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
what factors can affect the accuracy of risk assessment tools
has a history of multiple fractures
has had previous vertebral fracture(s)
has a high alcohol intake
is taking high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer)
has other causes of secondary osteoporosis
when to consider measuring bone mineral density
high risk or if they need treatment
when do you recalculate fracture risk
if the original calculated risk was in the region of the intervention threshold for a proposed treatment and only after a minimum of 2 years, or
when there has been a change in the person’s risk factors.
when to prescribe oral bisphosphonates
the person is eligible for risk assessment as defined in when to assess a person depending on age and sex and
the 10-year probability of osteoporotic fragility fracture is at least 1%.
when to prescribe IV bisphosphoantes
the person is eligible for risk assessment as defined in when to assess a person depending on age and sex and
the 10-year probability of osteoporotic fragility fracture is at least 10% or
cant take oral bisphosphonates
T score to diagnose osteoporosis
-2.5 or below
Management for osteoporosis
1) alendronate - 70mg weekly
lifestyle advice on osteoporosis
take regular exercise
- outdoors
- strength treaining
eat balanced diet
stop smoking
adverse effects of bisphosphonates
GI issues - gastritis, nausea, dyspepsia
bone, joint and/or muscle pain
oesophagitis, ulcers, stricutres, erosions
osteonecrosis of jaw
stress fractures
