bones + injuries Flashcards
(44 cards)
What is osteoporosis
reduction in the density of the bones
What is osteopaenia
less severe reduction in bone density than osteoporosis
What are the risk factors for osteoporosis
Older age Female Reduced mobility and activity Low BMI (<18.5 kg/m2) Rheumatoid arthritis Alcohol and smoking Long term corticosteroids Other medications
What medications can icrease risk of osteoporosis
SSRIs PPIs anti-epileptics anti-oestrogens. Long term corticosteroids
Why are post-menopausal woman at risk of osteoporosis
- oestrogen is a protective factors
- Unless they are on HRT postmenopausal women have less oestrogen
- They also tend to be are older and often have other risk factors for osteoporosis.
What is the FRAX tool
- gives a prediction of the risk of a fragility fracture over the next 10 year
- Involves looking at their BMI, smoking & alcohol history, FH and co-morbidities
- % 10 year probability of a:
Major osteoporotic fracture
Hip fracture
What is bone mineral density
- measured using a DEXA scan
- measured at any location on the skeleton, but the reading at the hip is best for FRAX assessment
- Bone density can be represented as a Z score or T score
What is a Z score
the number of standard deviations the patients bone density falls below the mean for their age
What is a T score
he number of standard deviations below the mean for a healthy young adult their bone density is.
What is considered a normal T score
> -1
What T score is considered to be osteopaenia
-1 - -2.5
What T score is considered to be Osteoporosis
Who should have a FRAX assessment
- Women aged > 65
- Men > 75
- Younger patients with risk factors such as a previous fragility fracture, history of falls, low BMI, long term steroids, endocrine disorders and rheumatoid arthritis.
What is the result of a FRAX outcome without a mineral bone density
- Low risk – reassure
- Intermediate risk – offer DEXA scan and recalculate the risk with the results
- High risk – offer treatment
What lifestyle changes can be done if osteoporotic
Activity and exercise Maintain a health weight Adequate calcium intake Adequate vitamin D Avoiding falls Stop smoking Reduce alcohol consumption
Who should given vitamin D and calcium
- patients at risk of fragility fractures with an inadequate intake of calcium
- Patients with an adequate calcium intake but lacking sun exposure should have vitamin D supplementation.
What do bisphosphonates do?
work by interfering with osteoclasts and reducing their activity, preventing the reabsorption of bone
Key side effects of bisphosphonates
Reflux and oesophageal erosions
Atypical fractures (e.g. atypical femoral fractures)
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal
What advice do you give patients taking bisphosphonates
taken on an empty stomach sitting upright for 30 minutes before moving or eating
examples of bisphosphonates
Alendronate 70mg once weekly (oral)
Risedronate 35 mg once weekly (oral)
Zolendronic acid 5 mg once yearly (intravenous)
If bisphosphonates are contraindicated, not tolerated or not effective what other options are there
- Denoxumab: monoclonal antibody
- Strontium ranelate
- Raloxifene is used as secondary prevention only
- Hormone replacement therapy
Strontium ranelate can increase the risk of what
DVT, PE and myocardial infarction.
How often should people have repeat DEXA scans
- Low risk no rx: 5 years
- On bisphosphonates: 3-5 years
Who should have a treatment holiday
- BMD has improved and they have not suffered any fragility fractures.
- This involves a break from treatment of 18 months to 3 years before repeating the assessment.
