Osteoporosis Flashcards
1
Q
Definition of osteoporosis
A
A metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk
2
Q
How is fracture risk assessed?
A
- FRAX - WHO fracture risk assessment tool
- Q fracture
- DEXA scan
3
Q
Endocrine causes of osteoporosis
A
- Thyrotoxicosis
- Hyper and hypoparathyroidism
- Cushings
- Hyperprolactinaemia
- Hypopituitarism
- Early menopause
4
Q
Rheumatic causes of osteoporosis
A
- Rheumatoid arthritis
- Ankylosing spondylitis
- Polymyalgia rheumatica
5
Q
Gastrointestinal causes of osteoporosis
A
- Inflammatory diseases: UC and crohns
- Liver diseases: PBC, CAH, Alcoholic cirrhosis, Viral cirrhosis( hep C)
- Malabsorption: chronic pancreatitis, coeliac disease, whipples disease, short gut syndromes and ischaemic bowel
6
Q
Medications which cause osteoporosis
A
- steroids
- PPI
- Enzyme inducing antiepileptic medications
- Aromatase inhibitors
- GnRH inhibitors
- Warfarin
7
Q
Treatment threshold for osteoporosis treatment
A
- Referral for DEXA scanning based on FRAX or QFracture score of >10% fracture risk at any site over next 10 years
- Treatment decisions after DEXA scanning and individual report-fracture risk
- around 20% 10 year risk would be treatment threshold
8
Q
Osteoporosis treatment
A
- HRT
- SERMS
- bisphosphnates
- denosumab
- teriparatide
9
Q
Side effects of hormone replacement therapy
A
- Increased risks of blood clots
- Increased risk of breast cancer with extended use into late 50s/early 60s
- Increased risk of Heart disease and stroke if used after large gap from menopause
10
Q
Negative effects of SERMS
A
- Hot flushes if taken close to menopause
- Increased clotting risks
- Lack of protection at hip site
11
Q
Bisphosphonates
A
- Oral Bisphosphonates generally the first line of treatment
- Adequate Renal function required
- Adequate Calcium and Vitamin D status
- Good Dental Health and Hygiene advised
- Notify dentist on Bisphosphonates
- Encourage regular check ups / well fitting dentures
12
Q
Side effects of bisphosphonates
A
- oesophagitis
- uveitis
- ONJ
- atypical femoral shaft fracture
13
Q
Denosumab
A
- Monoclonal antibody against RANKL
- Reduces osteoclastic bone resorption
- Subcutaneous injection every 6 months
- Safer in patients with significant renal impairment than bisphosphonates
14
Q
Denosumab side effects
A
- Allergy/rash
- Symptomatic hypocalcaemia if given when vitamin D depleted
- ONJ?
- Atypical femoral shaft fractures?
15
Q
Tereparatide
A
- increases bone mineral density (BMD)
- expensive
