Osteoporosis Flashcards
What is osteoporosis?
A skeletal condition characterised by low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture.
Non-modifiable risk factors of OP.
Advanced age >65 yo
Female gender
Caucasian or south Asians
Family history of osteoporosis-genetic
History of low trauma fracture
Modifiable risk factors of Osteoporosis.
Low body weight 58kg or BMI <21
Premature menopause <45
Calcium/Vit D def.
Inadequate physical activity
Cigarette smoking
Excessive alcohol intake
Drugs
Give example of drugs that can cause OP.
Corticosteroids
Aromatase inhibitors
PPis
SSRIs, anti-epileptics
How is a diagnosis of osteoporosis made?
By DEXA scanning of the lumbar spine and hip.
This is the gold standard for diagnosis.
How is a diagnosis of OP established from DEXA scan?
By T score.
T-score of minus 2.5 or less means osteoporosis.
Explain the T-score.
The number of SDs from the mean bone density of persons of same gender at age of peak density aka 25 years.
T score of minus 2.5 or less = OP
Normal BMD is T-score of -1 or more
What is osteopenia?
T-score between -1 and -2.5
What is the Z-score?
A comparison of the patient’s BMD with an age and gender matched population.
What does a Z-score of less than -2 suggest?
That prompt evaluation for causes of secondary osteoporosis should be done.
Also plain radiograph lack sensitivity to diagnose osteoporosis, but rib fractures or vertebral compression fractures without trauma history should prompt evaluation for OP.
Other investigations that are done in OP.
DEXA gold standard
Fracture risk assessment tool (FRAX)
X-ray
ALP
Serum calcium and albumin
Serum crea, phosphate and Vit D
Serum PTH and Thyroid
Serum cortisol, ACTH etc…
Serum testosterone
Symptoms and signs of OP.
There is usually no symptoms of OP.
Fractures is the only symptom of osteoporosis.
Vertebral fracture is suggested by the sudden onset of severe back pain.
Pain from mechanical derangement, increaseing kyphosis, height loss and abdominal protuberance may follow from vertebral fractures.
Colle’s fracture are common as well.
Any other sort of fracture from low-trauma or no trauma.
If there are no usual symptoms of OP except for fractures, how is the condition picked up?
By screening.
Explain assessment of Osteoporosis
1st step is to perform a FRAX assessment on patients at risk of osteoporosis;
Women aged > 65
Men > 75
Younger patients with risk factors such as a previous fragility fracture, history of falls, low BMI, long term steroids, endocrine disorders and rheumatoid arthritis.
Next step in management based on the probability of a major osteoporotic fracture from the FRAX score:
FRAX outcome without a BMD result will suggest one of three outcomes:
Low risk – reassure
Intermediate risk – offer DEXA scan and recalculate the risk with the results
High risk – offer treatment
FRAX outcome with a BMD result will suggest one of two outcomes:
Treat
Lifestyle advice and reassure
Indications of DEXA scanning.
Women aged >65
Men aged >70
Fragility fractures
Women < 65 with risk factors
Men < 70 with risk factors
