Bone Problems

Question 1

Treatment for osteoporosis?

Answer 1

A) over 65 and fracture = bone protection eg bisphosphonates (plus cal and vit D if deplete.

B) under 65 - need bone density scan

T score
> 0 = reassurance
0–1.5 = repeat scan in 1-3 years

Question 2

In someone starting long term steriods what’s the most appropriate approach to bone protection?

Answer 2

If going to be on them for >3 m best to start bone protection straight away

Question 3

What are the features of osteomalacia?

Answer 3

Bone pain, fractures, muscle tenderness, proximal myopathy.

Rickets: knock knee, bow leg, hypocalemia, lethargic

Question 4

Investigations in osteomalacia?

Answer 4

Bloods: low Ca,low phos, low vit D
High ALP

X-ray :
Children - cupped, ragged metaphyeal surfaces
Adults - translucent bands (looser zones/pseudofractures)

Question 5

Treatment for osteomalacia?

Answer 5

Calcium with vit D tablets

Question 6

T score Classification for osteopenia/porosis

Answer 6

> -1.0 = normal
-1.0 to -2.5 = osteopenia
< -2.5 = osteoporosis