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Y4: Rheumatology > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What T-score is an indicator to offer bone protection?

A

Score < (-2.5)

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2
Q

Describe osteoporosis?

A
  • Disorder characterised by loss of bone mass
  • Bone mineral denisty (BMD) < 2.5 standard deviations below the young adult mean density
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3
Q

Describe the risk factors of osteoporosis?

A
  • Age, female gender
  • Corticosteroid use
  • Smoking, alcohol
  • Low BMI
  • Family history
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4
Q

Describe the risk factors exclusively for secondary osteoporosis?

A
  • SHATTERED
    • Steroid use
    • Hyperthyroidism, hyperparathyroidism, hypercalciuria
    • Alcohol and tobacco use
    • Thin (BMI <18)
    • Testosterone deficit
    • Early menopause
    • Renal/liver failure
    • Erosive bone disease
    • Dietary
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5
Q

Describe the investigations into osteoporosis?

A
  • X-ray
  • DEXA scan
  • Ca, PO43- and ALP normal
  • Consider investigations for secondary causes
    • U&Es, LFTs, PTH, TFTs
    • Urinary bence jones protein, testosterone, oestrogen
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6
Q

Describe lifestyle measures for osteoporosis?

A
  • Stop smoking and alcohol
  • Weight bearing exercise
    • (increase bone density)
  • Calcium and vit D-rich diet
  • Fall prevention programme at home
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7
Q

Describe some of the pharmacological measures for osteoporosis?

A
  • Bisphosphonates (1st line)
    • Alendronic acid
  • Raloxifene
    • Prevention in post-menopausal women, less breast cancer risk than HRT
  • Calcitonin
    • Reduce pain after vertebral fracture
  • Testosterone
    • Helps hypogonadal men by promoting trabecular connectivity
  • Calcium/vitamin D supplements
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8
Q

Describe the use of bisphosphonates (alendronic acid) in osteoporosis?

A
  • Impairs the action of osteoclasts on bone
  • Consume with empty stomach and plenty water while sitting upright
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9
Q

Describe the use of DEXA bone densitometry?

A
  • Scan the hip and lumbar spine
  • Used to calculate a T score
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10
Q

Describe the pathophysiology of oteoporosis?

A
  • Reduced bone density
    • Loss of micro-architecture
    • => Increased risk of fractures
  • Bone marrow stem cells differentiate to adipocytes rather than osteoblasts
    • Imbalance in the bone remodelling cycle
  • Fracture risk increases with age
    • Increased falls risk
    • Age-related decline in bone mass (especially women)
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11
Q

Why do women have an accelerated rate of bone loss compared to men?

A

Oestrogen deficiency after menopause

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12
Q

Describe Secondary osteoporosus?

A
  • Osteoporosis associated with another disease process/drug treatment
  • Secondary osteoporosis is common in men
  • Hypogonadism, glucocorticoid use and alcohol excess are most important
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13
Q

How cna glucocorticoids cause osteoporosis?

A
  • Inhibit bone formation
  • Promote apoptosis of osteoblasts and osteocytes
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14
Q

What are the clinical features of osteoporosis?

A
  • Asympatomatic until a fracture occurs
  • Clinical signs of fracture:
    • Pain
    • Local tenderness
    • Deformity
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15
Q

Algorithm for DXA use

A
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16
Q

Adverse effects if bisphosphonates?

A
  • Upper GI intolerance
  • Acute phase response
  • Atrial fibrillation
  • Hypocalcaemia
17
Q

Describe the use of Denosumab for managing osteoporosis?

A
  • Monoclonal antibody
  • Inhibits bone resorption by neutralising RANKL
  • SC injection every 6 months
  • May cause hypocalcaemia
    • Give with calcium and vitamin D supplements
18
Q

Describe the use of calcium and vitamin D supplements in the managament of osteoporosis?

A
  • Limited efficacy in preventing pathological fractures
  • Improves the action of bisphosphonates
19
Q

Describe the use of Raloxifene in the management of osteoporosis?

A
  • Selective oestrogen receptor modulator (SERM)
  • Partial agonist of ostrogen receptor in bone and liver
  • Reduces risk of vertebral fractures
  • SE: muscle cramps, flushes
20
Q

Describe the use of surgery in the management of osteoporosis?

A
  • Internal fixation to stabilise osteoporotic fractures
  • Patients with femoral neck fracutures often need hip replacement due to risk of avascular necrosis
  • Verrtebroplasty can be use for painful vertebral compression fractures
21
Q

What do the different DXA scores mean?

A
  • Normal
    • > -1
  • Osteopenia
    • -1 to -2.5
  • Osteoporosis
    • < -2.5
22
Q

Describe the DXA scan?

A
  • Based on bone mass of young reference population
  • Adjusted for age, gender and ethinicity
23
Q

Describe a risk stratification score for osteoporosis?

A
  • FRAX score
  • Estimates 10 year fragility fracture risk
  • Suitable for patients aged 40 to 90

Y4: Rheumatology (19 decks)

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