osteoporosis

Question 1

what is osteoporosis

Answer 1

a progressive bone disease where a person has low bone mass ( measured by bone mineral density (BMD), and deterioration of bone tissue)

Question 2

what is a fragility fracture in osteoporosis

Answer 2

fractures resulting from low-level trauma

Question 3

when is osteoporosis considered severe

Answer 3

if there have been one or more fragility fractures

Question 4

what lifestyle changes can be used to manage osteoporosis

Answer 4

• increase level of physical activity
• stop smoking
• maintain a normal BMI level (between 20–25 kg/m²)
• reduce alcohol intake
• ensure an adequate intake of calcium and vitamin D (may need supplements)

note: aim of treatment is to improve their bone health and reduce the risk of fragility fractures

Question 5

what are the first line treatments for all types of osteoporosis ( Postmenopausal osteoporosis, Glucocorticoid-induced osteoporosis +Osteoporosis in men)

Answer 5

first line: oral bisphosphonates- Alendronic acid or Risedronate sodium

alternatives:
- ibandronic acid/ denosumab/ strontium
Hormone replacement therapy (HRT) - only in younger postmenopausal women

Question 6

which patient groups have a higher risk of osteoporosis

Answer 6

higher risk of osteoporosis in:

• postmenopausal women
• men over 50 years
• patients taking long-term oral corticosteroids (glucocorticoids)

Question 7

describe what is bone-protection treatment

Answer 7

Glucocorticoid treatment is strongly associated with bone loss and increased risk of fractures.

Bone-protection treatment should be started at the onset of glucocorticoid treatment in patients who are at high risk of a fracture to reduce bone loss

Question 8

which symptoms should patients report whilst taking bisphosphonates that may indicate atypical femoral fractures

Answer 8

Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate

*bisphosphonates = alendronic acid , Risedronate sodium, zoledronate *

Question 9

what is the risk associated with intravenous bisphosphonates

Answer 9

risk of osteonecrosis of the jaw

Patients should also maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms such as dental mobility, pain, or swelling, non-healing sores or discharge to a doctor and dentist during treatment.

*bisphosphonates = alendronic acid , Risedronate sodium, zoledronate *

Question 10

why should patients report any ear pain, discharge from the ear, or an ear infection during treatment with a bisphosphonate

Answer 10

because osteonecrosis of the external auditory canal has been reported whilst taking bisphosphonates.

This is rare + is associated with long-term therapy (2 years or longer).

*bisphosphonates = alendronic acid , Risedronate sodium, zoledronate *

Question 11

what should a patient taking alendronic acid do if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

Answer 11

stop taking the tablets and to seek medical attention

• Severe oesophageal reactions (oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal erosions) have been reported in patients taking alendronic acid

Question 12

how should alendronic acid be taken

Answer 12

• taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine)
• patient should stand or sit upright for at least 30 minutes after administration.