Musculoskeletal Conditions

Question 1

What is osteoporosis? What T-score on a DEXA scan suggests osteoporosis?

Answer 1

• Reduced bone mass + altered microarchitecture of bone tissue leading to inc. bone fragility and therefore inc. fracture risk.
• DEXA scan T-score of -2.5 or lower.

Question 2

Osteoporosis RF?

Mnemonic: SHATTERED FAMILY

Answer 2

S – Steroid use
H – Hyperthyroidism, hyperparathyroidism
A – Alcohol and smoking
T – Thin (BMI<22)
T – Testosterone deficiency
E – Early menopause
R – Renal/liver failure
E – Erosive/inflammatory bone disease
D – Diabetes
FAMILY HISTORY

Question 3

Sx of osteoporosis

Answer 3

• Back pain
• Loss of height over time
• Stooped posture
• Bone fracture - occurs more easily than expected

Question 4

Ix for Osteoporosis?

Answer 4

• DEXA scan - GS
• X-rays
• Bloods - vit D, calcium, hormone levels

Question 5

A DEXA scan T-score of what would suggest:
1. Normal bone density
2. Osteopenia (low)
3. Osteoporosis

Answer 5

1. > -1.0
2. Between -1.0 and -2.5
3. < or equal to -2.5

Question 6

What’s the name of the scoring system used to estimate the 10-year probability of a major osteoporotic fracture and a score of what would suggest:
1. Normal bone density
2. Osteopenia (low)
3. Osteoporosis

Answer 6

FRAX (Fracture Risk Assessment Tool) score

1. Normal: 10-year probability <10%
2. Osteopenia (low bone density): 10-year probability 10-20%
3. Osteoporosis: 10-year probability >20%

Question 7

Mx of osteoporosis

Answer 7

Lifestyle:
* Dec. RF - quit smoking + improve diabetes
* Adequate intake of vit D, calcium and protein
* Regular wgt bearing exercise

Pharmacological:
* 1st line - bisphosphonates (indicated for pts that have osteopenia or osteoporosis)
* 2nd line - denosumab, raloxifene, HRT

Question 8

How should bisphosphonates be taken and what are it’s side effects?

Answer 8

How to take: Taken on an empty stomach, with a full glass of water, and the patient should remain upright for at least 30 minutes after ingestion.

Side effects:
* GI Sx (e.g. dyspepsia, oesophagitis)
* MSK pain

Question 9

What tool is used to assess frailty in elderly patients?

Answer 9

The Rockwood Frailty Score, a.k.a. the Clinical Frailty Scale (CFS)

1–3: Fit to managing well.
4–5: Vulnerable or mildly frail.
6–7: Moderately to severely frail, needing help with daily activities.
8–9: Very severely frail or approaching end of life.