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-MSK Diseases > 7.3. Metabolic Bone Disease - Osteoporosis > Flashcards

7.3. Metabolic Bone Disease - Osteoporosis Flashcards

1
Q

What is the definition of Osteoporosis?

A

A Metabolic Bone Disease characterised by:

  1. Low Bone Mass
  2. Micro-Architectural Deterioration of Bone Tissue
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2
Q

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

A
  1. Enhanced Bone Fragility

2. Increased Fracture Risk

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3
Q

What is the biggest concern with Osteoporosis?

A

The Fracture Risk

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4
Q

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

A
  1. Age
  2. Bone Mineral Density (BMD)
  3. Falls
  4. Bone Turnover
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5
Q

What is measured to decide the treatment for Osteoporosis?

A

The Bone Mineral Density

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6
Q

What does the level of Bone Mineral Density (BMD) divide the severity of Osteoporosis into?

A
  1. Normal (T score above -1)
  2. Osteopenia (T score between -1 and -2.5)
  3. Osteoporosis (T score below -2.5)
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7
Q

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

A
  1. Reassurance

2. Life Advice

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8
Q

What is the treatment for a Bone Mineral Density (BMD) of Osteopenia (T score between -1 and -2.5)?

A
  1. Lifestyle Advice

2. Treat if previous fracture

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9
Q

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

A
  1. Lifestyle Advice

2. Offer treatment

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10
Q

What is the emphasis of Osteoporosis treatment based on?

A

Fracture Risk Assessment and Reduction

FRAX = WHO Fracture Risk Assessment Tool

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11
Q

What does FRAX (Fracture Risk Assessment Tool) take into account?

A
  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
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12
Q

What are the disadvantages of FRAX (Fracture Risk Assessment Tool)?

A
  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
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13
Q

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

A

Referral for a Dual X-ray Absorptometry (DXA)

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14
Q

What is the treatment decision of Osteoporosis dependent on?

A

The Dual X-ray Absorptometry (DXA) scanning and individual report-fracture risk
Note - Threshold of 20% 10 year risk

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15
Q

What are some Endocrine causes of Secondary Osteoporosis?

A
  1. Hyperthyroid
  2. Hyperparathyroid
  3. Hypoparathyroid
  4. Growth Hormone Deficiency
  5. Hyperprolactinaemia
  6. Cushings
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16
Q

What are some Malabsorption causes of Secondary Osteoporosis?

A
  1. Coeliac Disease

2. Cystic Fibrosis

17
Q

What Malignancy can cause Secondary Osteoporosis?

A

Myeloma

18
Q

What are some Rheumatic causes of Secondary Osteoporosis?

A
  1. Rheumatoid Arthritis
  2. Ankylosing Spondylitis
  3. Polymyalgia Rheumatica
19
Q

What Drugs can cause Secondary Osteoporosis?

A
  1. Steroids (Glucocorticoids)
  2. Heparin / Warfarin
  3. Anticonvulsants
  4. Proton Pump Inhibitors (PPI’s)
  5. GnRH inhibitors
  6. Aromatase Inhibitors
20
Q

What Amenorrhoea issues can cause Secondary Osteoporosis?

A
  1. Anorexia Nervosa
  2. Early Menopause
  3. Primary Ovarian Failure
21
Q

What are the methods used to Prevent Osteoporotic Fractures?

A
  1. Minimise Risk Factors
  2. Ensure good Calcium and Vitamin D Status
  3. Fall-Prevention Strategies
  4. Medications
22
Q

What medications can be used to help Prevent Osteoporotic Fractures?

A
  1. Bisphosphonates
  2. Hormone Replacement Therapy (HRT)
  3. Selective Oestrogen Receptor Modulator (SERM)
23
Q

What are the Side-Effects of Hormone Replacement Therapy (HRT)?

A
  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
Q

What are the Negative effects of Selective Oestrogen Receptor Modulator’s (SERM’s)?

A
  1. Hot flushes (if taken close to menopause)
  2. Increased clotting risk
  3. Lack of protection at the Hip site
25
Q

What is the first line treatment to Prevent Osteoporotic Fractures?

A

Bisphosphonates

26
Q

What is required for the use of Bisphosphonates to Prevent Osteoporotic Fractures?

A
  1. Adequate Renal Function
  2. Adequate Calcium / Vitamin D status
  3. Good Dental Health and Hygiene
27
Q

How do Bisphosphonates Prevent Osteoporotic Fractures?

A

Bisphosphonates containing Nitrogen inhibit Osteoclast action, forming stronger bones

28
Q

What Bisphosphonate medications are used?

A
  1. Aledronate
  2. Risedronate
  3. Raloxifene
  4. Teriparatide
29
Q

What are the Side Effects of Bisphosphonates?

A
  1. Oesophagitis
  2. Iritis / Uveitis
  3. Osteonecrosis of the Jaw
  4. Atypical Femoral Shaft Fractures
30
Q

What are the Side Effects of Teriparatide?

A
  1. Injection site irritation
  2. Rarely Hypercalcaemia
  3. Allergy
  4. COST
31
Q

What other treatment can be used for Osteoporosis?

A

Denosumab

32
Q

What type of medication is Denosumab?

A

Monoclonal Antibody against RANKL

33
Q

What is the effect of Denosumab?

A

Reduces Osteoclastic Bone Resorption

34
Q

How is Denosumab given?

A

Subcutaneous Injection every 6 months

35
Q

What is the main advantage of Denosumab?

A

It is safer in patients with significant Renal Impairments than Bisphosphonates

36
Q

What are the side effects of Denosumab?

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

-MSK Diseases (43 decks)

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