Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Skeletal condition characterised by low bone mass, deterioration of bone tissue and disruption of bone architecture which leads to reduced bone strength and increased fracture risk

Question 2

What are non-modifiable risk factors for osteoporosis?

Answer 2

• Age over 65 years
• Female gender
• Caucasian or South Asian
• Family history of osteoporosis
• History of low trauma fracture

Question 3

What are modifiable risk factors for osteoporosis?

Answer 3

• low body weight (BMI below 21)
• early menopause
• calcium/vit d deficiency
• inadequate physical activity
• cigarette smoking
• excessive alcohol intake (more than 3 drinks a day)
• corticosteroids, aromatase inhibitors (iatrogenic)

Question 4

How is a diagnosis of osteoporosis made?

Answer 4

• DEXA scan of lumbar spine and hip
• T-score (number of SDs from the mean bone density of persons of same gender at age of peak density (25 years) score of minus 2.5 or less means osteoporosis)

Question 5

What is the treatment for osteoporosis?

Answer 5

If osteopenia - focus on modification e.g. weight bearing exercise, vitamin D3 supplementation, limit alcohol, stop smoking and dietary advice esp related to calcium

If osteoporosis - Vitamin D and calcium supplementation and oral bisphosphonates (IV if needed) 1st line and denosumab or teriparatide 2nd line

Question 6

What are secondary causes of osteoporosis?

Answer 6

• Coeliac disease
• Eating disorders
• Hyperparathyroidism
• Hyperthyroidism
• Multiple myeloma