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Osteoporosis is defined as a syndrome associated with low bone mass and…
Osteoporosis is defined as a syndrome associated with low bone mass and microarchitectural
deterioration of bone tissue which lead to an increased risk of fractures
Background
Osteoporosis itself is asymptomatic
A fragility fracture is defined as a fracture following a fall from standing height or less, although vertebral fractures may occur spontaneously, or as a result of routine activities such as bending or lifting.
An osteoporotic fracture is a fragility fracture occurring as a consequence of osteoporosis
Osteoporosis is defined by the World Health Organization as a bone mineral density (BMD) of 2.5 standard deviations below the mean peak mass (average of young healthy adults) as measured by dual-energy X-ray absorptiometry (DXA) applied to the femoral neck and reported as a T-score
Risk Factors
Reduced Bone strength- Endocrine disease, GI disease, CKD, Chronic liver disease, COPD, Menopause, immobility, BMI <18.5/Weight
Age, gender, ethnicity,smoking, alcohol, previous fractures, RA, drugs, parental hip fracture
Risk of falls
Assessment
Identify high risk group
Assess fracture risk for people taking at risk medications- SSRI, antiepileptic, PPI,Aromatase inhibitors, such as exemastane, Gonadotropin-releasing hormone agonists, such as goserelin, Thiazolidinediones, such as pioglitazone
fragility fracture risk assessment
Management
Intermediate risk- arrange a DXA scan to measure their bone mineral density (BMD) and offer drug treatment if the T-score is -2.5 or less.
Low risk- offer lifestyle advice and follow up within 5 years.
High risk- offer DXA scan,then bone-sparing drug treatment if the T-score is -2.5 or less. If Score is greater than - 2.5 modify risk where possible,treat underlying conditions, repeat DXA within 2 years
Lifestyle advice- regular exercise, diet, smoking, alcohol and written and verbal information
Follow up - adverse effects (GI upset, bone pain), adherence, review 3-5 years
Complications
Hip fracture
Vertebral fracture
References
https://www.sign.ac.uk/media/1646/sign142-2020-update.pdf
https://cks.nice.org.uk/osteoporosis-prevention-of-fragility-fractures#!scenario
Prescribing
Calcium intake
Adequate 700mg/day-prescribe 10 micrograms (400 international units) of vitamin D (without calcium) for people not exposed to much sunlight
Inadequate-Prescribe 10 micrograms (400 international units) of vitamin D with at least 1000 mg of calcium daily.
Prescribe 20 micrograms (800 international units) of vitamin D with at least 1000 mg of calcium daily for elderly people who are housebound or living in a nursing home.
bone sparring treatment if not contraindicated and after counselling
alendronate 10 mg once daily or 70 mg once weekly, or risedronate 5 mg once daily or 35 mg once weekly
only alendronate (once-daily tablets) and risedronate (once-weekly tablets) are licensed for use in men.
Consider prescribing hormone replacement therapy (HRT) to women who have a premature menopause (menopause before 40 years of age) to reduce the risk of fragility fractures and for the relief of menopausal symptoms.
Referral
If an oral bisphosphonate is not tolerated or is contraindicated, consider specialist referral.