Mini Symposium: Osteoporosis And Metabolic Bone Disease

Question 1

What is the definition of osteoporosis?

Answer 1

Metabolic bone disease characterised by: low bone mass, microarchitectural deterioration of bone tissue. Leads to enhanced bone fragility and a consequent increase in fracture risk.

Question 2

What is the role of falls, trauma and osteoporosis in causing fractures?

Answer 2

X

Question 3

What is the epidemiology of fractures in older men and women?

Answer 3

1 in 2 >50yo women will have fracture before dying
1 in 5 >50yo men will have fracture
50yo women has lifetime risk of 17% of hip fractures

Question 4

What investigations are undertaken to confirm osteoporosis?

Answer 4

X

Question 5

What types of drugs are used to prevent and treat osteoporosis?

Answer 5

Prevention: minimise risk factors, good calcium and vitamin D status, falls prevention strategies, medications
Treatment:
BMD measurement
- normal = reassure, lifestyle advice
- osteopenia = lifestyle advice, treat if previous fracture
- osteoporosis = lifestyle advice, offer treatment

Oral biphosphonate generally the first line of treatment
Denosumab (monoclonal antibody) safer for those with renal impairment

Question 6

What is the outcome of osteoporosis in terms of quality of life and long term mobility?

Answer 6

X

Question 7

How is calcium and vitamin D metabolised?

Answer 7

Vitamin D stimulates the absorption of calcium and phosphate from the gut and calcium and phosphate the become available for bone mineralisation

Question 8

What is the pathogenesis of osteomalacia?

Answer 8

Severe nutritional vitamin D or calcium deficiency causes insufficient mineralisation and so rickets in children and osteomalacia in adults when epiphyseal lines are closed

Question 9

What investigations are used to confirm osteomalacia?

Answer 9

Blood tests 
- calcium
- phosphorus 
- vitamin D
- alkaline phosphatase 
X-ray

Question 10

What are the clinical features of osteomalacia and rickets?

Answer 10

Bone pain
Skeletal deformities
Dental problems 
Poor growth and development (rickets) 
Fragile bones (can lead to fractures)

Question 11

What are the biochemical and radiological abnormalities of osteomalacia?

Answer 11

X

Question 12

What is the differential diagnosis of osteomalacia?

Answer 12

Osteoporosis
Paget’s disease
Fibromyalgia
Cancer

Question 13

How is osteomalacia prevented and treated?

Answer 13

Correct vitamin D imbalance
Corrective surgery
Balanced diet
Time in the sun
Vitamin D supplement

Question 14

What is the epidemiology of Paget’s disease?

Answer 14

Paget’s has a strong genetic component and affects those of Anglo Saxon origin

Question 15

What causes Paget’s disease?

Answer 15

Localised disorder of bone turnover (increased bone resorption followed by increased bone formation) which leads to disorganised bone which is bigger, less compact, more vascular and more susceptible to deformity and fracture

Question 16

What are the clinical features of Paget’s disease?

Answer 16

Symptoms: >40yo, bone pain which is deep seated and constant, occasionally presents with bone deformity, excessive heat over the pagetic bone or by neurological complications such as nerve deafness.

Presentation: isolated elevation of serum alkaline phosphatase, bone pain and local heat, bone deformity or fracture, hearing loss

Question 17

What investigations are undertaken to confirm Paget’s disease and how are they different to other metabolic bone diseases?

Answer 17

X-ray
Bloods for serum alkaline phosphatase
Bone scan
Bone biopsy
Urine test (response to treatment)

Question 18

How is Paget’s disease managed?

Answer 18

Intravenous bisphosphonate therapy

- one off IV zoledronic acid