Bone disease

Question 1

Risk factors

Answer 1

• Female
• Maternal history of fragility
• fractures / osteoporosis
• older age
• low BMI
• Weight loss >10
• post menopause
• long term steroid use
• smoker
• Endocrine conditions
• ## conditions assoc with malabsoption

Question 2

Definition of osteoporosis

Answer 2

low bone density and abnormal bone structure - leads to compromised bone strength

Question 3

1st line treatment of osteoporosis

Answer 3

bisphosphonate e.g. alendronate

Question 4

Tools for assessing osteoporotic risk

Answer 4

QFracture or FRAX

Question 5

WHO defines osteoporosis as…..

Answer 5

BMD of less than 2.5 SD below the young adult mean density

Question 6

T score of what means treatment is recommended in osteoporosis?

Answer 6

-2.5

Question 7

how to bisphosphinates work?

Answer 7

decreases demineralisation in bone

Question 8

SE of bisphosphinates

Answer 8

oesophagitis
oesophageal uclers
diarrhoea / constipation

osteonecrosis of the jaw

may get an acute phase response - fever / myalgia and arthralgia

Question 9

counselling on bisphosphinates

Answer 9

tablets should be swallowed whole with a glass of water

sit up / stand up for 30 mins

take before breakfast / another oral medication

ONCE A WEEK

regular dental check ups

Question 10

life style factors on osteoporosis

Answer 10

exercise

stop smoking

Question 11

pagets disease definition

Answer 11

chronic bone disorder - unbalanced bone turn over

focal bone reabsorption followed by excessive and chaotic bone deposition

Question 12

which bones does pagets often affect

Answer 12

femoral
pelvis
skull

Question 13

how does pagets disease most often present

Answer 13

asymptomatic

but can present with long bone pain and facial pain

or pathological fracture

Question 14

primary imaging modality in pagets disease

Answer 14

plain x-ray - abnormal sclerotic bone

Question 15

Which blood test is raised in pagets disease

Answer 15

ALP

Question 16

osteomalacia is -

Answer 16

normal bony tissue but decreased mineral content

Question 17

osteomalacia in growing children =

Answer 17

rickets

Question 18

presentation of osteomalacia

Answer 18

bone pain
fractures
muscle tenderness
proximal myopathy

Question 19

Blood test results in osteomalacia

Answer 19

Raised ALP and low Vit D

Question 20

how to differentiate osteomalacia from pagets disease

Answer 20

Ostemalacia has low Vit D

Question 21

Main aim of treatment in pagtes disease

Answer 21

reduce osteoclast activity

Question 22

two treatment choices in pagets disease

Answer 22

bisphosphinates or calcitonin

Question 23

When is secondary prevention of osteoporosis treatment started ?

Answer 23

treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of - 2.5 SD or below). In women aged 75 years or older, a DEXA scan may not be required ‘if the responsible clinician considers it to be clinically inappropriate or unfeasible’
vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
alendronate is first-line

Question 24

Alternatives to alendronate

Answer 24

risederonate and etidronate

Question 25

When is secondary prevention of osteoporosis treatment started ?

Answer 25

Offer prophylactic bisphosphonates to those with a T-score < -1.5 if they are on steroids / going to be on steroids for 3 or more months (even if <65 years-old)