Osteoporosis

Question 1

OVERVIEW
i) what is it? how does it differ from osteopenia?
ii) how do the bones appear in osteoporosis?
iii) name four RF? long term use of which drugs can cause it?
iv) which key group of people should OP be considered in? why?

Answer 1

i) reduced bone density
osteopenia is a less severe reduction in bone density
ii) reduced BMD causes bones to be less strong and more prone to fractures
iii) older age, female, reduced mobility, low BMI, RA, ETOH, smoking
long term corticosteroids ( more than 7.5mg of pred per day for more than 3m)
iv) post menopausal women as oestrogen is protective against oporosis

Question 2

TOOLS
i) what does the FRAX tool predict? when is it done? what two outputs does it have?
ii) how is bone mineral density measured? how do they work? which score is produced and what does each mean
iii) which location is most important to measure BMD at? why?

Answer 2

i) FRAX predicts the risk of a fragility fracture over the next 10 years - first step in assess risk of OP
gives results as a % 10 year probability of a major osteoporotic fracture or a hip fracture
ii) measure BMD with a DEXA scan - look how much radiation is absorbed by the bones indicating how dense the bone is
can be done anywhere but need to do the hip
BMD can be repres as Z score or T score (how many SD BMD falls below the mean for their age)
T score = number of SD below the mean for a healthy young adult
iii) most important to meas BMD and T score at the HIP as it is used in WHO classification of OP

Question 3

OSTEOPOROSIS ASSESMENT
i) over what age in women and men should a FRAX assess be performed on? when may it be done on a younger person? (4)
ii) what three outomes are there for patients that have had FRAX but not a DEXA scan?
iii) what are the two outcomes for patients with a FRAX outcome and a DEXA outcome?

Answer 3

i) women >65yrs and men >75yrs
younger if previous fragility fracture, hx of falls, low BMI, long term steroids, endo disorders, RA
ii) low risk - reassure
intermed risk - offer DEXA and re calc risk
high risk - offer tx
iii) treat or lifestyle advice/reassure

Question 4

OSTEOPOROSIS MX
i) name five lifestyle changes
ii) which two supplements are recommended for patients at risk of fragility fractures? name an example of what can be given
iii) what is the first line treatment? how do they work?
iv) name three key SE of the above drug/?
v) what can be given if these are CI or not working? (MAB)

Answer 4

i) activity and exercise, maint healthy weight, calcium/vit D intake, avoid falls, stop smoking, reduced ETOH
ii) supplement with calcium and vit D eg calcichew D3
iii) bisphosphonates are first line (alendronate) - interfere with osteoclasts and reduce their activity to prevent resorption of bone
iv) SE of BP are reflux and oes erosions (take on empty stomach sitting up)
atypical fractures eg femoral
osteonecrosis of the jaw
osteonecrosis of ext aud canal
v) can also give denosumab (blocks OCs)