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PR3154 > IC18 Management of osteoporosis > Flashcards

IC18 Management of osteoporosis Flashcards

1
Q

What is osteoporosis?

A

It is a metabolic bone disease characterised by:
1. Low bone density
2. Decreased bone strength
3. Increased risk of fracture

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2
Q

What are the 2 ways that can cause a decrease in bone mass?

A
  1. Excessive bone resorption
  2. Decreased bone formation
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3
Q

What are possible primary causes for ↓ in bone mass?

A
  1. Age
  2. Menopause
  3. Alcohol consumption
  4. Smoking
  5. Low sr Ca
  6. Physical inactivity
  7. Medication use
  8. Other diseases
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4
Q

What medications can contribute to drug-induced osteoporosis?

A
  1. *Glucocorticoid
  2. Immunosuppressants
  3. Antiseizure medications
  4. Heparin
  5. Cancer chemotherapy
  6. GnRH agonists and antagonists
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5
Q

Are there any symptoms in early stages of osteoporosis?

A

No.
Osteoporosis is often undiagnosed until presented w fragility fracture.

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6
Q

What is fragility fracture?

A

Fragility fracture is a type of fracture caused by low trauma that normally doesn’t cause fractures.

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7
Q

What are the goals of therapy of osteoporosis?

A
  1. Prevention of fractures* [most impt]
  2. Improve QoL
  3. Reduce economic burden
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8
Q

What are the 2 main risk factors for osteoporosis?

A
  1. Post-menopausal women
  2. Men ≥ 65yo

Other risk factors:
- Low body weight
- Low Ca intake
- Smoking
- Excessive alcohol intake
- etc.

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9
Q

What is the T score for:
- Osteoporosis
- Osteopenia
- Normal bone density?

A

Osteoporosis: ≤ -2.5 SD
Osteopenia: -1 to -2.5 SD
Normal bone density: ≥ -1 SD

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10
Q

Z-score is another score that tells us if there are other co-existing problems that can contribute to osteoporosis.

What is the Z-score value that tells us that the osteoporosis caused by other co-existing problems?

A

Z-score ≤ -2 SD

This indicates that other co-existing problems - such as alcoholism or glucocorticoid therapy can contribute to osteoporosis.

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11
Q

FRAX score is another assessment tool to measure a pt’s risk of fracture.

What is the FRAX score for:

  1. Pt at risk of major osteoporotic fracture?
  2. Pt at risk of hip fracture?
A
  1. Pt at risk of major osteoporotic fracture - risk score of ≥ 20%
  2. Pt at risk of hip fracture - risk score of ≥ 3%
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12
Q

What is the process of diagnosing a pt with osteoporosis and initiating treatment?

A
  1. Check pt for risk factors
  2. Check DXA score of pt (see if T-score is ≤2.5)
  3. Check FRAX score
  4. Diagnose pt with osteoporosis
  5. Start treatment
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13
Q

When do we initiate treatment for osteoporosis?

A
  1. Pt presents with fragility fracture
  2. Pt has a T score ≤2.5
  3. Pt w T score <-1 to >-2.5, & high risk of fracture (FRAX >3% for hip fracture OR FRAX ≥ 20% major osteoporotic fracture)
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14
Q

What are the treatments available for osteoporosis?

A
  1. Oral bisphosphonates - Alendronate, Risendronate
  2. IV bisphosphonates - Zoledronic acid
  3. SC Denosumab - RANKL inhibitor
  4. Raloxifene - oestrogen receptor modulator
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15
Q

What are the contraindications of oral bisphosphonates?

A

Oral bisphosphonates are contraindicated in:
- CrCL < 30ml/min
- Hypocalcaemia
- Oesophageal or gastric abnormalities
- Pt w inability to stand/sit upright ≥30mins
- Aspiration risk

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16
Q

What are the contraindications in IV bisphosphonates?

A

IV bisphosphonates are contraindicated in:
- CrCL <35ml/min
- Hypocalcaemia

Note: Oral bisphosphonate is CI in CrCL <30ml/min, while IV Oral bisphosphonates is CI in CrCL<35ml/min

17
Q

What are the ADR of both Oral & IV bisphosphonates?

A
  1. Osteonecrosis of the jaw (ONJ)
  2. Atypical femoral fracture
18
Q

How long should treatment be for oral and IV bisphosphonates?

A

Length of therapy:
Oral bisphosphonates - 5 years
IV bisphosphonates - 3 years

19
Q

When will we consider using denosumab?

A

Denosumab is only considered if pt is renally impaired + unable to take oral bisphosphonates.

20
Q

What is the contraindication of Denosumab?

A

Hypocalcaemia

21
Q

What are the ADRs of denosumab?

A

Similar to oral & IV bisphosphonates.

  1. ONJ
  2. Atypical femoral fracture
  3. Increased risk of infections
22
Q

If a pt is on bisphosphonates, which medical professional must they inform?

A

Dentists.

Pt on bisphosphonates must inform their dentist as there is risk of ONJ.

23
Q

What is considered atypical fractures?

A

Example of atypical fractures is:
- Shaft fracture

Common fracture area is the hip joint.

24
Q

What labs must we check before we initiate any treatment for osteoporosis?

A

We need to check:
1. Serum Ca levels
2. Vitamin D (Vit D ≥ 20-30ng/ml)

25
Q

What supplements must we give pt if they are on treatment for osteoporosis?

A

Give Ca and Vit D supplementation during treatment.

Take Ca and Vit D 2hrs apart from oral bisphosphonates.

26
Q

What are some non-pharmacological treatment for osteoporosis?

A
  1. Weight bearing exercises - tai chi, walking, elastic band exercises
  2. Take high Ca food
  3. Take Vit D - can ↓ falls
  4. Smoking cessation
  5. Limit alcohol intake (<2 units/day)

PR3154 (19 decks)

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