Osteoporosis Flashcards
What is osteoporosis?
Skeletal condition characterised by low bone mass/reduced bone density, deterioration of bone tissue and disruption of bone architecture; all of the above leaves to decreased bone strength and increased fracture risk.
Explain the difference between the different types of osteoporosis, include:
- Primary osteoporosis: type 1 and type 2
- Secondary osteoporosis
Primary Osteoporosis
- Type 1: post menopausal women (generally women aged 50-70yrs)
- Type 2: age-associated “senile osteoporosis” (>70yrs)
Secondary Osteoporosis: due to underlying disease process, medications or lifestyle behaviours.
What’s the difference between osteoporosis and osteopenia?
Osteopenia= less severe reduction in bone density compared to osteoporosis
State some causes of secondary osteoporosis
Diseases/medical conditions
- Coeliac disease
- Eating disorders
- Cystic fibrosis
- Hyperparathyroidism
- Hyperthryoidism
- Multiple myeloma
Drugs
- Corticosteroids
Discuss the pathophysiology of osteoporosis
Bone resorption > bone deposition
State some risk factors for osteoporosis- think about modifiable and non-modifiable risk factors
Non-modifiable
- Age(>65yrs)
- Female
- Caucasian or south asian
- Family history
- History of low trauma fracture
- Rheumatoid arhritis
Modifiable
- Low body weight
- Premature menopause
- Calcium/vit D deficiency
- Inadequete physical activity
- Cigarette smokiing
- Excessive alcohol intake
- Iatrogenic e.g. corticosteroids, aromatase inhibitors, SSRIs, PPIs
State some symptoms & signs of osteoporosis
Which categories of pts should you consider assessing for osteoporosis? (3)
- Women >65yrs
- Men >75yrs
- Younger pts with risk factors
What tool is used to assess someones risk of osteoporosis?
FRAX tool
- Prediction of risk of fragility fracture in next 10yrs
- Uses information such as:
- Age
- BMI
- Co-morbidities
- Smoking
- Alcohol
- Family history
- Result from DEXA scan (don’t have to enter this so can use tool without DEXA scan)
-
Gives result as % 10 year probability of a:
- Major osteoporotic fracture
- Hip fracture
What would be the next step following if you do a FRAX assessment without DEX and the result is:
- Low risk
- Intermediate risk
- High risk
- Low= reassure
- Intermediate= offer DEXA and recalculate with results
- High= offer treatment
A FRAX assessment with a DEXA scan will suggest two options; what are these options?
FRAX assessment with DEXA will either tell you to:
- Treat
- Give lifestylae advice and reassure
What is the main investigation you want to do for a pt with suspected osteoporosis?
DEXA scan (dual energy x-ray absorptiometry) which measures bone mineral density
Describe how a DEXA scan works
Results from which part of skeleton are most important in the classification and hence management of osteoporosis?
- Brief x-ray scan that measures how much radiation is absorbed by bone to indicate density of bone
- Can measure bone density at any location in skeleton but the reading at the hip is key
Bone density, obtained from a DEXA scan, can be represented as two scores. State the two scores and state what each score is
Which score is most clinically important?
- Z score: number of standard deviations below the mean bone density for their age and gender
- T score: number of standard deviations below the mean bone density of a person who is the same gender at age of peak density (25yrs)
T score is most clinically important as it is used in WHO classification of osteoporosis
Interpret the following T scores according to the WHO classification:
- > -1
- -1 to -2.5
- < -2.5
- < -2.5 + fracture
Describe the mechanism of action of teriparatide
(parathyroid hormone analogue)
Discuss when we can consider a treatment holiday for bisphosphonates
