Osteoporosis

Question 1

what is osteoporosis?

Answer 1

reduction in density of bones

Question 2

osteopenia?

Answer 2

less severe reduction in bone density

Question 3

risk factors for osteoporosis?

Answer 3

older age, female, reduced mobility and activity, low BMI, Rheumatoid arthritis, alcohol/smoking, long term corticosteroids (reduced ability to absorb calcium),SSRIs, PPIs, antiepileptics and anti oestrogens

Question 4

how to predict risk of fragility fracture over next 10 years?

Answer 4

FRAX tool

Question 5

what is T score?

Answer 5

DEXA scan- number of standard deviation below the mean for a healthy young adult their bone density is.

Question 6

T score at hip?

Answer 6

more than -1 = normal
-1 to -2.5 = osteopenia
less than -2.5 = osteoporosis

Question 7

first line treatment of osteoporosis?

Answer 7

bisphosphonates

Question 8

how do bisphosphonates work?

Answer 8

reducing osteoclast activity preventing reabsorption of bone.

Question 9

side effects of bisphosphonates?

Answer 9

reflus/oesophageal erosions, so sit upright for 30 minutes after taking on empty stomach
atypical fractures
osteonecrosis of jaw
osteonecrosisof auditory canal

Question 10

examples of bisphosphonate?

Answer 10

alendronate 70mg once weekly
risedronate 35 mg once weekly
zolendronic acid 5mg once yearly iv

Question 11

alternatives to bisphosphonates?

Answer 11

1. denosumab- blocking activity of osteoclasts
2. strontium ranelate- similar to ca stimulates osteoblasts and blocks osteoclasts but increases rism of DVT, PE and MI
3. Raloxifene- prevention. selective oestrogen receptor modulator stimulates oestrogen receptors on bone
4. HRT

Question 12

patients on bisphosphonates should?

Answer 12

repeat FRAX and DEXA scan after 3-5 years and a treatment holiday if bone mineral density has improved (18 months-3 years)

Question 13

patients over 75 with a fragility fracture are assumed?

Answer 13

to have osteoporosis without a DEXA scan

Question 14

if patients are less than 75 then?

Answer 14

DEXA scan should be arranged

Question 15

diference in T and Z score?

Answer 15

T- based on bone mass of young reference population
Z- adjusted for age gender and ethnic factors

Question 16

risk of osteporosis rises significantly if a patient is taking?

Answer 16

equivalent of prednisolone 7.5mg a day for 3 months or more

Question 17

management of patients with corticosteroid induced osteoporosis?

Answer 17

greater than 0- reassure
0–1.5- repeat dexa 1-3 years
less than -1.5- bone protection

Question 18

why cant 25% patients tolerate alendronate?

Answer 18

upper GI problems

Question 19

strontium ranelate can cause?

Answer 19

skin reaction (stevens johnson syndrome), increased thromboembolic events, cardiovascular disease

Question 20

how does denosumab work?

Answer 20

inhibits RANK ligand which inhibts maturation of osteoclasts
given as single injection subcut every 6 months

Question 21

What does teriparatide do?

Answer 21

increases bone mineral density