Osteoporosis and Osteoarthritis Flashcards
What is Osteoporosis?
- Low bone mass and microarchitectural deterioration of bone tissue
- Inc bone fragility and susceptibility to fracture
- Common fractures = hip, wrist, vertebral fractures
- It is the fractures that kill people, cause disability, unable to walk independently, loose ability to carry out one independent activity of daily living
RF for Osteoporosis (SHATTERED)
SHATTERED mnemonic for RF
- Steroid use
- HYPERS -thyroidism, -parathyroidism -calciuria
- Alcohol and smoking
- Thin BMI<19
- Testosterone dec
- Early or untreated menopause
- Renal or liver failure
- Erosive/Inflammatory bone disease
- Dietary Ca dec/malabsorption
How is bone strength determined?
Bone strength determined by:
- Bone minerality density (BMD)
- peak bone mass is reached at ~30years and then declines with age. - Bone size i.e. thicker and bigger bones are stronger
- Bone quality: bone turnover, trabecular architecture, mineralisation
Presentation of Osteoporosis
- Asymptomatic until fracture occurs
- Back pain
Diagnosis of Osteoporosis
(1.) Bloods: FBC, U&E, CRP, Bone profile, LFT, TFT, Vitamin D
(2.) DXA and T-score
- Measures BMD
- Quantitative info and generates T-score (standard-deviation score)
- T-score:
> -1.0 = normal
-1.0 to -2.5 = osteopenia
< - 2.5 = osteoporosis
Treatment (Anti-resorptive and Anabolic)
and Management of Osteoporosis (4)
(1.) FRAX: 10-y probability of fragility fracture >40y. Determine whether to treat pharmacologically
(2. ) Anti-resorptive: Dec osteoclast activity and bone turnover
(a. ) Bisphosphonates (1st line) [alendronate, risedronate, ibandronate, alendronic acid]
(b. ) HRT for early menopausal women
(c. ) Denosumab: Mabs that switch off bone reabsorb
(3. ) Anabolic: Inc osteoblast activity & bone formation
- Teriparatide
(4. ) Lifestyle measures
- Prophylaxis if osteopenia: Ca and Vit D supps
- Ca and Vit D rich diet
- Quit smoking and reduce alcohol consumption
- Weight bearing exercise may increase bone mineral density
Causes of Osteoporosis (7).
(1.) Inflammatory disease: RA, seronegative arthritis, CTD, IBD
(2. ) Endocrine disease
- TH = inc metabolic rate of body & bone, PTH = drive bone resorption to inc Ca
- Cushing Syndrome: inc cortisol inc bone resorption, osteoblast apoptosis
- Oestrogen/Testosterone control bone turnover e.g. early menopause, male hypogonadism
(3. ) Reduced skeletal loading inc resorption
- Low body weight, BMI
(4. ) Immobility
(5. ) Medications e.g. Glucocorticoids
(6. ) Reduced Ca, Vit D = Hypocalcaemia, Vit D deficiency
How does early or untreated menopause in risk of osteoporosis
- There is the loss of restraining effect of oestrogen on bone turnover.
- So, there is a high bone turnover: resorption rate>formation
- Net effect of is bone loss, trabeculae loss and ultimately microarchitectural disruption
- This is preventable by oestrogen replacement
What is Osteoarthritis?
- Slow onset, joint pain causes by progressive loss of articular cartilage, remodelling of adjacent bone structures and inflammation
- Synovial joint affected: knees, hips, small joints of hand
- Comprises of: synovitis, fibrillations (cracks in the cartilage) osteophytes (Herberden, bouchard nodes)
- Causes functional limitation and reduced QoL
RF of OA (6)
- Age >65y
- Female: menopause
- Obesity: Fat tissue is pro-inflammatory & weight-bearing on joints
- Joint injury/trauma/overuse/stress - occupational + recreational:
- Manual labour = OA of small joints in hand
- Farming = OA of hip
- Football = OA of knee - RA + Others: neurological disorders, genetics, medication
Sx and signs of Osteoarthritis
(1. ) Joint pain is exacerbated by exercise and relieved by rest
(2. ) Joint warmth and/or tenderness suggesting synovitis
(3. ) Crepitus - grinding, cracking sensation when moving it common in OA knee flex
(4. ) Bony swelling and deformity (severe case)
- due to osteophytes, swelling at distal (Heberden’s) or proximal IP joints (Bouchard’s). –> Remember BP petrol and HD tele.
(5. ) Absence of systemic symptoms!
- DDx: In RA, painful swelling + systemic Sx of fever, rash would be seen
Important to consider:
- Is there reduced range of joint movement
- Functional impairment? Walking, activities of daily living?
- Pt may demonstrate loss of independence in OA
Dx of Osteoarthritis (w/o Ix)
Dx of OA can be made clinically without Ix if:
- aged >45y; and
- Has activity related joint pain; and
- No morning joint stiffness or lasts <30mins
Ix of Osteoarthritis
(1.) Bloods: FBC, creatinine, LFTs (checked before NSAID use)
(2. ) Plain film Xray (not routine) concs
- Important radiological features in advanced OA:
(a. ) Osteophytes formation
(b. ) joint space Narrowing
(c. ) bone Cysts
(d. ) subarticular Sclerosis.
(e. ) abnormal bone Contour
(3.) Joint aspiration - consider if joint swollen to exclude septic arthritis, gout
Tx and Mx of Osteoarthritis
Conservative/Non-medical
(1. ) Pt education
(2. ) Exercise: muscle strengthening exercises, aerobic exercise
(3. ) Weight loss
(4. ) Aids and devices e.g. Footwear, Orthoses, Walking aids
(5. ) Physiotherapy, Occupational therapy
Medical
(1. ) Topical paracetamol, capsaicin or NSAIDs considered before oral
(2. ) Intra-articular corticosteroid injections (Hyaluronic acid) - If moderate-severe pain
(3. ) Transdermal patches
Surgery
(1. ) Arthroplasty/joint replacement indicated:
- Uncontrolled pain (at night too)
- Limitation of function
- Age is a consideration
(2. ) Fusion
- Usually ankle and foot, this sacrifices movement for pain relief
