Osteoporosis 🦴

Patient groups at increased risk of osteoporosis

Postmenopausal women. Men 50+yrs. Patient on long-term CCS (glucocorticoids).

Additional risk factors for osteoporosis

• Age increase.

• Vit D & calcium deficiency.

• Lack of exercise.

• Low BMI.

• Smoking & drinking.

• History of fractures.

• Early menopause.

Lifestyle advice for osteoporosis

Increase exercise. Eat balanced diet. Maintain ideal BMI. Smoking cessation. Reduce alcohol intake. Increase vitamin D & calcium (supplement if needed).

When should the need for osteoporosis medication be reviewed after initiation?

Review need for medication after 5 years (3 years for zoledronic)

First line drug treatment of osteoporosis

Oral bisphosphonates (alendronic acid 70mg weekly or 10mg daily/risedronate sodium 35mg weekly or 5mg daily)

Alternative osteoporosis drug treatment for postmenopausal women

Ibandronic acid. Denosumab. Raloxifene. Strontium. (RIDS)

Alternative osteoporosis drug treatment for younger menopausal women

• HRT

• Tibolone

Drug treatment for severe osteoporosis in postmenopausal women

Teriparatide

Alternative osteoporosis drug therapies for men

Zolendronic acid. Denosumab. Teriparatide. Strontium. (STDZ)

Alternative drug therapies for glucocorticoid-induced osteoporosis

Zolendronic acid. Denosumab. Teriparatide. (TDZ)

What is considered a large dose of glucocorticoids?

Prednisolone ≥ 7.5mg daily or equivalent for at least 3 months

Risk factors for glucocorticoid-induced osteoporosis in women

• 70yrs+

• Previous fragility fracture.

• Large glucocorticoid doses for >3 months.

Risk factors for glucocorticoid-induced osteoporosis in men

70yrs+ AND previous fragility fracture. Large glucocorticoid doses for >3 months.

Large glucocorticoid treatment for what length of time is a risk factor for glucocorticoid-induced osteoporosis?

3 months

When should prophylactic treatment start in high risk patients?

At the onset of glucocorticoid treatment

!MHRA Alerts! associated with bisphosphonates

• Atypical femoral fractures

• Osteonecrosis of the jaw

• Osteonecrosis of the external auditory canal.

!MHRA Alert! Bisphosphonates: Atypical femoral fractures

Report any thigh, hip or groin pain

!MHRA Alert! Bisphosphonates: Osteonecrosis of the jaw

Report dental pain, swelling, non-healing sores or discharge. Maintain good oral hygiene.

!MHRA Alert! Bisphosphonates: Osteonecrosis of the external auditory canal

Report ear pain, discharge or ear infection

General advice for how to take bisphosphonates

Take with a full glass of water while standing/sitting up. Take on empty stomach at least 30mins before breakfast. Remain upright for at least 30mins after taking.

Can cause oesophageal reactions → report & stop if any esophageal irritation, dysphagia, heartburn.

When should patients take alendronic acid?

30mins before first food, drink & other oral meds

When should patients take risedronate sodium?

30mins before first food, drink & other oral meds. Alternatively, avoid food 2 hours before & after if taking any other time of the day.

___ Vitamin __ must be given to patients with renal failure.

Fill in the gaps

Activated Vitamin D

(As they can’t activate it themselves)

Primary Osteoporosis causes

• Post menopause = decrease in oestrogen (oestrogens inhibits osteoclasts - cause bone resorption/breakdown)

• Old age = less vitamin D which means less calcium absorbed, Calcium starts to get taken from bones)

Secondary Osteoporosis causes

(As a result of another condition)

• Rheumatoid arthritis

• Hyperthyroidism

• Cushing’s

• Diabetes Mellitus

• Malignancy

• Steroid use

Alendronic acid doses for men & women

Men: 10mg daily

Women: 10mg daily or 70mg once weekly (postmenopausal osteoporosis women)