Components of FRAX score (risk factors for fractures)
- race (risk higher for whites and asians)
- age
- sex
- low BMI
- family history
- smoking
- steroid treatment
- RA
- osteoporosis
- excess alcohol consumption
- bone mineral density of femoral neck
Additional components in QFracture score (apart from FRAX)
- T2DM
- CVS disease
- Asthma
- TCA antidepressant use
- Chronic liver disease
- GI malabsorption
- Thyrotoxicosis, Cushing’s
- menopause
- Use of HRT
How does HRT affect falls risk?
Protective for duration of use, but effects are substantially diminished after stopping
How are hip fractures assessed in ED
Inability to do straight leg raise
What to look for when inspecting MSK patient
WADES
wasting asymmetry dysfunction erythema swelling
Osteoporosis definition
More than -2.5 SD at femoral neck
Osteopenia definition
-1 to -2.5 SD at femoral neck
What drugs are given for osteoporosis
- bisphosphonates
- calcium supplements
- vit D supplements
Types of bloods that must be taken prior to joint replacement surgery
- INR
- Group n save (in case of need of blood transfusion)
- FBC: check for anaemia (increased risk of needing blood transfusion)
- UnEs: get baseline for anaesthetist
Causes of low oestrogren in females
” Early menopause (before 45y)
“ Anorexia
“ Ovary removal
“ Excessive exercise
Medications that increase falls risks
” Steroids
“ anti-epileptics
“ breast cancer drugs (aromatase inhibitors)
“ prostate cancer drugs
Describe compartment syndrome
- High pressure in closed fascial space
- Causes reduced blood supply
- Leads to tissue death
Pharmacodynamics of bisphosphonates
Encourage osteoclasts to undergo apoptosis (thus reduce breakdown of bone)
Side effects of bisphosphonates
Osteonecrosis of the jaw
