Osteoporosis Angela Robertson Radiographer Highlands and Islands Osteoporosis

Osteoporosis Angela Robertson Radiographer Highlands and Islands Osteoporosis Service

What is Osteoporosis

Bone Structure Thick outer shell of cortical bone Strong inner mesh of trabecular bone Trabecular bone Cortical bone

BONE Bone is a living growing tissue Osteoclasts break down old bone Osteoblasts build new bone This is called bone turnover Takes about 7 -10 years to replace all old bone with new bone Osteoporosis occurs when this cycle is out of balance and we break down more bone than is replace

Osteoporosis occurs when the struts that make up the structure of bone become thinner. This causes the bones to become weaker and easier to break (fracture) Healthy Bone Osteoporotic Bone

Risks Factors of Bone Loss • • • Age Gender Vitamin D deficiency Low calcium intake Physical inactivity Low body weight Family history Current smoking Alcohol > 3 units per day

Risk Factors of Bone Loss - 2 • Diseases (a) Endocrine e. g. hyperparathyroidism (b) Chronic diseases (c) Rheumatoid Arthritis (d) Stroke/MS (e) Gastrointestinal e. g. Coeliac • Drugs (a) Corticosteroids (b) Anticonvulsants (c) Breast and Prostate cancer medication

STATISTICS • 50% women and 20% men >50 yrs will have a fracture • Lifetime risk of fracture in women age 50 yrs is greater than the risk of breast cancer or cardiovasular disease • 300, 000 osteoporotic fractures per year in UK

Common fracture sites Wrist Compressed vertebrae in spine Hip

Diagnosing Osteoporosis

Bone density (DXA) scanning • Useful for those with significant risk factors to decide whether drug treatment is necessary • When it is uncertain if bones are fragile • Those taking drug treatments to see if a treatment is working

BMD T-score Diagnosis § T-score ≥ -1 Normal § -1 > T-score > -2. 5 Low bone mass § T-score ≤ -2. 5 Osteoporosis § T-score ≤ -2. 5 with existing fracture Severe osteoporosis One SD corresponds to ~10% change in BMD

Changes in vertebral fractures between scans 2011 T 11 L 3 2008 T 11 L 3

Treatments for Osteoporosis

Drugs Treatments • Bisphonates e. g. Alendronic acid, Actonel, Bonviva etc • Calcium and Vit D • Denosumab (Prolia) • Strontium Ranelate (Protelos) • Teriparatide (Forsteo or Preotact)

Oral Bisphonates Correct Administration is key to success Normally taken once a week First thing in morning on empty stomach Take with full glass of tap water and swallow whole • Nothing to eat or drink for at least 30 mins • Stay upright DO NOT LIE DOWN • No calcium/vit D for at least 4 hours • •

Oral Bisphonates • • Side Effects: Upper GI symptoms Low risk of ONJ Atypical fermoral fractures

Calcium/Vit D • Normally given as a chewy tablet, tablet to suck or a powder to dissolve • 2 tablets given either twice a day morning and night or both at the same time depending on other medications. • Many different preparations available if struggling with side effects/compliance • Vitamin D can be taken with other routine medication

Vitamin D • ~ 90% comes from sunlight exposure on skin • May to September • Supplements recommended for care home populations • Can reduce fracture risk in care home populations

Other Therapies • Considered if: unable to tolerate bisphonates or in the event of treatment failure (continuing to fracture despite treatment) • Denusomab – given as a 6 monthly subcutaneous injection administered by GP practice • Strontium Ranelate – taken every night dissolved in water, nothing to eat 2 hours before or after • Teriparatide – daily self administered subcutaneous injection given for 2 year period (secondary care only)

Services in Highland • • • One DXA scanner for the whole of the Highlands Based at Ross Memorial Hospital Dingwall 4 trained scanning staff Open to GP and consultant referrals Fracture Liaison Service

Summary • Osteoporosis is a common condition that can lead to painful and disabling fractures • Those at risk need appropriate assessment of their bone health • Drug therapies to treat osteoporosis and reduce the risk of fractures are available for those at highest risk

Thank you Any Questions?