osteoporosis, Spondylolysis, spinal stenosis, excessive thoracic kyphosis, excessive lumbar lordosis and scoliosis., Adolescent idiopathic scoliosis, back strains, sprains and spasms, Flashcards
What is osteoporosis, and how is it characterized in terms of bone density and porosity?
Osteoporosis is a quantitative bone defect characterized by reduced bone mineral density and increased porosity.
What are the differences between Type I and Type II osteoporosis in terms of onset, risk factors, and associated fractures?
Type I osteoporosis involves exacerbated bone loss post-menopause, influenced by early menopause, familial factors, and environmental risks. It often leads to Colles fractures and vertebral insufficiency fractures. Type II osteoporosis occurs in old age with a significant decline in bone density, and factors like chronic diseases, inactivity, and reduced sunlight exposure contribute. This type is associated with femoral neck and vertebral fractures.
Name the various secondary causes of osteoporosis.
Secondary causes of osteoporosis include drugs (corticosteroids, aromatase inhibitors), alcohol abuse, malnutrition, GI disorders, chronic diseases (CKD, malignancy, rheumatoid arthritis), endocrine disorders (Cushing?s, hyperthyroidism, hyperparathyroidism), and immobilization.
Explain the pathophysiology of osteoporosis, including factors influencing peak bone mass and the changes that occur with aging.
Peak bone mass is determined by hereditary and environmental factors. After reaching peak bone mass, there’s an average annual bone loss of 0.7%. Aging reduces osteoblast function, response to growth factors, and physical activity, leading to increased porosity and reduced density, which heightens fracture risk.
How does osteoporosis increase the risk of fractures, and what are the implications of reduced density and increased porosity in bones?
Osteoporosis increases the fragility of bones, raising the risk of fractures even with minimal trauma. Reduced density and increased porosity amplify bone fragility, leading to conditions like vertebral compression fractures.
What are the direct effects of corticosteroids on bones?
Corticosteroids directly affect bones by reducing osteoblast activity and lifespan, suppressing replication of osteoblast precursors, and reducing calcium absorption.
List the common sites for osteoporotic fractures.
Common sites for osteoporotic fractures include the neck of the femur, vertebral bodies, distal radius, and humeral neck.
What risk assessment tools are used in osteoporosis evaluation, and who should undergo a DEXA scan?
Risk assessment tools for osteoporosis include a 10-year osteoporotic fracture risk calculator. DEXA scans are recommended for individuals over 50 years with risk factors, and for those under 50 years with very strong clinical risk factors (e.g., early menopause, glucocorticoid use).
How is osteoporosis diagnosed using DEXA scanning, and what are the definitions for osteoporosis and severe osteoporosis?
Osteoporosis is diagnosed when bone density is 2.5 standard deviations below the mean peak value of young adults of the same race and sex. Severe osteoporosis is defined as bone density 2.5 standard deviations below the mean peak value of young adults, combined with a fragility fracture.
What are some additional investigations recommended for assessing decreased bone density, and why are they conducted?
Additional investigations for assessing decreased bone density include U+Es, LFTs, FBC, PV, TSH, protein electrophoresis/Bence Jones proteins, coeliac antibodies, testosterone, 25OH vitamin D, and PTH. These tests aim to ensure safety in treatment and rule out underlying conditions contributing to decreased bone density.
Explain the goal of osteoporosis management and outline the lifestyle advice recommended for managing the condition.
Osteoporosis management aims to slow further deterioration and decrease the risk of subsequent fractures. Lifestyle advice includes increasing calcium intake, high-intensity strength training, low-impact weight-bearing exercises, avoiding excess alcohol and smoking, and focusing on fall prevention.
What pharmacological management options are available for osteoporosis, and what are the primary considerations for their usage?
Pharmacological management for osteoporosis includes calcium and/or vitamin D supplements for individuals with poor dietary intake or limited sunlight exposure. Oral bisphosphonates such as alendronic acid, risedronate, and etidronate are used to reduce osteoclastic resorption, typically as a first-line treatment, especially when the T score is equal to or less than -2.5.
Explain the function and application of oral bisphosphonates in osteoporosis management.
Oral bisphosphonates reduce osteoclastic resorption and are considered first-line treatments for most patients. Consider treatment when the T score is less than or equal to -2.5. For those with an ongoing steroid requirement of 7.5mg prednisolone for three months or longer or those with a prevalent vertebral fracture, treatment should be considered when the T score is less than -1.5.
What is the purpose and recommended use of Zoledronic acid in osteoporosis treatment?
Zoledronic acid is an annual intravenous bisphosphonate and is considered a second-line treatment for many patients, particularly those who experience side effects with oral bisphosphonates.
Describe the mechanism of action of Teriparatide and its specific recommendation in osteoporosis treatment.
Teriparatide, a recombinant parathyroid hormone, stimulates bone growth (anabolic) rather than reducing bone loss. It’s recommended to reduce the risk of vertebral and non-vertebral fractures in postmenopausal women with severe osteoporosis. It’s also recommended over oral bisphosphonates for postmenopausal women with at least two moderate or one severe low trauma vertebral fracture to prevent vertebral fracture.
What is Romosozumab, and for which patient group is it recommended in osteoporosis management?
Romosozumab is a monoclonal antibody that binds to and inhibits sclerostin to increase bone formation and reduce bone resorption. It’s recommended for postmenopausal women with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture within 24 months.
How can peak bone mineral density be influenced to prevent osteoporosis, and what lifestyle measures are recommended for prevention?
Peak bone mineral density can be influenced by exercise, a good diet, and healthy sunlight exposure before the decline in bone density begins, thereby potentially reducing the risk of osteoporosis.
What is osteoporosis?
Osteoporosis involves a significant reduction in bone density, making bones weaker and more susceptible to fractures.
What does osteopenia refer to?
Osteopenia refers to a less severe decrease in bone density compared to osteoporosis.
How does the World Health Organization (WHO) define bone conditions based on the T-score at the femoral neck from a DEXA scan?
WHO defines normal bone density with a T-score greater than -1, osteopenia with a T-score between -1 and -2.5, osteoporosis with a T-score less than -2.5, and severe osteoporosis with a T-score less than -2.5 along with a fracture.
How is bone mineral density (BMD) measured, and what method is commonly used for this measurement?
BMD is measured using a DEXA scan (dual-energy x-ray absorptiometry), which measures bone density by analyzing the radiation absorption of bones.
Which areas of the skeleton are assessed for bone mineral density, and which is considered most important?
Bone mineral density can be measured in various parts of the skeleton, but the femoral neck reading is considered most crucial for assessment.
How are the Z-score and T-score different in bone mineral density evaluation?
The Z-score measures standard deviations from the average bone density for the patient’s age, sex, and ethnicity, whereas the T-score measures deviations from an average healthy young adult and is primarily used for diagnosis.
What does a T-score of -1 signify?
A T-score of -1 indicates that the bone mineral density is one standard deviation below the average for healthy young adults.
How are diagnoses for normal, osteopenia, osteoporosis, and severe osteoporosis made based on the T-score?
Normal diagnosis corresponds to a T-score greater than -1, osteopenia is between -1 and -2.5, osteoporosis is less than -2.5, and severe osteoporosis is below -2.5 accompanied by a fracture.
What are the common risk factors associated with osteoporosis?
Older age, post-menopausal women, reduced mobility and activity, low BMI (under 19 kg/m^2), low calcium or vitamin D intake, alcohol and smoking, personal or family history of fractures, chronic diseases (e.g., chronic kidney disease, hyperthyroidism, and rheumatoid arthritis), long-term corticosteroids (e.g., 7.5mg or more of prednisolone daily for longer than 3 months), certain medications (e.g., SSRIs, PPIs, anti-epileptics, and anti-oestrogens).
Why are post-menopausal women specifically at risk for osteoporosis?
Post-menopausal women are at increased risk due to a significant drop in protective estrogen levels after menopause. Hormone replacement therapy (HRT) is protective against osteoporosis due to its estrogen content.
How are risk assessments recommended for osteoporosis?
Assessments are recommended for individuals on long-term oral corticosteroids, those with a previous fragility fracture, anyone 50 and over with risk factors, all women 65 and over, and all men 75 and over.
What tools can be used to calculate the 10-year risk of osteoporotic fractures?
The QFracture tool and the FRAX tool are used to calculate the 10-year risk of major osteoporotic and hip fractures.
How are patients categorized based on risk assessment tools?
Patients are categorized as low, intermediate, or high risk based on the risk calculator output. For QFracture, patients above 10% risk are considered for a DEXA scan, while FRAX’s categorization is guided by the NOGG guideline chart.
Are there exceptions to the assessment recommendations?
Yes, for instance, a DEXA may be arranged without calculating the risk in patients over 50 with a fragility fracture. Treatment might start without a DEXA in patients with a vertebral fracture.
What is the initial approach in managing osteoporosis concerning reversible risk factors?
The first step involves addressing reversible risk factors, such as increasing physical activity, maintaining a healthy weight, quitting smoking, and reducing alcohol consumption.
How is insufficient intake of calcium and inadequate vitamin D corrected in osteoporosis management?
For insufficient calcium intake (less than 700mg per day) and inadequate vitamin D due to limited sun exposure, additional calcium (at least 1000mg) and vitamin D (400-800 IU) are recommended.
What is the primary or first-line treatment for osteoporosis?
Bisphosphonates are the main recommended treatment for osteoporosis. They work by interfering with osteoclasts’ attachment to bone, reducing their activity and bone reabsorption.
