RP osteoporosis Flashcards
what are some key risk factors for osteoporosis?
postmenopausal women
men over 50
long term oral corticosteroids (glucocorticoids)
low BMI
smoking
history of fractures
what lifestyle chages can reduce risk of osteoporosis?
increase exercise
smoking cessation
maintain ideal BMI
reduce alcohol intake
sufficient intake of vit D and calcium
when do you review bisphosphonates?
5 years
3 years for zoledronic
what female pts need bisphosphonates for osteoporosis prophylaxis when starting glucocorticoids?
women
- 70yrs+
- previous fragility fracture
- large doses (7.5mg pred or above)
do all males pts over 70 need bisphosphonates for osteoporosis prophylaxis?
no, only if previous fragility fractue or large dose
what are the 3 MHRA warning s for bisphosphonates?
- atypical femoral fractures: report any thigh hip or groin pain
- osteonecrosis of the jaw
- osteonecrosis of external auditory canal
how long do you need to leave before eating something after taking risedronate?
2 hours
what are the natural and synthetic oestrogens?
natiral = estradoil
synthetic = ethinylestradoil
what activity does tibolone have?
oestrogenic, progestoegenic and weakly androgenic
when do you give osetrogens with progesterone?
in women who still have a uterus
what symptoms can oestrogens allevitate?
vaginal atrophy (topical)
vasomotor instability (systemic)
also reduce postmenopausal osteoporosis
what an alternative drug to manage menopause sympomts - note not 1st line due to lots of SE
clonidine
what are the cancer risks of HRT?
increased risk of breast cancer, endometrial cance,r ovarian cancer
is breast cancer risk higher with oestrogen only or oestrogen and progesterone?
higher with combined
how long does the risk of breast cancer last once someone has stopped taking HRT?
10 years
is the endometrial cancer risk in women with a uterus higher with oestrogen only or combined?
risk of lower with combined
tibolone also increases risk
how would you describe the risk of ovarian cancer?
only small increased risk, risk dissapears years after stopping HRT
alongsied cancer risk, what other risks come with HRT?
VTE
stroke
coronoary heart disease
what’s are the 3 HRT regimines for women with a uterus?
- oestrogen with cyclical progestogen for the last 12 to 14 days of the cycle
- continuous administration of an oestrogen and a progestogen
- continous combined and tibolone
when does tibolone need to be avoided?
avoided in perimenopausal phase or if within 12 months of last menstural period
what are the options for HRT regimines in patients without a uterus?
- continuous oestrogen use
when should patients stop HRT before elective surgery and when can it be restarted?
4 - 6 weeks
restart when fully mobile
what should be given to a patient having non-elective surgery to prevent clots?
prophylactic heparin and compression stockings
name some reasons why HRT should be stopped
- sudden severe chest pain/breathlessness (PE)
- unexplained swelling or severe pain in calf
- severe stomach pain
- serious neurological effects
- hepatitis/jaundice
- BP >160/95
- prolonged immobility
