osteoporosis Flashcards

1
Q

what is osteoporosis?

A

reduced density of the bones

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2
Q

osteopenia

A

less severe reduction in bone density

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3
Q

what does reduced bone density lead to?

A

often fractures

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4
Q

risk factors

A
older age 
women 
reduced mobility and activity
low BMI
rheumatoid arthritis
alcohol and smoking 
long term steroids 
PPIs, SSRIs
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5
Q

post-menopausal women

A

oestrogen is protective

unless on HRT have less oestrogen and are at higher risk

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6
Q

FRAX tool - what it tells you

A

prediction of risk of fragility fracture over next 10 years
major osteoporotic fracture
hip fracture

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7
Q

FRAX tool - information inputted

A
age 
BMI
co-morbidities 
smoking 
alcohol 
FH
enter result from DEXA scan
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8
Q

what does DEXA scan show?

A

bone mineral density

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9
Q

what is DEXA scan?

A

dual-energy xray absorptiometry

how much radiation absorbed by bones

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10
Q

2 scores from DEXA scan

A

T score and Z score

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11
Q

Z scores

A

number of SDs bone density below age average

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12
Q

T score

A

number of SDs below healthy young adult

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13
Q

most clinically important outcome - DEXA scan

A

T score at hip

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14
Q

T score at hip and what it means

A

more than -1=normal
-1 to -2.5 = osteopenia
less than -2.5 = Oporosis
less than -2.5 +# = severe OP

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15
Q

first step to assess for osteoporosis

A

FRAX assessment

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16
Q

patients at risk of osteoporosis

A

women >65
men >75
young - fragility #, history of falls, long term steroids, low BMI, rheumatoid arthritis

17
Q

frax outcome with no BMD - what next?

A

low risk = reassure
intermediate risk = DEXA
high risk = treat

18
Q

FRAX with BMD outcomes

A

treat or lifestyle advice and reassure

19
Q

lifestyle changes

A
activity and exercise 
calcium and vitamin D
avoid falls 
stop smoking 
healthy weight
20
Q

supplements

A

calcium and vit D
calcichew-D3
1000mg calcium and 800 units vitamin D

21
Q

first line treatment

A

bisphosphonates

22
Q

how do bisphosphonates work?

A

interfere with osteoclasts and reduce activity

23
Q

side effects of bisphosphonates

A

reflux and oesophageal erosions
atypical fractires
osteonecrosis of jaw and external auditory canal

24
Q

examples of bisphosphonates

A

alendronate 70mg
risedronate 35mg
zolendronic acid 5mg IV once yearly

25
Q

other medications if bisphosphonates CI

A

denoxumab
HRT
strontium ranelate
raloxifene - secondary prevention only

26
Q

follow up

A

low risk - 5 years repeat assessment
bisphosphonates = 3-5year FRAX and DEXA scan
treatment holiday considered