Metabolic Bone Disease

Question 1

How do you investigate for osteoporosis?

Answer 1

Dexa bone scan

Question 2

What are some side effects of denosumab?

Answer 2

Osteonecrosis of the jaw

Hypocalcaemia

Immunosuppression

Question 3

What are some secondary causes of osteoporosis?

Answer 3

Cushing syndrome (rare) or exogenous corticosteroids (>5mg/day for >3months)

Excessive alcohol use

Smoking

Malabsorption

Primary or secondary hypogondaism (eg aromatase inhibitors)

Question 4

What are some risk factors for osteonecrosis of the jaw?

Answer 4

Poor dentition

Any dental procedures breaching the gum

Question 5

How long do you continue someone on bisphosphonates? Why stop?

Answer 5

5 years

Increased risk of atypical fractures

Question 6

What are some therapies for osteoporosis?

Answer 6

Bisphosphonates

Teriparatide (recombinant PTH, used in pulsatile manner for refractive osteoporosis)

Denosumab

HRT - Not used now due to increased CVD and cancer mortality

Raloxifene - selective estrogen receptor modulator (only works on vertebrae, increases clotting risk)

Question 7

What factors would you want to take on Hx in a ?osteoporotic fracture

Answer 7

Exercise levels

Smoking

Co-morbidities

Poor nutrition, life time low calcium intake

Vitamin D deficiency

Prolonged amenorrhoea in younger years

Age of menopause

Question 8

Which drugs can be used in stage 4 kidney disease?

Answer 8

Denosumab

Question 9

What is adynamic bone disease?

Answer 9

A state of stasis of bone metabolism - no osteoclastic or blastic activity

Question 10

How is the diagnosis of osteoporosis made?

Answer 10

Can be made clinically if low trauma fracture

Or dexa scan

Question 11

Which bisphosphonates are used in Australia? How are they administered?

Answer 11

Alendronate - Oral

Risedronate - Oral

Zoledronate - IV

Question 12

What is cholecalciferol?

Answer 12

An inactive form of Vitamin D that is converted to calcitriol in via hyroxylations in the liver and kidney. Calcitriol then directly acts on vitamin D receptors

Question 13

What is P1NP?

Answer 13

Procollagen type 1 propeptides - a bone turn over marker

Question 14

What are some bone turn over markers?

Answer 14

P1NP

CTX

Question 15

When is recombinant PTH (teriparatide) used?

Answer 15

Severe osteoporosis

T score = <-3

2 Minimal fractures

1 fracture despite 12 months of anti-resorptive therapy

Or

Intolerance to oral or IV bisphonates

Question 16

How must oral bisphosphonates be administered?

Answer 16

With the patient sitting up and staying like that for an hour

No other food for 30 minutes