Osteoporosis Flashcards
what is osteoporosis?
Osteoporosis is characterised by low bone mineral density (BMD) and microarchitectural deterioration of bone tissue, leading to bone fragility and increased fracture risk.
list the common sites of minimal-trauma fractures in osteoporosis?
vertebral bodies, distal radius, proximal humerus, pelvis and proximal femur.
what is the ‘T-score’ and ‘Z-score’ on BMD measurements?
The T-score is the number of standard deviations by which a patient’s BMD varies from the young adult mean for their sex, as measured by DXA. Relative fracture risk approximately doubles for each standard deviation decrease in T-score.
The Z-score is the number of standard deviations a person’s BMD varies from the age- and sex-matched mean BMD.
Are plain XRAYS helpful to dx osteoporosis?
Plain X-rays can be used to identify fractures but not to diagnose osteoporosis.
Vertebral fractures are painless in 70% of cases, but may be suspected in patients with significant height loss (3 cm or more) or kyphosis (curvature of the spine). X-rays can be used to confirm fracture in these patients.
what does a T-score of ‘-1 or higher’ mean?
normal BMD
what does a T-score of ‘-1 and -2.5’ mean?
osteopenia or low bone density
what does a T-score of ‘-2.5 or lower’ mean?
osteoporosis
list some ‘non-modifiable’ risk factors for minimal-trauma fractures in osteoporosis
previous minimal-trauma fracture
female sex
postmenopause
early menopause
late menarche
ageing
family history of osteoporosis
list some ‘modifiable’ risk factors for minimal-trauma fractures in osteoporosis
- Falls and factors that increase the risk of falls
- drugs that affect bone homeostasis and density
- lifestyle and nutrition factors
- lifestyle and nutrition factors
- disorders that affect bone homeostasis or density
list 10 drugs that affect bone homeostasis or density
- glucocorticoids
- androgen deprivation therapy for prostatic cancer
- aromatase inhibitors for breast cancer
- excessive thyroid hormone replacement
- long-term heparin
- selective serotonin reuptake inhibitors
- antiepileptic drugs, particularly 8. hepatic enzyme inducers (modest effect)
- thiazolidinediones (modest effect)
- protein pump inhibitors (modest effect)
list some factors that increase falls risk and should be considered in patients to help prevent falls?
balance disorder visual impairment muscle weakness and sarcopenia sedating drugs antihypertensive drugs
what lifestyle and nutrition factors can you educate on to reduce risk of minimal-trauma fractures in osteoporosis?
smoking hazardous alcohol consumption physical inactivity immobilisation low calcium intake vitamin D deficiency low protein intake
list 5 endocrine disorders that affect bone homeostasis or density?
endocrine disorders:
- sex hormone deficiency
- Cushing syndrome
- hyperthyroidism
- hyperparathyroidism
- diabetes mellitus
list 3 malabsorption disorders that affect bone homeostasis or density?
malabsorption syndromes:
- coeliac disease
- gastric or bowel resection
- bariatric surgery
others:
chronic disorders (eg liver, kidney or cardiopulmonary diseases)
low body weight and weight loss, including anorexia nervosa
rheumatoid arthritis and other connective tissue diseases
haematological disorders (eg multiple myeloma, myeloproliferative disorders)
what are 7 important aspects to consider in a consult to advise and assist patients at risk of minimal trauma fractures?
Advise and assist all patients at risk of minimal-trauma fracture to:
- implement strategies to prevent falls
- increase weight-bearing exercise and balance training
- ensure adequate calcium intake
- ensure vitamin D sufficiency
- stop smoking
- limit alcohol intake to two standard drinks per day
- maintain ideal body weight.
