Endocrinology

Question 1

Modifiable risk factors for Minimal Trauma Fractures

Answer 1

1 - implement strategies to prevent falls
2- increase weight-bearing exercise and balance training
3- ensure adequate calcium intake
4- ensure vitamin D sufficiency
5- stop smoking
6- limit alcohol intake to two standard drinks per day
7- maintain ideal body weight.

Question 2

Calcium and Vitamin D

Answer 2

Calcium >1300mg daily intake per day

Vitamin D > 50

Question 3

Preventing Falls - Strategies

Answer 3

1 - improving vision
2- adjusting drug therapy if possible (eg drugs causing sedation, altered gait or postural hypotension)
3- minimising household risks (preferably under the guidance of an occupational therapist)
4- providing aids for daily living (eg walking aids, rails)
5- minimising periods of immobilisation
6- promoting exercise to maintain mobility, balance and strength.
7 - Consider referral to a falls prevention clinic.

Question 4

Investigations for secondary cause of Osteoporosis

Answer 4

serum calcium concentration
serum phosphate concentration
serum alkaline phosphatase concentration
serum 25-hydroxyvitamin D concentration
serum thyroid stimulating hormone concentration
liver biochemistry
kidney function.

serum parathyroid hormone concentration
urinary calcium excretion
serum and urine protein electrophoresis
erythrocyte sedimentation rate
coeliac serology
serum testosterone concentration in men
serum follicle stimulating hormone and estradiol concentrations in women
24-hour urinary free cortisol test, overnight dexamethasone suppression test or late-night salivary free cortisol test.