OP

Question 1

How is osteoporosis (OP) defined?

Answer 1

-Bone mineral density (BMD) ≤ -2.5
-clinical diagnosis if low-trauma fracture of hip, vertebra, or pelvis in individuals ≥40 years old
-an absolute risk ≥20%.

Question 2

What defines a fragility fracture?

Answer 2

A spontaneous fracture or a fracture following minor trauma, such as a fall from standing height.

Question 3

How can you assess for osteoporosis during a clinical exam?

Answer 3

1. Height loss >6 cm.
2. Kyphosis (>5 cm occiput-to-wall distance).
3. Perform the ‘Get up and go’ test.

Question 4

What are risk factors for osteoporosis requiring BMD assessment?

Answer 4

• Fragility fracture ≥40 years old.
• Prolonged glucocorticoid use (>3 months).
• ≥2 falls in the last year.
• Parental history of hip fracture.
• BMI <20.
• Current smoker.
• High alcohol use.
• Secondary OP (meds or medical disorders).
• Height loss >2 cm/year or >6 cm lifetime.
• Occiput-to-wall distance >5 cm.

Question 5

When should a BMD test be ordered?

Answer 5

• Age 50–64 years with ≥1 risk factor.
• Age 65–69 years with ≥1 risk factor.
• Age ≥70 years.

Question 6

What are the pharmacotherapy options for osteoporosis?

Answer 6

• Anabolic therapy: Romosozumab, Teriparatide.
• Antiresorptives: Bisphosphonates, Denosumab, Raloxifene (SERM).

Question 7

When should a patient with osteoporosis be referred to a specialist?

Answer 7

• Ongoing bone loss.
• Extremely low BMD.
• Long-term glucocorticoid use.

Question 8

What is the management for a patient with 10-year fracture risk <15% or T-score >-2.5?

Answer 8

• Do not start pharmacotherapy.
• Repeat BMD in 5–10 years if FRAX <10%.
• Repeat BMD in 5 years if FRAX is 10–15%.

Question 9

What is the management for a patient with 10-year fracture risk 15–19.9% or T-score between </= -2.5 and age <70 years?

Answer 9

• Order a lateral spine X-ray.
• Suggest pharmacotherapy.
• Reassess BMD in 3 years.

Question 10

What is the management for a patient with 10-year fracture risk ≥20%, T-score ≤-2.5 and age ≥70 years?

Answer 10

• Order a lateral spine X-ray.
• Start pharmacotherapy.
• Reassess BMD in 3 years.

Question 11

When should a drug holiday be considered in osteoporosis management?

Answer 11

After reassessment, consider a drug holiday 3 years after starting medication if fracture risk has stabilized.

Question 12

Define osteopenia

Answer 12

T-score between -1 to -2.5