osteoporosis in practice Flashcards
what is the literal definition of osteoporosis?
porous bones
what are the symptoms of osteoporosis?
Osteoporosis has no symptoms per se but it is important to patients because it
increases risk of fracture!
what does # mean?
fracture
how do we increase public health when it comes to osteoporosis and bone health?
- education of younger people
- effective fracture reduction to reduce morbidity, mortality and cost
when does fracture risk increase?
it increases with age
what are the most common areas of osteoporotic fracture?
hip, wrist and spine
who are hip fractures more serious in and why?
Hip fracture is the most serious consequence of falls among
older people
– Reduced function, loss of independence, loss of confidence, high
mortality rate (
what interventions are there to prevent further hip fractures?
• Prevent further fracture “secondary prevention” (see later) • If already on treatment check adherence and administration • Lifestyle advice • Falls assessment • Including medication review • Prevention of venous thromboembolism with LMWH • Appropriate pain management
what are vertebral fractures in practice?
• Spine: Compression fractures
– Acute and chronic back pain
– Height loss, kyphosis
what are interventions for vertebral fractures?
• Secondary fracture(#) prevention • Lifestyle advice • Pain control and analgesia review • Physiotherapy • Surgical management
what are the risk factors for osteoporosis?
• Fragility # • Excess alcohol • Smoking • Immobility • Drugs e.g. • Parental hip fracture • Secondary causes e.g. menopause/hypogonadism – low BMI • (Falls)
what are some drugs that increase the patients risk of osteoporosis?
– Corticosteroids – PPIs – Anti-epileptics – SSRIs – Aromatase inhibitors
what are some secondary causes of osteoporosis?
– amenorrhoea – eating disorders – inflammatory bowel disease – Rheumatoid Arthritis – COPD – early menopause/ hypogonadism – low BMI
how do we identify someone who may need treatment- primary prevention?
People who have never had a fracture but are at increased risk of fracture NICE G146 on fracture risk assessment outlines who should be assessed (updated 2017)
how do we identify people who need secondary treatment?
People who have already had a fracture and need to reduce the risk of further fracture Fracture liaison services have an important role here- pick up over 50s with fragility fracture and offer DXA scan
who do you target for fracture risk assessment?
– All older patients (>65 female >75 male)
– Other patients with specified risk factors
what are the fracture risk assessment tools availible?
FRAX® and QFracture®
what are the options availible following risk assessment?
– lifestyle advice only
– refer for DXA or
– start treatment
what is FRAX and who can it be used for?
• FRAX is an online tool that can be used to assess fracture risk (40-90 yrs) • Gives a result as: • 10 year risk of osteoporotic fracture and 10 yr risk of hip fracture (%)
what does FRAX link to?
Links to NOGG (National Osteoporosis Guideline Group) guidance which classifies patients as red (start treatment) amber (DXA scan) or green (lifestyle advice)
what are the pharmacological treatment options for osteoporosis?
bisphosphonates
denosumab
less common: HRT, raloxifene, teriparatide, strontium
why is patient information essential in osteoporosis?
Prophylactic treatment requires motivation
• Patients must be involved in treatment decision
what should you explain to a person who has osteoporosis?
– Why they have been prescribed their medication
– How it works
– Benefits
– How to take correctly
– Side effects & what to do if they occur
– Length of treatment
what is first line treatment for osteoporosis?
oral bps
- cost effective if patient is eligible for risk assessment and has a 10 year probabiliyy of fracture at least 1%
how to you avoid drug interactions due to absorption with oral bps?
– Avoid any other medicines for at least 30 mins
– Avoid calcium supplements for at least 2 hours (preferably 4hrs)
what are the main cautions and contraindications with oral bisphosphonates?
– eGFR <35ml/min/1.73m2 Alendronic acid
– eGFR <30ml/min/1.73m2 Risedronate (however note that some clinicians will use below this)
– Known hypocalcaemia
– Dysphagia/swallowing difficulties
– (Recent) GI bleed
– Note that Risedronate may cause fewer GI side-effect
when should you review oral BPS?
Review after 5 years (continue vs. stop vs. pause in treatment ‘drug
holiday’)
what advice would you give for oral bisphosphonates?
• This medication will help to reduce chance of breaking a bone (by up to 50%);
you only need to take it once a week.
• Take at least 30 minutes before breakfast, with a full glass of water, then
remain upright for 30 mins after (because…)
• If you take calcium supplements take at a completely different time or miss
the morning dose on that day.
• The most common side effect with this medication is heartburn/indigestion,
though not everybody gets this. If it happens to you and it is severe, stop
taking the medicine and go to see your GP. They may be able to switch you to
an alternative [i.e. some people may tolerate risedronate better from GI point
of view]
• Maintain good dental hygiene, report any thigh/hip/groin pain…
• Usually we would review your treatment after 5 years, to check that you still
need it and to reduce the risk of any longer term side effects.
what is the difference in counselling with oral bisphosphonates and ibandronate?
similar but once monthly, 1 hr rather than 30min
