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
how to prevent osteoporosis?
Minimise risk factors
Ensure good calcium and Vitamin D status
Falls prevention strategies
Medications
when is treatment recommended?
-Recommended after DXA scan predicts 10% risk of fracture within the next 10 years in Scotland
treatment ?
1--Bisphosphonates- first choice 2-Denosumab anti-RANK 3- Teriparatide 4- HRT 5- Testosterone 6- SERMS
risk factors
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
Presentation
- If trabecular bone involved: crushed vertebrae e.g. short old ladies
- If cortical bone involved: long bones involved e.g. long femur neck fracture
Risks of bisphosphonates
- 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?
Investigations
XRAY
DEXA SCAN
How to read a DEXA scan
- 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