Osteoporosis

Question 1

What are the two unique characteristics of osteoporosis

Answer 1

Low bone density and micro-architectural defects in bone tissue

Question 2

What is th result of low bone density and micro-architectural defects in bone tissue

[characteristics of osteoporosis]

Answer 2

Increased bone fragility and susceptibility to fragility fractures

Question 3

Define osteopenia

Answer 3

Less severe reduction in bone density than osteoporosis (-1 to -2.5 T score)

Question 4

Define fragility fracture

Answer 4

A fracture following a fall from standing height or less

Question 5

What are the two main risk factors for osteoporosis

Answer 5

Age and female sex

Question 6

Age is a risk factor for osteoporosis, but it is different between genders.

What age is a risk factor for males and females

Answer 6

> 50 for women

> 65 for men

Question 7

Age and female gender is the two main risk factors for osteoporosis.

Name furthur risk factors

Answer 7

“SHATTERED FAMILY”

S – Steroid use

H – Hyperthyroidism, hyperparathyroidism

A – Alcohol and smoking

T – Thin (low BMI)

T – Testosterone deficiency

E – Early menopause

R – Renal/liver failure

E – Erosive/inflammatory bone disease

D – Diabetes

Family history

Question 8

What are the clinical features of osteoporosis

Answer 8

With the exception of fracture, osteoporosis is an asymptomatic condition.

Question 9

What are the 3 most common places to get a fragility fracture

Answer 9

Wrist

Spine

Hip

Question 10

What is FRAX or QFracture

Answer 10

Screening tool for osteoporosis

Assesses the 10-year risk of a patient developing a fragility fracture

Question 11

What is the name of the screening tool used in osteoporosis to assess the 10-year risk of a patient developing a fragility fracture

Answer 11

FRAX or QFracture

Question 12

FRAX or QFracture is the screening tool used in osteoporosis to assess the 10-year risk of a patient developing a fragility fracture. It categories patients into three groups based on their risk.

Name these groups

Answer 12

high, intermediate and low risk

The scan is not mandatory and clinicians may proceed straight to DXA scan

Question 13

What is the gold standard investigation used in osteoporosis

Answer 13

DXA scan (dual energy x-ray absorptiometry)

Question 14

What is a DXA scan

Answer 14

X-ray scan used to measure bone mineral density

Gold standard investigation for osteoporosis/osteopenia

Question 15

DXA Scan is used at the gold standard investigation for osteoporosis. Where in the body is it usually done on?

Answer 15

Hip

Question 16

DXA Scan is used at the gold standard investigation for osteoporosis. The result is represented as a T score.

What is the T score

Answer 16

The number of standard deviations below the mean for a healthy young adult their bone density is

Question 17

DXA scan is used as the gold standard investigation for osteoporosis.

What is the T score for osteoporosis

Answer 17

< - 2.5

Question 18

DXA scan is used as the gold standard investigation for osteoporosis.

What is the T score for osteopenia

Answer 18

Between -1 and -2.5

Question 19

What is the goal of osteoporosis management

Answer 19

Preventation of fragility fractures

Question 20

Osteoporosis managed with a combination of lifestyle changes and pharmacological treatment.

Name some lifestyle changes

Answer 20

Adequate calcium and vitamin D intake (can be given supplementation)

Weight-bearing exercise to maintain bone strength

Question 21

Osteoporosis managed with a combination of lifestyle changes and pharmacological treatment.

What is the 1st line pharmacological used in osteoporosis management

Answer 21

Oral Bisphosphonates

Question 22

Oral bisphosphonates is the 1st line pharmacological used in osteoporosis management.

Describe bisphosphonates mechanism of action

Answer 22

Interfere with osteoclasts reducing their activity and thus inhibits bone resorption

Question 23

Oral bisphosphonates is the 1st line pharmacological used in osteoporosis management.

Name some side effects of bisphosphonates

Answer 23

GI disturbance

Oesophagitis

Atypical femoral fractures

Question 24

Osteoporosis managed with a combination of lifestyle changes and pharmacological treatment.

What is the 2nd line pharmacological used in osteoporosis management

Answer 24

Denosumab

Question 25

Denosumab is the 2nd line pharmacological used in osteoporosis management.

Describe denosumab mechanism of action

Answer 25

Monoclonal antibody that blocks the activity of osteoclasts

Question 26

Denosumab is the 2nd line pharmacological used in osteoporosis management.

Name a side effect of denosumab

Answer 26

Cellulitis

Question 27

Oral bisphosphonates and denosumab are the 1st and 2nd line therapy in the pharmacological management of osteoporosis.

What other drugs can be used

Answer 27

Raloxifene

Hormone replacement therapy (in women with premature menopause)

Question 28

Raloxifene can be used as an additional therapy in managing osteoporosis.

What is its mechanism of action

Answer 28

Binds to oestrogen receptors and exerts same protective action that oestrogen performs on bones by inhibiting osteoclastic action

Question 29

Raloxifene is an additional therapy in the pharmacological management of osteoporosis.

In what patient group is it most useful in

Answer 29

Post-menopausal women