Osteoporosis Flashcards
What is osteoporosis?
- progressive systemic skeletal disease
- characterised by
- reduced bone mass and micro-architectural deterioration of bone tissue
How will the bones be affected as a result of O?
- More fragile
- More susceptible to fractures
Which bones are commonly affected by osteoporotic fractures?
- spine
- forearm
- hip
- shoulder
What is osteoporotic fractures?
- fractures that result from mechanical forces that would not ordinarily result in fracture
How would you clinically define Osteoporosis?
- bone mineral density (BMD) of 2.5 standard deviations below the mean peak mass
What are the RF of osteoporosis?
* think BMD dependent and independent
BMD dependent
- Post-menopausal women
- Caucasian/asian
- Chronic kidney disease
- Vitamin D deficiency
- Endocrine disorders (Cushing syndrome, hyperparathyroidism)
- Osteogenesis imperfecta
BMD independent
- Age
- Previous fragility fracture
- Family history of hip fracture
- Corticosteroids
- Alcohol (3 units or greater / day)
- Smoking
- Rheumatoid arthritis
- Low body mass index
What is the Px of O?
Age
- Age > activity of osteoclasts increases and is not matched by osteoblasts
Oestrogen
- osteoclast survive longer in absence of Oestrogen
- Oestrogen def > arrest of osteoblastic activity
Prolong steroid use
- Increase turnover of bone
Which pt group should be considered for fracture risk assessment?
- All women aged 65 years and over
- All men aged 75 years and over
Women aged under 65 years and men aged under 75 years in the presence of risk factors
- Previous fragility fracture
- History of falls
- Family history of hip fracture
- Current use or frequent recent use of oral or systemic glucocorticoids
- Low BMI (
- Other causes of secondary osteoporosis
- Smoking
- Alcohol intake of more than 14 units per week for men and women.
Which pt group under 50 should be screened for fracture risk assessment?
- Current or frequent use of oral corticosteroids.
- Untreated premature menopause.
- A previous fragility fracture
Which pt group under 40 should be screened for fracture risk assessment?
- 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.
What medications apart from steroid would increase risk of O?
- SSRIs
- GNRH agonists
- aromatise inhibitors
- antiepileptics
- PPIs
- thiazolidinediones
What risk assessment tools are used to assess fracture risk?
- FRAX
- QFracture
What scan is used to assess fracture risk?
- DXA
- Osteopenia: A T-score of -1 to -2.5
- Osteoporosis: A T-score of ≤ -2.5
When would you consider to perform a vertebral fracture assessment?
- History of ≥4cm height loss
- Kyphosis
- Recent or current long-term oral corticosteroids
- BMD T-score ≤-2.5
What are pathologicla fractures?
- fractures that occur secondary to malignancy (primary bone or metastasis)
How would you mx high risk of fragility fracture?
- DXA scan
T-score is ≤ -2.5:
- Medication
- Optimise RF
- Treat underlying cause
T-score is > -2.5:
- Optimise RF
- Treat underlying cause
How would you mx low risk of fragility fracture?
- Optimise risk factors
- treat any underlying conditions
- follow up within 5 years
What pharmacological tx are used for O?
- bisphosphonates (first lines)
-
Alendronate
- PO daily in the morning before 30mins of eating or drinking
-
Zoledronic acid
- IV injection once/year
-
Alendronate
-
Denosumab
- monoclonal antibody against Receptor Activator of Nuclear factor Kappa B ligand (RANK ligand)
- SC injection every 6 months.
-
Raloxifene
- selective oestrogen receptor modulator
- HRT
- Vit D and Calcium supplementation
What are the SE of Biphosphonates?
What are the contraindications of Biphosphonates?
- GI disturbance
- oesophagitis
- headaches
- renal impairment
- hypocalcaemia
- pregnancy
- lactation
- hypersensitivity.
What is FRAX?
- estimates the 10-year risk of fragility fracture
- aged 40-90 years
What is QFracture?
- estimates the 10-year risk of fragility fracture
- aged 30-99 years
When should the DEXA scan be offered?
- A FRAX score of 10% or greater
How yould you interpret the results of FRAX tool?
- low risk: reassure and give lifestyle advice
- intermediate risk: offer BMD test
- high risk: offer bone protection treatment
When would it be better to use DEXA scan straight away instead of the fracture screening tools?
- before starting treatments that effect bone density
- sex hormone deprivation for treatment for breast or prostate cancer
- in people aged under 40 years who have a major risk factor
- multiple fragility fracture
- major osteoporotic fracture
- current or recent use of high-dose oral or high-dose systemic glucocorticoids (> 7.5 mg prednisolone/day for >3months).
