Osteoporosis Flashcards
(20 cards)
Secondary cause: Medical conditions
Chronic - CD, coeliac disease, primary biliary cirrhosis, liver and renal disease
Endocrine - Cushing’s syndrome, hyperpara and hyperthyroidism, Acromegaly, gonadal failure
Others - RA, diabetes,
Secondary cause: Medicines
Corticosteroids, Heparin, Ciclosporin, PPI
Clinical Features: 3 sites
Thoraic and lumbar vertebrae
Neck of femur
Distal radius - Colle’s fracture
Assessment: Fragility Fracture risk
T-scores, ages for assessments
DXA scan - measures BMD
Osteoporosis - T-score of -2.5 SD or below
Osteopenia - T-score between -1 and -2.5 SD
Women - aged 65 yrs and over
Men - aged 75 yrs and over
Assessment of medicines
SSRIs
Antiepileptics
Aromatase inhibitors - Examestane
GhRH agonists - Goserelin
PPI
Pioglitazone
Assessment: Tools
FRAX
QFracture
Management: Antiresorptive drugs
Oral Bisphosphonates - 1st line
IV Bisphosphonates e.g. Zoledronic acid - can be 1st line after hip fracture
Bisphosphonates: Alendronic Acid
Dosing, how to take it, S/E
Once daily or once weekly dosing
Take with water while sitting straight or standing in an empty stomach at least 30mins before breakfast
S/E - Oesophageal reactions, dysphagia, new or worseing heartburn, pain on swallowing
Bisphosphonates: Risedronate sodium
Dosing, how to take it
Once daily or Once weekly dosing
Take with water while sitting straight or standing in an empty stomach at least 30mins before breakfast
Bisphosphonates: S/E
Osteonecrosis of the jaw and auditory canal - more likely in IV bisphosphonates
Atypical femoral fractures
Bisphosphonates: Treatment holiday
Oral - review after 5 years
IV - review after 3 years (zoledronic acid)
Longer treatment of 10 yrs - consider in over 70yrs
Denosumab
Route, monitoring, S/E
SC
Monitor - calcium (causes hypocalcaemia)
Alternative for oral bisphosphonates due to swallowing difficulties or contraindications
S/E - osteonecrosis of the jaw, atypical femoral fractures
Selective Oestrogen-Receptor Modulator (SERM): Raloxifene
Given if oral bisphosphonates are not suitable
Strontium Ranelate
Why it is given, dosing, counselling
Specialist for severe osteoporosis and when other treatment are not suitable
Can’t be given to people who are at high risk of CVD e.g. previous MI, stroke, VTE
Bedtime dosing - 2g in 3ml of water
Avoid food for 2 brs before and after
Hormone Replacement Therapy
Risks, other indications, what is given
Only given if all other options are not suitable or contraindicated
Increases risk of CVD e.g. VT - give transdermal
Other risks - stroke, endometrial and breast cancer
Not suitable for cancer patients
For menopausal symptoms - Oestrogen+Progesterone (women with uterus), Oestrogen only (without uterus)
Tibolone
Option for younger postmenopausal women
Given if other options are not suitable
Teriparatide
When to give, route, condition over oral bisphosphonate
Ony for postmenopausal women with severe osteoporosis at very high risk fractures
Specialist initiation
SC
Given in postmenopausal women with vertebral fracture - sever or moderate low-trauma
Romosozumab
When to give, S/E, condition over oral bisphosphonate
Ony for postmenopausal women with severe osteoporosis who have previously experienced a fragility fracture and at risk of another one
S/E - Osteonecrosis of jaw, atypical femoral fracture, hypocalcaemia
Given in postmenopausal women with vertebral fracture - severe or moderate low-trauma
Corticosteroid-Induced
1st and 2nd line
Alendronate and Risedronate - 1st line
Zoledronic acid, Denosumab and Teriparatide - 2nd line
Osteoporosis in Men
1st and 2nd line
Alendronate and Risedronate - 1st line
Zoledronic acid, Denosumab and Teriparatide - 2nd line
