Osteoporosis

Question 1

What acronym is used for RF of osteoporosis?

Answer 1

SHATTERED

Question 2

What are RF for osteoporosis?

Answer 2

1. Steroid use of >5mg/d of prednisolone
2. Hyperthyroidism, hyperparathyroidism, hypercalciuria
3. Alcohol and tobacco use
4. Thin BMI <18.5
5. Testosterone low
6. Early menopause
7. Renal or liver failure
8. Erosive/inflammatory bone disease
9. Dietary: low calcium/malabsorption, DMT1

Question 3

What is classic epid for osteoperosis?

Answer 3

• Female

- Old

Question 4

What are symptoms and signs of osteoperosis?

Answer 4

• Asymptomatic until fracture occurs
  1. Back pain
  2. Kyphosis
  3. Impaired vision
  4. Impaired gait, imbalance, and lower extremity weakness

Question 5

What are possible DDx of osteoperosis?

Answer 5

1. Multiple myeloma
2. Osteomalacia
3. CKD bone and mineral disorder
4. Primary hyperparathyroidism
5. Metastatic bone malignancy
6. Vertebral deformities

Question 6

What is the diagnosis of osteoporosis based on?

Answer 6

history of prior fragility fracture or low bone mineral density T score

Question 7

What imaging is done for osteoperosis?

Answer 7

• DXA

- X ray

Question 8

What would DXA show for osteoperosis?

Answer 8

1. T-score of ≤-2.5 indicates osteoporosis

2. T-score ≤-2.5 with fragility fracture(s) indicates severe (or established) osteoporosis

Question 9

What bloods are measured in osteoperosis?

Answer 9

1. Ca2+
2. PO43-
3. ALP

Question 10

What are the bloods like in osteoperosis?

Answer 10

all normal

Question 11

What would DEXA score of -1 to -2.5 suggest?

Answer 11

osteopenia, risk of later osteoperositc fracture, offer lifestyle advice

Question 12

What is the management for a post-menopausal women in osteoperosis?

Answer 12

1. 1st line: bisphosphonate e.g. alendronic acid: 10mg orally once daily
   Plus: calcium and vit D supplementation
2. 2nd line: denosumab 60mg sub every 6 months
3. 3rd line: parathyroid hormone agonist e.g. teriparatide 20mcg

Question 13

What is an example of bisphosphonate?

Answer 13

alendronic acid: 10mg orally once daily

Question 14

What is an example of parathyroid hormone agonist?

Answer 14

teriparatide 20mcg

Question 15

What other management is available for osteoporosis if these prior are not tolerated?

Answer 15

1st line: Selective oestrogen receptor modulator e.g. raloxifene 60mg orally once daily
Plus: calcium and vit D supplement
2nd line: HRT

Question 16

What is an example of a selective oestrogen receptor modulator?

Answer 16

raloxifene 60mg orally once daily

Question 17

What further management is available for osteoporosis?

Answer 17

1st line: intranasal calcitonin
2nd line: conjugated oestrogens
3rd line: romosozumab

Question 18

What are possible complications of osteoporosis?

Answer 18

1. Hip fractures
2. Rib fractures
3. Wrist fracture
4. Chronic pain syndrome
5. DVT with raloxifene treatment

Question 19

What is the deifniton of osteoperosis?

Answer 19

reduced bone density

Question 20

What are classic osteoperosis fracture types?

Answer 20

1. Hip – neck of femur (NOF)
2. Wrist – Colles’ fractures
3. Lumbar spine - vertebral wedge fractures
4. Shoulder - neck of humerus

Question 21

What does T score calculate?

Answer 21

Patient’s BMD compared to young, healthy adult

Question 22

What does Z score do?

Answer 22

Patient’s BMD compared to age-matched BMD

Question 23

What is DEXA used to calculate?

Answer 23

FRAX score:
10 year risk of developing fragility fractures
Which can help decide if Tx is required

Question 24

What does T score of -2.5 to -1 mean?

Answer 24

osteopenia