NOF

Question 1

Risk factors

Answer 1

• Chronic vitamin D deficency
• poor calcium intake
• menopause
• smoking
• alcohol
• prev. fragility fracture
• low BMI

Question 2

consequences of long lie

Answer 2

• pain
• dehydration
• delirium
• muscle wasting (rhabdomyolysis)

Question 3

presentation of NOF

Answer 3

• externally rotated shortened leg
• pain
• pt may be confused
• hx of trauma (may be minor)

Question 4

Management

Answer 4

• analgesia, fluids
• identify infection
• if medically stable operate within 48hrs

Question 5

Next steps (post surgery) in managing these patients

Answer 5

• rehab: physio, exercises etc
• discharge planning
• falls assessment
• osteoporosis assessment

Question 6

Preventative measures

Answer 6

• calcium and vitamin D
• oral bisphosphonaes
  (other methods: strontium, teraparatide, SERMS)

Question 7

NICE recommendations for bisphosphonates in women

Answer 7

1. women >75 w/o DEXA scan

2. women 65-74 with a fracture need DEXA scan- if T

Question 8

points to consider before prescribing bisphosphonates

Answer 8

• previous hx of GI bleeds/ulcers
• eGFR >35
• cognitive impairment?/
• if stop/miss dose can worsen bone density
• must have normal calcium (can cause hypocalcaemia)