[Geriatrics] Osteoporosis

Question 1

what is osteoporosis characterised by?

Answer 1

low bone mass and structural deterioration of bone tissue

Question 2

what does osteoporosis result in?

Answer 2

increased bone fragility and susceptibility to fractures

Question 3

osteoporotic fractures are usually low impact and what do they affect?

Answer 3

• hip (neck of femur)
• vertebrae (compression fracture)
• wrist (Colles’ fracture)

Question 4

what is the WHO definition for osteoporosis?

Answer 4

bone mineral density of 2.5 standard deviations below the mean peak mass

Question 5

what is the 1st line ix for osteoporosis?

Answer 5

DEXA scan

Question 6

how is a DEXA scan reported?

Answer 6

as a score:

T-score = BMD compared to young adult

Z-score = BMD compared to age matched individual

Question 7

what DEXA scan score should prompt further ix?

Answer 7

-2

Question 8

risk factors for osteoporosis: age

Answer 8

all women >65 years

men >75 years

Question 9

risk factors for osteoporosis: >50 years + risk factors

Answer 9

• past fragility fracture
• use of steroids
• smoker / high alcohol intake
• low BMI
• endocrine conditions / chronic illness (i.e. CKD / COPD / chronic liver disease)

Question 10

risk factors for osteoporosis: <50 years

Answer 10

• past fragility fracture

- use of steroids

Question 11

for pts with risk factors for osteoporosis, what should be done next?

Answer 11

calculate “Q-Fracture” or “FRAX” score

Question 12

when do you arrange a DEXA scan?

Answer 12

if:

1. high fracture risk (≥10% using QFracture risk or FRAX red zone)
2. intermediate risk (8-10% QFracture or FRAX orange zone) + risk factors

Question 13

what does a DEXA score of 0 to -2.5 mean?

Answer 13

osteopenia

Question 14

how do you manage a pt with osteopenia?

Answer 14

• lifestyle advice
• regular exercise
• reduce alcohol
• balanced diet
• treat underlying causes

Question 15

when should you repeat DEXA for a pt with osteopenia?

Answer 15

at 2 years

Question 16

what does a DEXA score of

Answer 16

osteoporosis

Question 17

how do you manage a pt with osteoporosis?

Answer 17

1st line: bisphosphonates (oral) e.g. alendronic acid 10mg OD or 70mg once weekly

replace vitamin D (if inadequate sunlight exposure) and calcium (if inadequate intake)

Question 18

when should you repeat DEXA for a pt with osteopenia?

Answer 18

review Rx every 3-5 years

Question 19

what can be trialled if pt cannot tolerate 1st line Rx for osteoporosis?

Answer 19

IV bisphosphonates, denosumab, raloxifene and teriparatide

Question 20

what should be discussed in women with premature menopause?

Answer 20

hormone replacement therapy (HRT)

Question 21

osteoporosis vs osteopenia: bone mass

Answer 21

osteoporosis - reduced

osteopenia - normal

Question 22

osteoporosis vs osteopenia: bone mineral density

Answer 22

osteoporosis - reduced

osteopenia - may be reduced

Question 23

osteoporosis vs osteopenia: symptoms

Answer 23

both: asx, fractures, bone pain

Question 24

osteoporosis vs osteopenia: pt demographic

Answer 24

osteoporosis - post-menopausal women, chronic steroid use, older age

osteopenia - people with little sunlight exposure, disorders causing hypophosphatemia

Question 25

what blood results can you see in osteoporosis?

Answer 25

normal calcium, phosphate and ALP

Question 26

what blood results can you see in osteopenia?

Answer 26

reduced calcium, phosphate and vitamin D

elevated ALP

Question 27

bisphosphonate use, jaw pain and swelling. dx?

Answer 27

osteonecrosis of the jaw

Question 28

fall onto outstretched hand and “dinner fork deformity”. dx?

Answer 28

Colles’ fracture

Question 29

normal serum calcium and phosphate, with elevated ALP. dx?

Answer 29

Paget’s disease of the bone