osteoporosis Flashcards
what is osteoporosis?
reduced density of the bones
osteopenia
less severe reduction in bone density
what does reduced bone density lead to?
often fractures
risk factors
older age women reduced mobility and activity low BMI rheumatoid arthritis alcohol and smoking long term steroids PPIs, SSRIs
post-menopausal women
oestrogen is protective
unless on HRT have less oestrogen and are at higher risk
FRAX tool - what it tells you
prediction of risk of fragility fracture over next 10 years
major osteoporotic fracture
hip fracture
FRAX tool - information inputted
age BMI co-morbidities smoking alcohol FH enter result from DEXA scan
what does DEXA scan show?
bone mineral density
what is DEXA scan?
dual-energy xray absorptiometry
how much radiation absorbed by bones
2 scores from DEXA scan
T score and Z score
Z scores
number of SDs bone density below age average
T score
number of SDs below healthy young adult
most clinically important outcome - DEXA scan
T score at hip
T score at hip and what it means
more than -1=normal
-1 to -2.5 = osteopenia
less than -2.5 = Oporosis
less than -2.5 +# = severe OP
first step to assess for osteoporosis
FRAX assessment
patients at risk of osteoporosis
women >65
men >75
young - fragility #, history of falls, long term steroids, low BMI, rheumatoid arthritis
frax outcome with no BMD - what next?
low risk = reassure
intermediate risk = DEXA
high risk = treat
FRAX with BMD outcomes
treat or lifestyle advice and reassure
lifestyle changes
activity and exercise calcium and vitamin D avoid falls stop smoking healthy weight
supplements
calcium and vit D
calcichew-D3
1000mg calcium and 800 units vitamin D
first line treatment
bisphosphonates
how do bisphosphonates work?
interfere with osteoclasts and reduce activity
side effects of bisphosphonates
reflux and oesophageal erosions
atypical fractires
osteonecrosis of jaw and external auditory canal
examples of bisphosphonates
alendronate 70mg
risedronate 35mg
zolendronic acid 5mg IV once yearly
