Osteoporosis

Question 1

Why do menopausal women have increased risk of osteoporosis?

Answer 1

Because they lose oestrogen, which normally maintains bone function

Question 2

What T score on the DXA scan indicates osteoporosis?

Answer 2

< -2.5

Question 3

What are the risk factors of osteoporosis?

Answer 3

Female
Increasing age
Menopause
Drugs - steroids
Fragile people
Asians/Caucasians

Question 4

What are the investigations used to diagnose osteoporosis?

Answer 4

DXA (dual energy x-ray) scan to measure bone density
T score
X-ray

Question 5

What factors should you consider when assessing a person for osteoporosis?

Answer 5

Gender
Menopausal
Current medications
Age
Weight

Question 6

What is the FRAX tool?

Answer 6

Scoring system to assess the risk of a fracture within the next 10 years.

Question 7

What factors does the FRAX tool take into account?

Answer 7

Age/sex
BMI
Previous fractures
Smoking/alcohol
Current steroid treatment
Secondary causes

Question 8

How do bisphosphonates work?

Answer 8

They inhibit osteoclast activity, so less bone is shed

Question 9

What is the 1st line treatment of osteoporosis?

Answer 9

Oral bisphosphonates, which can include:
Alendronic acid 70mg weekly
Risedronate sodium 35mg weekly

Question 10

What are the 2 bisphosphonates which are available as injections, and when are they only given?

Answer 10

Ibandronic acid
Zoledronic acid
Only given annually if patients FRAX score is >10%

Question 11

Why cant Ca2+ be taken with alendronic acid?

Answer 11

Because it will bind to the Ca2+ and have no effect on bones, leading to no efficacy

Question 12

How should a patient take alendronic acid, and why?

Answer 12

Sitting upright with a full glass of water 30mins before breakfast, to avoid any oesophageal reactions.

Question 13

What do patients taking IV bisphosphonates/denusomab need?

Answer 13

Good dental/oral hygiene, to avoid osteonecrosis of the jaw.

Question 14

When should the use of bisphosphonates be reviewed?

Answer 14

Every 5 years.

Question 15

What can long-term use of bisphosphonates cause?

Answer 15

Osteonecrosis of the auditory ear canal

Question 16

What is the dosing of denusomab?

Answer 16

60mg every 6 months

Question 17

How does denusomab work?

Answer 17

It is a monoclonal antibody which inhibits osteoclast formation by binding to RANKL.

Question 18

When is denusomab used?

Answer 18

In post-menopausal women, if no other treatment has worked.

Question 19

What 2 substances can bind to osteoblasts, leading to increased bone formation?

Answer 19

Oestrogen and teriparatide

Question 20

What factors are taken into account when assessing which treatment a patient requires for their osteoporosis?

Answer 20

Age
Alcohol intake
RA
History of fractures
Other risk factors

Question 21

When is HRT used in osteoporosis?

Answer 21

In premature menopausal women, and stopped at the natural age of menopause

Question 22

What are the holiday periods for bisphosphonates to avoid atypical fractures?

Answer 22

Remember RAZ123

Risedronate sodium - 1 year
Alendronic acid - 2 years
Zoledronic acid - 3 years

Question 23

What is the 1st line treatment for osteoporosis in men?

Answer 23

Alendronic acid 70mg weekly, OR
Risedronate sodium 35mg weekly