7.3. Metabolic Bone Disease - Osteoporosis Flashcards Preview

3rd Year - MSK Diseases > 7.3. Metabolic Bone Disease - Osteoporosis > Flashcards

Flashcards in 7.3. Metabolic Bone Disease - Osteoporosis Deck (36):
1

What is the definition of Osteoporosis?

A Metabolic Bone Disease characterised by:
1. Low Bone Mass
2. Micro-Architectural Deterioration of Bone Tissue

2

What does the Micro-Architectural Deterioration of Bone Tissue, in Osteoporosis, lead to?

1. Enhanced Bone Fragility
2. Increased Fracture Risk

3

What is the biggest concern with Osteoporosis?

The Fracture Risk

4

What is the Risk of Fracture related to, with regards to Osteoporosis?

1. Age
2. Bone Mineral Density (BMD)
3. Falls
4. Bone Turnover

5

What is measured to decide the treatment for Osteoporosis?

The Bone Mineral Density

6

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)

7

What is the treatment for a Bone Mineral Density (BMD) of Normal (T score above -1)?

1. Reassurance
2. Life Advice

8

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

9

What is the treatment for a Bone Mineral Density (BMD) of Osteoporosis (T score below -2.5)?

1. Lifestyle Advice
2. Offer treatment

10

What is the emphasis of Osteoporosis treatment based on?

Fracture Risk Assessment and Reduction
FRAX = WHO Fracture Risk Assessment Tool

11

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

12

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

13

What does a FRAX (or QFracture) score of >10% 10 year fracture risk, lead to?

Referral for a Dual X-ray Absorptometry (DXA)

14

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

15

What are some Endocrine causes of Secondary Osteoporosis?

1. Hyperthyroid
2. Hyperparathyroid
3. Hypoparathyroid
4. Growth Hormone Deficiency
5. Hyperprolactinaemia
6. Cushings

16

What are some Malabsorption causes of Secondary Osteoporosis?

1. Coeliac Disease
2. Cystic Fibrosis

17

What Malignancy can cause Secondary Osteoporosis?

Myeloma

18

What are some Rheumatic causes of Secondary Osteoporosis?

1. Rheumatoid Arthritis
2. Ankylosing Spondylitis
3. Polymyalgia Rheumatica

19

What Drugs can cause Secondary Osteoporosis?

1. Steroids (Glucocorticoids)
2. Heparin / Warfarin
3. Anticonvulsants
4. Proton Pump Inhibitors (PPI's)
5. GnRH inhibitors
6. Aromatase Inhibitors

20

What Amenorrhoea issues can cause Secondary Osteoporosis?

1. Anorexia Nervosa
2. Early Menopause
3. Primary Ovarian Failure

21

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
4. Medications

22

What medications can be used to help Prevent Osteoporotic Fractures?

1. Bisphosphonates
2. Hormone Replacement Therapy (HRT)
3. Selective Oestrogen Receptor Modulator (SERM)

23

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)

24

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

25

What is the first line treatment to Prevent Osteoporotic Fractures?

Bisphosphonates

26

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

27

How do Bisphosphonates Prevent Osteoporotic Fractures?

Bisphosphonates containing Nitrogen inhibit Osteoclast action, forming stronger bones

28

What Bisphosphonate medications are used?

1. Aledronate
2. Risedronate
3. Raloxifene
4. Teriparatide

29

What are the Side Effects of Bisphosphonates?

1. Oesophagitis
2. Iritis / Uveitis
3. Osteonecrosis of the Jaw
4. Atypical Femoral Shaft Fractures

30

What are the Side Effects of Teriparatide?

1. Injection site irritation
2. Rarely Hypercalcaemia
3. Allergy
4. COST

31

What other treatment can be used for Osteoporosis?

Denosumab

32

What type of medication is Denosumab?

Monoclonal Antibody against RANKL

33

What is the effect of Denosumab?

Reduces Osteoclastic Bone Resorption

34

How is Denosumab given?

Subcutaneous Injection every 6 months

35

What is the main advantage of Denosumab?

It is safer in patients with significant Renal Impairments than Bisphosphonates

36

What are the side effects of Denosumab?

1. Allergy / Rash
2. Symptomatic Hypocalcaemia (if given when Vitamin D deplete)
3. Osteonecrosis of the Jaw?
4. Atypical Femoral Shaft Fractures?

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