Disorders of Bone Health Flashcards
(61 cards)
common fracture sites?
neck of femur
vertebral body
distal radius
humeral neck
what usually causes a colles fracture?
fall onto outstretched hand
why does osteoporosis cause a curvature of the spine (e.g thoracic kyphosis, loss of height)?
crumbing of vertebrae/wedge fractures in vertebrae
what is the most common osteoporotic fracture?
colles in younger
hip in elderly
how can bone density be assessed?
BMD (predicts fracture risk independently of other risk factors)
DEXA scan = most commonly used method of measuring BMD
how is DEXA scan used?
compares to other people of same age
= Z score
compares to young adult average
= Gives T score (<2.5 = osteoporosis)
what is a normal BMD?
within 1 standard deviation of the young adult reference average
osteopaenia BMD?
> 1 standard deviation below young adult mean but <2.5 SD below this value
osteoporosis BMD?
2.5 or more SD below young adult mean
severe osteoporosis = >2.5 below with a fragility fracture
which score is used if under 20?
only Z score
who should be refered for a DEXA scan?
patients over 50 with a low trauma fracture (often identified through fracture laison service)
patients at increased risk of fracture based on risk factors (calculated using risk assessment tool - FRAX or Qfracture - if >10% fracture risk over 1 years
SIGN objectives of osteoporosis management?
address risk factors for fracture (modifiable and non-modifiable)
assess fracture risk (use tools)
non modifiable fracture risk factors?
age gender ethnicity previous fracture family history menopause <45 co-existing disease
modifiable risk factors for fracture?
BMD alcohol weight smoking physical inactivity pharmacological
what is the WHO fracture risk calculator?
calculates absolute risk by incorporating additional risk factors rather than just BMD
predicts 10 year fracture risk
who should be assessed with risk fracture assessment (Qfracture or WHO calculator)?
over 50 with risk factors
under 50 with very strong clinical risk factors (early menopause, glucocorticoids)
slide 41 algorithm
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what tests are done for osteoporosis?
history and examination Us&Es LFTs bone biochemistry FBC PV TSH consider - Protein electrophoresis/Bence Jones proteins Coeliac antibodies Testosterone 25OH Vitamin D PTH
name 4 secondary causes for osteoporosis
endocrine (hyperthyroid, hyperparathyroid, cushings)
GI (coeliac, IBD, chronic liver disease, chronic pancreatitis)
resp (CF, COPD)
chronic kidney disease
general lifestyle advice for osteoporosis?
High intensity strength training Low-impact weight-bearing exercise (standing, one foot always on the floor) Avoidance of excess alcohol Avoidance of smoking Fall prevention
describe the osteoporotic diet?
RNI 700mg calcium (2-3 portions from milk and dairy foods group)
Postmenopausal women aim dietary intake 1000 mg calcium per day to reduce fracture risk (3-4 portion calcium rich foods)
Non-dairy sources include
bread and cereals (fortified)
fish with bones, nuts,
green vegetables, beans
what drug treatments are available for osteoporosis?
Calcium & vitamin D supplementation Bisphosphonates Denosumab Teriparatide HRT SERMS (Selective Estrogen Receptor Modulators) Testosterone
when are calcium and vit D supplements used? (SIGN guidelines)
… slide 47
what are bisphosphonates and what do they do?
Anti-resorptive agents – alendronate and risedronate
Prevent bone loss at all sites vulnerable to osteoporosis and Reduce risk of hip and spine fracture
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