Osteoporosis: Assessing Risk Flashcards
At what age should people be assessed for osteoporosis?
Women 65 years and older.
Men 75 years and older.
OR
Women 50-64 and atleast 1 risk factor
Men 50-74 and atleast 1 risk factor
What risk factors are present in younger patients that could make them prone to develop osteoporosis?
- Previous fragility fracture
- current use or frequent recent use of oral or systemic
- glucocorticoid
- history of falls
- family history of hip fracture
- other causes of secondary osteoporosis
- low body mass index (BMI) (less than 18.5)
- smoking
- alcohol intake of more than 14 units per week for women and more than 21 units per week for men.
How do we assess the risk of developing a fracture?
- Use either FRAX or QFracture
- OR go straight to BMD (Dex) scan if:
- Rapid adverse effect on bone density (e.g sex hormone deprivation for breast or prostate cancer.)
-
Under 40 years and have a major risk factor.
- Steroid use. (7.5mg per day for 3/12 or more)
- Multiple fragility fractures.
- A major osteoporotic fracture.
Describe FRAX assessment
- Estimates the 10-year risk of fragility fracture
- Valid for patients aged 40-90 years
- Based on international data so use not limited to UK patients
-
Assesses the following factors:
- Age
- Sex,
- Weight,
- Height,
- Previous fracture,
- Parental fracture,
- Current smoking,
- Glucocorticoids,
- Rheumatoid arthritis,
- Secondary osteoporosis,
- Alcohol intake
- Bone mineral density (BMD) is optional, but clearly improves the accuracy of the results.
- NICE recommend arranging a DEXA scan if FRAX (without BMD) shows an intermediate result
Describe QFracture
- Estimates the 10-year risk of fragility fracture
- Developed in 2009 based on UK primary care dataset
- Can be used for patients aged 30-99 years (this is stated on the QFracture website, but other sources give a figure of 30-85 years)
- Includes a larger group of risk factors:
- Cardiovascular disease
- History of falls
- Chronic liver disease
- Rheumatoid arthritis
- Type 2 diabetes
- Tricyclic antidepressants
What are the categories for interpreting FRAX if done WITHOUT a bone mineral density measurement?
- Low risk: reassure and give lifestyle advice
- Intermediate risk: offer BMD test
- High risk: offer bone protection treatment
What are the categories for FRAX results if done WITH a bone mineral density measurement?
- Reassure
- Consider the treatment
- Strongly recommend treatment
When should we reassess a patient’s risk?
Reasses only after a minimum of 2 years if person was on threshold for treatment.
Or if risk factors change.
Dr Zaidi recommends:
Every 3 years do a repeat DEXA scan to see if change in BMD.
- if no change in BMD then still winning as not decreased.
- If decreased then can refer to Geriatrician.
When should we stop bisphosphonates?
Reasses risk at 3-5 years using FRAX +/- DEXA
If fracture risk low and no fractures - can stop.
If fracture risk moderate - continue to treat until 5 to 6 years are up. Then offer drug holiday.
If fracture risk high after 5 years - continue treatment for 10 years or change to nonbisphosphonate therapy.
NOTE: Drug holiday is for 1 to 3 years or until significant loss of BMD or fracture.
What is a good alternative to FRAX or QFracture (AND MUCH SIMPLER!!!)
SCORE
6 questions
Sensitivity of 91 percent and a specificity of 40 percent.
http://osteoed.org/tools.php
How do you interpret DEXA scans?
-
T score: based on bone mass of young reference population
- T score of -1.0 means bone mass of one standard deviation below that of young reference population
- Interpretation
- > -1.0 = normal
- -1.0 to -2.5 = osteopaenia
- < -2.5 = osteoporosis
-
Z score compares your BMD to what might be expected in someone your age.
- It is adjusted for age, gender and ethnic factors
