Osteoporosis

Question 1

What is it?

Answer 1

Reduced bone mineral density and microarchitectural deterioration of bone

Leads to increased bone fragility and increased risk of fracture

Question 2

What is the pathophysiology?

Answer 2

Bone mass increases during childhood and reaches a peak at 30’s before declining

Women have accelerated loss of bone density post menopausally due to lack of oestrogen

Question 3

What are the risk factors?

Answer 3

Age
Female
Genetics
RA/seronegative spondyloarthropathy
Previous fracture
Immobility
Smoking
Alcohol misuse
Liver disease
Systemic steroid use

Question 4

What are causes of secondary osteoporosis?

Answer 4

Primary hyperparathyroidism

Thyrotoxicosis

Steroid induced
-related to dose and duration

Cushings

Anorexia Nervosa

Malabsorptive conditions

Chronic inflammatory disease

Question 5

What are the symptoms?

Answer 5

Often asymptomatic
Fragility fractures
-wrist
-NOF
-Spine

Back pain
Height loss
Kyphosis

Question 6

What investigations are needed?

Answer 6

Bloods- underlying cause

• TFTs
• calcium
• PTH
• Sex hormones
• Phosphate
• ESR
• VitD

DEXA Scan

• to determine bone density
• > 2.5 standard deviations from a healthy patient (T score)= osteoporosis
• between 1 and 2.5= osteopenia
• numbers are negative

Question 7

What is the conservative management?

Answer 7

Conservative

• improve calcium intake
• weight bearing exercises
• smoking cessation
• decreased alcohol intake

Question 8

What is the medical management?

Answer 8

Bisphosphonates (1st line)

• causes death of osteoclasts
• Alendronic Acid
• -must sit upright for 30 mins post taking it
• -can cause atypical fractures and osteonecrosis of jaw
• Zolendronic acid IV once yrly- often in hospital

Selective oestrogen receptor modulator

• for younger women
• oestrogen mimicking effects on bone
• causes hot flushes, leg cramps and blood clots

Denosumab

• inhibits osteoclasts
• SC injection once every 6 months
• causes hypocalcaemia and cellulitis

Teriparatide

• promotes new bone growth
• Cause arthralgia, headache, dizziness and depression
• daily SC injection

Question 9

What screening is in place for osteoporosis?

Answer 9

FRAX tool to assess risk of fragility fracture

• women >65
• men >75

Gives a risk level

• low=reassure
• intermediate= offer dexa scan and use result to determine if tx needed
• high= treatment