Rheumatology Flashcards
What does it mean by osteoporosis and osteopenia?
Osteoporosis is a condition where thee is reduction in bone mineral density.
Osteopenia is less severe reduction in bone density than osteoporosis.
(Bones becomes less strong and are more prone to fractures)
What are the risk factors for osteoporosis?
- older age
- female
- reduced mobility and activity
- low BMI
- rheumatoid arthritis
- alcohol and smoking
- Long term corticosteroids
- other medications such as SSRIs, PPIs, anti-epileptics and anti-oestrogen
Post-menopausal women is a key group where osteoporosis should be considered
What tool is used to identify the risk of fragility fracture over the next 10 years?
FRAX tool
(inputs info such as age, BMI, co-morbidities, smoking, alcohol and family history
What scan identifies bone mineral density (BMD)?
DEXA scan (dual-energy xray absorptiometry).
T score of persons hip to classify the level of osteoporosis?
More than -1 = normal
-1 ro -2.5 = osteopenia
less than -2.5 = osteoporosis
less than -2.5 plus a fracture = severe osteoporosis
Lifestyle changes for the management of osteoporosis?
- Activity and exercise
- Maintain a healthy weight
- Adequate calcium intake
- Adequate vitamin D
- Avoiding falls
- Stop smoking
- Reduce alcohol consumption
what vitamin D and calcium supplement is given to patients with osteoporosis?
Calcichew-D3 (contains 1000mg of calcium and 800 units of vit D (colecalciferol)
What is the first line treatment for osteoporosis?
Bisphosphonates - interfere with osteoclasts and reduce their activity, preventing the reabsorption of bone
Key side affects of bisphosphonates
- Reflux and oesophageal erosion (if taken on empty stomach, sit upright for 30 mins before moving or eating)
- Atypical fractures
- osteonecrosis of the jaw
- osteonecrosis of external auditory canal
Examples of bisphosphonates
- Alendronate 70mg once weekly (oral)
- Risedronate 35mg once weekly (oral)
- Zoledronic acid 5mg once yearly (IV)
What are other medical options if there is contraindications for bisphosphonates for osteoporosis?
- Denosumab: is a monoclonal antibody that works by blocking the activity of osteoclasts.
- Strontium ranelate: is a similar element to calcium that stimulates osteoblasts and blocks osteoclasts but increases the risk of DVT, PE and myocardial infarction.
- Raloxifene: is used as secondary prevention only. It is a selective oestrogen receptor modulator that stimulates oestrogen receptors on bone but blocks them in the breasts and uterus.
- Hormone replacement therapy: should be considered in women that go through menopause early.
When are the follow ups (osteoprosis) for:
- Low risk patients
- patients on bisphosphonates
- Low risk patients not on treatment followed up within 5 years for a repeat assessment.
- Patients on bisphosphonates should have repeat FRAX and DEXA scan after 3-5 years and treatment holiday considered if BMD is improved. This involves a break from treatment of 18 months to 3 years before repeating the assessment.
How is the fracture of the neck of the femur characterised?
shortened and externally rotated leg.
What are the characteristics of osteopetrosis?
Cortical bone overgrowth and sclerosis due to defective osteoclast
What are the characteristics of osteomalacia (due to vit D deficiency)?
Impaired osteoid mineralization and hyperactive osteoblasts
