Osteoporosis

Osteoporosis:

  • DEXA scan: Screen all women (post-menopausal) +65 years old at least once!
    • T-score compares a patient’s bone mineral density to that of a healthy young adult
    • WHO criteria:
      • T-score within 1 standard deviation (SD) or better is NORMAL.
      • T-score of -1 to -2.5 SD is defined as OSTEOPENIA.
      • T-score of less than -2.5 SD is defined as OSTEOPOROSIS.
      • T-score of less than -2.5 SD with fracture is defined as SEVERE OSTEOPOROSIS.
  • Tool used to Dx: https://www.shef.ac.uk/FRAX/tool.jsp
  • Tx: Calcium supplement and Vitamin D supplements.
    1. Vitamin D (Ergocalciferol) 50,000U PO capsule – Take 1 capsule each week for 12 weeks.
    2. OTC Calcium carbonate 1250mg tablets
    3. Alendronate Sodium (bisphosphonate) 70 MG Oral Tablet – Take 1 tablet once a week 30-60 minutes prior to breakfast or the patient can take 10mg PO qd each morning before breakfast.
      1. ADR: GI symptoms. Recommend that the patient remain upright for at least 1 hour following medication.
    4. Zoledronic acid (use if cannot tolerate GI side effects of bisphosphonate)
  • Other recommendations: quit smoking (smoking cessation), increase exercises (weight bearing exercises), decrease coffee/cokes/alcohol use.
  • Others: Raloxifene (if pt has breast cancer too), and discontinue meds such as Heparin and Glucocorticoids
  1. Hormone Replacement Therapy (HRT) is effective in preventing osteoporosis, but it is NOT recommended because it will increase the risk for cancer (breast and endometrial) as well as heart disease.

Ex: Osteoporosis: Started Alendronate 70mg tablet once a week. Take in the morning with plenty of water and stay upright for an hour following taking this medication. Also start taking calcium and vitamin D supplements. The patient will need a repeat DEXA scan after taking bisphosphonate for 2 years to reassess osteoporosis. Weight bearing exercises are also recommended.

FRAX (Osteoporosis): calculate an individual’s 10-year probability of fracture

Need the following information about the patient: age, gender, weight (in kg), height (in cm), previous fracture, parent fractured a hip, current smoking, glucocorticoid use, RA, secondary osteoporosis, alcohol use, and femoral neck bone mineral density (use DEXA scan results).

Calculator: http://www.shef.ac.uk/FRAX/tool.aspx?country=9

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