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Osteoporosis - Coggle Diagram
Osteoporosis
Assessment
All others with risk factors: calculate the 10-year fragility fracture risk prior to arranging DXA - QFracture or FRAX.
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Offer a dual-energy x-ray absorptiometry (DXA) scan to measure bone mineral density with calculating fragility fracture risk in those over 50 with history of fragility fracture and those younger than 40 who have a major risk factor.
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Exclude secondary causes of osteoporosis - endocrine conditions, rheumatological conditions, gastrointestinal conditions, chronic liver disease, COPD.
Exclude non-osteoporotic causes for fragility fracture - metastatic bone disease, multiple myeloma, osteomalacia, or Paget's disease.
High risk groups
People younger than 50 who use corticosteroids currently/frequently, untreated premature menopause or previous fragility fracture
All people younger than 40 - Current or recent use of high-dose oral corticosteroids, previous fragility fracture to the spine, hip, forearm or proximal humerus, or history of multiple fragility fractures.
All women 50-64 year, and all men 50-74 years with a risk factor.
All women over 65 years and over, all men 75 years and over.
Consider in all who take SSRI, antiepileptic medication, aromatase inhibitors, Gonadotropin-releasing hormone agonists, proton pump inhibitors or Thia.zolidinediones
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Risk factors
Falls: Impaired vision, neuromuscular weakness and incoordination, cognitive impairment, use of alcohol and sedative drugs.
Unestablished mechanisms: SSRI, Proton pump inhibitors, anticonvulsant drugs.
Do not reduce BMD: age, oral corticosteroids, smoking, alcohol, previous fragility fracture, rheumatological conditions, parental history of hip fracture.
Reduce Bone Mass Density (BMD): Endocrine disorders, gastrointestinal conditions, Chronic Kidney disease, COPD, Menopause, Immobility, low BMI
Management: Treatment
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Consider prescribing HRT to younger post-menopausal women to reduce risk of fragility fractures and relief of symptoms.
If calcium intake adequate prescribe vitamin D (without calcium) for those not exposed to much sunlight.
Bone-sparing treatment recommended - prescribe Bisphosphonate if there are no contraindications (Alendronate 10mg daily/70mg once weekly etc).
Management: Results
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Low risk: do not offer drug treatment, offer lifestyle advice and follow up within 5 years.
High risk of fragility fracture: offer DXA scan, then a bone sparing drug treatment if T-score is -2.5 or lower, if T-score greater modify risk factors where possible, treat underlying conditions and repeat DXA at appropriate interval.
Definition: Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and fracture. Osteoporosis itself is asymptomatic. Osteoporotic fracture is a fragility fracture as a consequence of osteoporosis, a fragility fracture is a fracture following a fall from standing height or less. It is caused by an imbalance in the normal process of bone remodelling.