Osteoporosis

Question 1

Typical patient

Answer 1

Women over 65, underweight, low physical activity

Question 2

Pathophysiology

Answer 2

Skeletal condition resulting in:
1. Reduced bone density
2. Disrupted bone architecture
3. Reduced bone strength
4. Increased risk of fracture

Question 3

Risk factors

Answer 3

Female
FHx
Over 65
Early menopause
Smoking
Alcohol
Low BMI (<21)
Low vitamin D/ Calcium
Corticosteroids

Question 4

Risk factors

Answer 4

Female
FHx
Over 65
Early menopause
Smoking
Alcohol
Low BMI (<21)
Low vitamin D/ Calcium
Corticosteroids

Question 5

Investigations

Answer 5

DEXA Scan
Investigate secondary causes: TFT, FBC

Question 6

Scoring tools

Answer 6

T Score: Bone density compared to same gender at age 25.
Less than -1: Normal
-1 to -2.5: Osteopenia
Less than -2.5: Osteoporosis

Z Score: Bone density compared to same age and gender.
Less than -2: Secondary cause likely.

Question 7

Secondary Causes

Answer 7

Hyperthyroidism
Hyperparathyroidism
Eating disorders
Multiple Myeloma

Question 8

Osteopenia treatment

Answer 8

1. Weight baring exercise
2. Stop smoking
3. Reduce alcohol intake
4. Vitamin D supplement (If required)
5. Encourage increasing calcium intake.

Question 9

Osteoporosis treatment

Answer 9

1. Vitamin D supplement
2. Calcium Supplement
3. Bisphosphonates (Alendronic acid)
4. Denosumab

Question 10

Oral bisphosphonate instructions

Answer 10

1. Eat on empty stomach
2. Drink full glass of water
3. Do not eat for 30min - 2hrs after taking
4. Sit up for 30 mins after taking
5. Take separately from other medication

If not tolerated orally (Nausea ,Heartburn, difficulty swallowing) Give IV.