Osteoporosis: Management Flashcards
When is treatment for osteoporosis indicated in postmenopausal women?
- Following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of - 2.5 SD or below).
- In women >= 75 years - DEXA scan may not be required.
What supplements should be offered to all postmenopausal women unless they are getting enough in their diet?
Vitamin D and calcium supplementation
What is the first line treatment for osteoporosis?
Alendronic acid
What % of patients cannot tolerate alendronic acid?
25% due to upper GI problems
What should be offered to patients who cannot tolerate alendronic acid?
Risedronate or etidronate
What can be offered to patients if they cannot tolerate bisphosphonates?
Strontium ranelate and Raloxifene
If alendronic acid isn’t tolerated, what is the most important things to know before starting alternative treatment?
- The T-score criteria for risedronate or etidronate are less than the others implying that these are the second line drugs
- If alendronate, risedronate or etidronate cannot be taken then strontium ranelate or raloxifene may be given based on quite strict T-scores (e.g. a 60-year-old woman would need a T-score < -3.5)
- The strictest criteria are for denosumab.
What is Raloxifene?
A SERM (selective oestrogen receptor modulator)
What are some side effects of Raloxifene?
- VTEs
- Worsening of Post Menopausal Symptoms.
- May reduce the risk of breast cancer
What bisphosphonates licensed for?
- Post-menopausal osteoporosis
- Glucocorticoid-induced osteoporosis
If prescribing Vitamin D + Calcium supplement, what should you do & why?
Monitor calcium at 1 month.
Because Vitamin D can unmask underlying hyperparathyroidism - hypercalcaemia.
Vitamin D doesn’t need to be monitored.
Who might Vitamin D might be unsuitable for?
Patients with renal calculi or bone metastases.
(Boney mets can cause calcium to leech into the blood)
