Osteoporosis

Question 1

What is the definition of osteoporosis?

Answer 1

Decreased bone density by 2.5+ SD below young adult mean value (T<-2.5)

Question 2

It is low ? Not ?

Answer 2

Low density Not mineralisation (this is osteomalacia)

Question 3

What is the pathology?

Answer 3

Low bone density = high resorption > formation

Question 4

What is the typical Px?

Answer 4

50+ post menopausal caucasian women

Question 5

What are the RF for osteoporosis ?

Answer 5

SHATTERED
Steroids
Hyperthyroid/parathyroid
Alcohol/smoking
Thin (low BMI)
Testosterone low
Early menopause (low oestrogen)
Renal/liver failure
Erosive + inflammation disease
Dmti or malabsorption

Question 6

Sx of osteoporosis

Answer 6

Only fractures

fragility fractures, proximal femur falls
Colles’ (forked wrist, fall on outstretched wrist)
Compression/vertebral crush (may cause kyphosis/widow stoop)

Question 7

Dx of osteoporosis

Answer 7

DEXA scan
Dual energy Xray absorptiometry - tests bone density
Yields T score (compares Px BMD to reference)

Also FRAX score (fracture risk assessment tool –> access 10 year fracture risk in osteoporotic Px)

Question 8

Decribe the T score and different values

Answer 8

T score = Young adult bone density
0<T<1 - Normal within 1SD
-1<T<-2.5 = low BMD, osteopenia (precursor to osteoporosis)
T<-2.5 = BMD 2.5+ Sis below normal young adult = OSTEOPOROTIC

Question 9

Treatment for Osteoporosis

Answer 9

1. Bisphosphonates (Alendronate, risedronate)
2. mAB denosumab (monoclonal Ab) - Inhibit Rank L therefore osteoclasts
   HRT
   Oestrogen receptor modulator - Raloxifene
   Recombinant PTH - Tenparatide

Question 10

How do bisphosphonates work?
What Is their side effect?

Answer 10

Inhibit RANK L signalling therefore osteoclast inhibitors

SE = Reflux

Question 11

What advice is used for taking alendronates?

Answer 11

Taken first thing
Empty stomach
Upright 30 mins after taking