Osteoporosis Flashcards
WHO definition
Bone mineral density less than 2.5 standard deviations below the young adult mean density
Risk factors
Older age
Female
Corticosteroid use
Smoking
Alcohol
Low BMI
Family history
Screening tool
FRAX to assess 10-year risk of patient developing fragility fracture
Assessing bone mineral density
Dual-energy xray absoptiometry (DEXA)
Looks at hip and lumbar spine
If either have T score <-2.5 then treatment is recommended
First line treatment
Oral bisphosphonates (alendronate)
Vitamin D and calcium supplementation should be offered to all women unless confident they have adequate intake
Alendronate side effects
Upper GI problems
If cannot tolerate should be offered risendronate or etidronate
What is recommended if patient cannot tolerate bisphosphonates?
Strontium ranelate and raloxifene
T score criterias
Less than the others for risendronate and etidronate
Strontium ranelate or raloxifene may be given based on strict T-scores
Strictest criteria for denosumab
Bisphosphonates
Licensed for treatment and prevention of post-menopausal and glucocorticoid-induced osteoporosis
Ibandronate is a once monthly oral bisphosphonate
Raloxifene
Selective oestrogen receptor modulator
May worsen menopausal symptoms
Increased risk of thromboembolic events
May decrease risk of breast cancer
Strontium ranelate
Increases deposition of new bone by osteoblasts and reduces resorption of bone by inhibiting osteoclasts
Only prescribed by specialist
Increased risk of cardiovascular events
Increased risk of thromboembolic events
May cause serious skin reactions (Stevens Johnson syndrome)
Denosumab
Human monoclonal antibody inhibits RANK ligand which inhibits the maturation of osteoclasts
Given as single SC injection every 6 months
