osteoporosis and pressure ulcers

Question 1

what can contribute to the development of osteoporosis?

Answer 1

menopause 
smoking and alcohol 
low body weight 
hyperthyroidism 
hyperparathyroidism 
hypoadrenogism 
kidney failure 
immobility

Question 2

what drugs can cause secondary OP?

Answer 2

Steroids
phenytoin
long term heparin
ciclosporin

Question 3

how does OP present?

Answer 3

usually asymptomatic and diagnosed when fractures occur

Fragility fractures include

• wrist
• femoral neck
• crush fracture of vertebral body

Question 4

How is OP diagnosed?

Answer 4

DEXA scan

• T-score of -2.5 or less
• -1 to -2.5 = osteopenia

Question 5

How is OP managed?

Answer 5

Bisphosphonates
calcium and Vit D supps
Denosumab - Denosumab is a fully human monoclonal antibody that binds RANKL, preventing RANKL from activating RANK, its receptor on the osteoclast surface
Tenparatide or abaloparatide (PTH receptor agonist)
Raloxifene or bazedoxifene (Selective oestrogen receptor modulator)
Intransal calcitonin

Question 6

what are the side effects of bisphosphonates?

Answer 6

dysphagia
oesophagitis
gastric ulcers
osteonecrosis of the jaw

Question 7

how are pressure ulcers graded?

Answer 7

1 = non-blanching erythema

2 = broken skin or blistering limited to epidermis and dermis

3 = ulcer down to subcutaneous fat

4 = ulcer down to bone, joint or tendon

Question 8

how are pressure ulcers managed?

Answer 8

pressure relieving devices

• foam matresses
• waterbeds or air fluidised matresses

Turning and handling

Promote healing

• nutrition
• manage incontinence
• glycaemic control

Analgesia

ABx

Debridement