osteoporosis Flashcards
define osteoporosis
characterized by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
define osteoporotic fracture
fragility fracture occurring as a consequence of osteoporosis.
WHO definition of osteoporosis
T less than 2.5 on DEX scan
pathophysiology of osteoporosis
end result of an imbalance in the normal process of bone remodelling by osteoclasts and osteoblasts
complications of osteoporosis
fragility fractures
- hip
- vertebral - back pain, loss of height, kyphosis
severe kyphosis can cause
breathing difficulties
GI problems - indigestion
cant bend reach
risk factors that reduce Bone mineral density
- Endocrine disease including Diabetes mellitus, Hyperthyroidism, and hyperparathyroidism.
- Gastrointestinal conditions that cause malabsorption such as Crohn’s disease, Ulcerative colitis, Coeliac disease, and Pancreatitis - chronic.
- Chronic kidney disease.
- Chronic liver disease.
- Chronic obstructive pulmonary disease.
- Menopause.
- Immobility.
- Body mass index of less than 18.5 kg/m²
risk factors that reduce BMD
- Age - risk increases with age and is at least partly independent of BMD.
- Oral corticosteroids (dependent on the dose and duration of treatment).
- Smoking.
- Alcohol (3 or more units daily).
- Previous fragility fracture (risk increases with increasing number of fractures). Risk is highest for previous hip fractures and lowest for previous vertebral fractures.
- Rheumatological conditions such as rheumatoid arthritis, and other inflammatory arthropathies.
- Parental history of hip fracture.
drugs that increase risk of osteoporosis
- SSRIs
- PPIs
- anticonvulsant drugs - carbamazepine
- glitaxones
- aromatase inhibitors
- Gonadotropin releasing hormone agonists
risk factors for falls
- impaired vision
- neuromuscluar weakness and incoordination
- cognitive impairment
- use of alcohol and sedative drugs
high risk groups of osteoporosis
65 and over women
75 and over women
when should you asses women 50-64 and men 50-74
- A previous osteoporotic fragility fracture.
- Current use or frequent recent use of oral corticosteroids.
- History of falls.
- Low body mass index (less than 18.5 kg/m2
- Smoker.
- Alcohol intake of more than 14 units per week.
- A secondary cause of osteoporosis, including:
- Hypogonadism in either sex, including untreated premature menopause (menopause before 40 years of age), treatment with aromatase inhibitors (such as exemastane) or gonadotrophin-releasing hormone agonists (such as goserelin).
– Endocrine conditions, including diabetes mellitus, Cushing’s disease, hyperthyroidism, hyperparathyroidism, and hyperprolactinaemia.
– Conditions associated with malabsorption including inflammatory bowel disease, coeliac disease, and chronic pancreatitis.
– Rheumatoid arthritis and other inflammatory arthropathies.
– Haematological conditions such as multiple myeloma and haemoglobinopathies.
– Chronic obstructive pulmonary disease.
– Chronic liver failure.
– Chronic kidney disease.
– Immobility.
when do you assess people under 50
- Current or frequent use of oral corticosteroids.
- Untreated premature menopause.
- A previous fragility fracture.
when do you assess people under 40
- Current or recent use of high-dose oral corticosteroids equivalent to, or more than, 7.5 mg prednisolone daily for 3 months or more.
- Previous fragility fracture of the spine, hip, forearm, or proximal humerus.
- History of multiple fragility fractures.
how do you estimate absolute risk of fractures over 10 years
use FRAX - 40-90 with or eothour BMD values
Qfracture - 30-84 - does not incorporate BMD values
