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Y3 - Endocrine and metabolic > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

a significant reduction in bone density

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2
Q

What is osteopenia?

A

reduced bone mass

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3
Q

What measurement is used to diagnose osteoporosis?

A

T-scores

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4
Q

What scan is used to calculate T-scores?

A

DEXA

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5
Q

What does the T-score from a DEXA scan tell?

A

the number of standard deviations the patient is from an average healthy young adult (e.g. a score of -1 means the bone mineral density is 1 standard deviation below the average for healthy adults)

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6
Q

What is considered a normal T score?

A

anything above -1

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7
Q

What T-score range is considered osteopenia?

A

-1 to -2.5

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8
Q

What T-score is considered osteoporosis?

A

less than -2.5

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9
Q

What is the criteria for the diagnosis of severe osteoporosis?

A

1) a T-score of less than 2.5
2) fracture

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10
Q

What does DEXA stand for?

A

dual energy X-ray absorptiometry

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11
Q

How do DEXA scans work?

A

they use X-rays to measure how much radiation is absorbed by the bones indicating how dense the bone is

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12
Q

Which bone region is the most important when determining bone density with DEXA?

A

femoral neck

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13
Q

What is a Z-score?

A

the number of standard deviations the patient is from the average for their age, sex and ethnicity

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14
Q

Give 10 risk factors for osteoporosis:

A

1) reduced calcium or vitamin D
2) older age
3) history or family history of fragility fractures
4) reduced mobility and activity
5) alcohol and smoking
6) long term corticosteroid use
7) reduced BMI
8) chronic diseases (CKD, hyperthyroidism)
9) post-menopausal women)
10) certain medications (steroids, SSRIs, PPIs, anti-epileptics)

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15
Q

Give two examples of chronic conditions that increase risk for osteoporosis:

A

1) chronic kidney disease
2) hyperthyroidism

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16
Q

Give 4 groups of medications that increase the risk of osteoporosis:

A

1) steroids
2) SSRIs
3) PPIs
4) anti-epileptics

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17
Q

What female hormone is protective against osteoporosis?

A

oestrogen

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18
Q

Why are menopausal women at risk of osteoporosis?

A

oestrogen is protective for osteoporosis and a sudden drop puts them at risk

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19
Q

Give 5 groups of patients who are indicated for osteoporosis assessment:

A

1) anyone on long term oral corticosteroids
2) anyone with previous fragility fracture
3) anyone 50 or over with risk factors
4) all women 65 and over
5) all men 75 and over

20
Q

Name two risk calculating scores for 10-risk of a major osteoporotic fracture for when determining whether to book a DEXA scan:

A

1) QFracture tool
2) FRAX tool

21
Q

Are male or females more at risk of osteoporosis?

A

female

22
Q

Give an instance where risk calculation is not required for a DEXA scan:

A

a patient over 50 presents with a fragility fracture

23
Q

Give an instance where osteoporosis treatment can be commenced without a DEXA scan:

A

patient presents with fragility vertebral fracture

24
Q

Describe the clinical presentation of osteoporosis:

A

osteoporosis remains asymptomatic until a fracture occurs

25
Q

What is a fragility fracture?

A

a low impact fracture from standing height or less

26
Q

Give 3 common sites of fragility fractures:

A

1) spine (vertebral fractures are often asymptomatic)
2) hip (proximal femur)
3) wrist (distal radius)

27
Q

What 4 molecules are measured in a bone profile?

A

1) serum calcium
2) serum phosphate
3) serum albumin
4) alkaline phosphatase

28
Q

Give 3 lifestyle changes advised in osteoporosis:

A

1) regular exercise (particularly strength based and weight bearing)
2) stop smoking and reduce alcohol
3) ensure adequate dietary intake of calcium and sun exposure for vitamin D

29
Q

What is the threshold for calcium and vitamin D supplementation treatment:

A

1) less than 700mg a day of calcium
2) below 50nmol/L of vitamin D

30
Q

Name a combined calcium and vitamin D supplement:

A

calcichew D (1000mg calcium and 800 IU vitamin D)

31
Q

What is the first line treatment for osteoporosis?

A

bisphosphonates

32
Q

How do bisphosphonates treat osteoporosis?

A

they interfere with the way osteoclasts attach to bone, reducing their activity and reabsorption of bone

33
Q

Give 4 key side effects of bisphosphonates:

A

1) reflux and oesophageal erosions
2) atypical fractures
3) osteonecrosis of the jaw (dental check ups advised)
4) osteonecrosis of the external auditory canal

34
Q

Describe the recommended way of taking bisphosphonates:

A

they should be taken on an empty stomach with a full glass of water and afterwards, the patient should sit upright for 30 mins before moving or eating to reduced risk of reflux and oesophageal erosions

35
Q

Give 3 examples (and their doses) of bisphosphonates:

A

1) alendronate (70mg once weekly)
2) risedronate (35mg once weekly)
3) zoledronic acid (5mg once yearly)

36
Q

Name two osteoporosis medications for post-menopausal women:

A

1) raloxifene
2) HRT

37
Q

Describe how raloxifene treats osteoporosis in post-menopausal women:

A

it is a selective oestrogen receptor modulator (SERM) that increases the effect of oestrogen on bones (oestrogen is protective from osteoporosis)

37
Q

Name the osteoporosis drug that acts against RANK-L to reduce osteoclast activity:

A

denosumab

38
Q

How does denosumab treat osteoporosis?

A

it is a monoclonal antibody against RANK-, reducing osteoclast activity

39
Q

How is denosumab administered?

A

Subcutaneous injection every 6 months

40
Q

Describe the risk associated with suddenly stopping denosumab:

A

the ‘rebound effect’ - where a large increase in osteoclast activity begins following withdrawal of denosumab

41
Q

How is the rebound effect of withdrawing denosumab managed?

A

giving bisphosphonates for 1-2 years after

42
Q

What is the name of the synthetic parathyroid hormone used to treat osteoporosis?

A

it is a synthetic form of parathryoid hormone that increases new bone formation

43
Q

How is teriparatide administered?

A

daily subcutaneous injection

44
Q

How often should osteoporosis patients get DEXA scan reviews?

A

every 3-5 years

Y3 - Endocrine and metabolic (20 decks)

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