Flashcards in 7.3. Metabolic Bone Disease - Osteoporosis Deck (36):
What is the definition of Osteoporosis?
A Metabolic Bone Disease characterised by:
1. Low Bone Mass
2. Micro-Architectural Deterioration of Bone Tissue
What does the Micro-Architectural Deterioration of Bone Tissue, in Osteoporosis, lead to?
1. Enhanced Bone Fragility
2. Increased Fracture Risk
What is the biggest concern with Osteoporosis?
The Fracture Risk
What is the Risk of Fracture related to, with regards to Osteoporosis?
2. Bone Mineral Density (BMD)
4. Bone Turnover
What is measured to decide the treatment for Osteoporosis?
The Bone Mineral Density
What does the level of Bone Mineral Density (BMD) divide the severity of Osteoporosis into?
1. Normal (T score above -1)
2. Osteopenia (T score between -1 and -2.5)
3. Osteoporosis (T score below -2.5)
What is the treatment for a Bone Mineral Density (BMD) of Normal (T score above -1)?
2. Life Advice
What is the treatment for a Bone Mineral Density (BMD) of Osteopenia (T score between -1 and -2.5)?
1. Lifestyle Advice
2. Treat if previous fracture
What is the treatment for a Bone Mineral Density (BMD) of Osteoporosis (T score below -2.5)?
1. Lifestyle Advice
2. Offer treatment
What is the emphasis of Osteoporosis treatment based on?
Fracture Risk Assessment and Reduction
FRAX = WHO Fracture Risk Assessment Tool
What does FRAX (Fracture Risk Assessment Tool) take into account?
1. Age - Peaks at 85
2. Gender - Higher in women
3. Bone Mineral Density (BMD) - higher in low BMD
4. Glucocorticoid Use
5. Family History
6. Country Specific
What are the disadvantages of FRAX (Fracture Risk Assessment Tool)?
1. Does not accomodate all known risk factors
2. Lacks detail on some risk factors
3. Depends on adequacy of Epidemiological data
4. Limited country models available
5. Model relevant only for untreated patients
6. Does not replace Clinical Judgement
What does a FRAX (or QFracture) score of >10% 10 year fracture risk, lead to?
Referral for a Dual X-ray Absorptometry (DXA)
What is the treatment decision of Osteoporosis dependent on?
The Dual X-ray Absorptometry (DXA) scanning and individual report-fracture risk
Note - Threshold of 20% 10 year risk
What are some Endocrine causes of Secondary Osteoporosis?
4. Growth Hormone Deficiency
What are some Malabsorption causes of Secondary Osteoporosis?
1. Coeliac Disease
2. Cystic Fibrosis
What Malignancy can cause Secondary Osteoporosis?
What are some Rheumatic causes of Secondary Osteoporosis?
1. Rheumatoid Arthritis
2. Ankylosing Spondylitis
3. Polymyalgia Rheumatica
What Drugs can cause Secondary Osteoporosis?
1. Steroids (Glucocorticoids)
2. Heparin / Warfarin
4. Proton Pump Inhibitors (PPI's)
5. GnRH inhibitors
6. Aromatase Inhibitors
What Amenorrhoea issues can cause Secondary Osteoporosis?
1. Anorexia Nervosa
2. Early Menopause
3. Primary Ovarian Failure
What are the methods used to Prevent Osteoporotic Fractures?
1. Minimise Risk Factors
2. Ensure good Calcium and Vitamin D Status
3. Fall-Prevention Strategies
What medications can be used to help Prevent Osteoporotic Fractures?
2. Hormone Replacement Therapy (HRT)
3. Selective Oestrogen Receptor Modulator (SERM)
What are the Side-Effects of Hormone Replacement Therapy (HRT)?
1. Increased risk of Blood Clots
2. Increased risk of Breast Cancer (with extended use into the late 50's / early 60's)
3. Increased risk of Heart Disease and Stroke (if used after large gap from menopause)
What are the Negative effects of Selective Oestrogen Receptor Modulator's (SERM's)?
1. Hot flushes (if taken close to menopause)
2. Increased clotting risk
3. Lack of protection at the Hip site
What is the first line treatment to Prevent Osteoporotic Fractures?
What is required for the use of Bisphosphonates to Prevent Osteoporotic Fractures?
1. Adequate Renal Function
2. Adequate Calcium / Vitamin D status
3. Good Dental Health and Hygiene
How do Bisphosphonates Prevent Osteoporotic Fractures?
Bisphosphonates containing Nitrogen inhibit Osteoclast action, forming stronger bones
What Bisphosphonate medications are used?
What are the Side Effects of Bisphosphonates?
2. Iritis / Uveitis
3. Osteonecrosis of the Jaw
4. Atypical Femoral Shaft Fractures
What are the Side Effects of Teriparatide?
1. Injection site irritation
2. Rarely Hypercalcaemia
What other treatment can be used for Osteoporosis?
What type of medication is Denosumab?
Monoclonal Antibody against RANKL
What is the effect of Denosumab?
Reduces Osteoclastic Bone Resorption
How is Denosumab given?
Subcutaneous Injection every 6 months
What is the main advantage of Denosumab?
It is safer in patients with significant Renal Impairments than Bisphosphonates