osteoporosis Flashcards
(21 cards)
risk factors for osteoporosis
age
women
corticosteroid use
rheumatoid arthritis
smoking
alcohol excess
low BMI
FH - esp of hip fracture
what endocrine disorders can increase your risk of osteoporosis
hyperthyroidism
hypogonadism - Turners, testosterone deficiency
diabetes
hyperparathyroidism
cushings
medications that may worsen osteoporosis
glucocorticoids!
SSRIs
antiepileptics
PPIs
glitazones
long term heparin therapy
aromatase inhibitors ! - anastrozole
bone protection when taking glucocorticoids
if it likely patient will take steroids for at least 3 months –> start bone protection straight away
(alendronate)
management of patients at risk of corticosteroid-induced osteoporosis
> 65 OR already had fragility fracture = alendronate
<65 = bone density scan
- >0 = reassure
- 0- -1.5 = repeat in 1-3yrs
- < -1.5 = offer alendronate
when can a DEXA scan be offered without calculating fragility risk score;
> 50yrs with hx of fragility fracture
<40yrs with major RF for fragility frac
before starting tx that have rapid adverse effect on bone density - sex hormone deprevation in breat/prostate ca
score to calculate 10-year risk of developing a fracture
FRAX or QFracture
management if 10-year fracture risk >=10% on Qfracture score
order DEXA scan
management based on FRAX score
orange zone = DEXA, to further refine 10yr risk
red zone = DEXA, baseline + guide drug tx
when should FRAX/Qfracture be reassessed
- original calculated risk was in the region of intervention threshold for a proposed tx only after min of 2yrs
- when been change in persons risk factors
1st + 2nd line mx of osteoporosis
1st = alendronate
2nd = denosumab - monoclonal antibody
who can skip straight to bisphosphonate tx (no DEXA)
> =75 who’ve had fragility frac
postmenopausal women + men >=50 who
- treated with glucocorticoids
- osteoporotic vertebral frac
T score in DEXA scan
based on bone mass of young reference population
Z score
is adjusted for age, gender + ethnic factors
T score = osteopaenia or osteoporosis
> -1 = normal
-1 - -2.5 = osteopaenia
<-2.5 = osteoporosis
bisphosphonates mode of action
inhibit osteoclasts by reducing recruitment + promoting apoptosis
analogues of pyrophophate, a molecule which decreases mineralisation in bone
side effects of bisphosphonates
oesophageal reactions - oesophagitis, ulcers
osteonecrosis of jaw - more common if IV bisphosphonates for cancer or prior poor dental hygiene
increase risk of atypical stress fracture - proximal femoral shaft
hypocalcaemia
poor dental hygiene + require bisphosphonate tx
get dental check prior to starting
counselling required for those taking bisphosphonates
swallow whole with plenty water while sitting or standing
- give on empty stomach 30mins before brekky or another medications
- stay upright for 30mins after taking
bisphosphonates if existing hypocalcaemia/vit D deficiency
must correct first !!
- only if dietary intake inadequate
who should have their bisphosphonate tx stopped at 5years
pateint <75yrs
femoral neck T-score >-2.5
low risk according to FRAX/NOGG
