Osteoporosis: management Flashcards
treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis with
T-score of - 2.5 SD or below
Tx of osteoporosis first line ?
vitamin D and calcium supplementation should be offered to all
alendronate is first-line
side effects of alendornate ?
25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems
patients cannot tolerate alendronate, usually due to upper gastrointestinal problems patients should be offered
risedronate or etidronate
second line if bisphosphantes cannot e tolerates ?
strontium ranelate and raloxifene
or last Denosumab
what is Raloxifene
elective oestrogen receptor modulator (SERM)
Raloxifene benefits ?
prevent bone loss and to reduce the risk of vertebral fractures - but has not yet been shown to reduce the risk of non-vertebral fractures
may decrease risk of breast cancer!!!
side effects of Raloxifene
worsen menopausal symptoms
increased risk of thromboembolic events
Strontium ranelate mechanism of action
‘dual action bone agent’ - increases deposition of new bone by osteoblasts (promotes differentiation of pre-osteoblast to osteoblast) and reduces the resorption of bone by inhibiting osteoclasts
risk factors for Strontium ranelate
risk of cardiovascular events: any history of cardiovascular disease or significant risk of cardiovascular disease is a contraindication
increased risk of thromboembolic not used in patients with a history of venous thromboembolism
may cause serious skin reactions such as Stevens Johnson syndrom
strontium ranelate or raloxifene may be given based on quite strict T-scores (e.g
60-year-old woman would need a T-score < -3.5
risedronate may be superior to etidronate in preventing?
hip fractures
