Osteoporosis

Question 1

What are some properties/features of osteoporosis?

Answer 1

1. Low bone density
2. Impaired bone architecture
3. Compromised bone strength

Question 2

Osteoporosis increases risk of ______

Answer 2

Fracture
- Require hospitalisation –> further morbidity / mortality due to prolonged immobilisation
- May not return to previous functional status, require long term care

Question 3

What is the WHO diagnosis classification of osteoporosis?

Answer 3

Bone mineral density at hip/ lumbar spine >= 2.5 standard deviations below the mean BMD of a young adult reference population (T score)

Question 4

Most common sites of osteoporosis

Answer 4

• Hip (proximal femur)
• Spine (vertebrae)
• Wrist

Question 5

What is the process of bone remodelling?

Answer 5

Older bone is periodically resorbed by OSTEOCLASTS at discrete sites and replaced with new bone made by OSTEOBLASTS

Question 6

What happens to the levels of osteoclasts and osteoblasts in someone with osteoporosis?

Answer 6

• Oversupply of osteoclasts relative to the need for remodeling or
• Undersupply of osteoblasts relative to the need for cavity repair

Question 7

What happens to serum minerals in someone with osteoporosis?

Answer 7

Calcium and phosphorus are withdrawn from skeletal stores if they are inadequate in the body. Continued removal of bone tissue over time degrades skeletal architecture and elevates risk for fractures.

Question 8

When does the bone mass peak?

Answer 8

Early 20s, high peak bone mass protects against osteoporosis later in life

Question 9

Which age/gender should be evaluated for osteoporosis risk to determine the need for BMD testing and/or vertebral imaging?

Answer 9

• ALL postmenopausal women
• Men aged 50 yo and older

Question 10

What are the risk factors for a fall?

Answer 10

• Environmental (e.g. dim lighting, slippery floor, obstacles in stairs, lack of assistive devices in bathrooms)
• Psychological (anxiety, agitation, depression, lowered cognitive acuity, fear of falling)
• Advanced age
• Neurological and musculoskeletal/ other medical conditions
• Medications
• Lifestyle

Question 11

What are some lifestyle risk factors for OP?

Answer 11

1. Alcohol >= 3 drinks/day
2. Low BMI
3. Excess Vitamin A
4. Frequent falls
5. High salt intake
6. Sedentary lifestyle/ immobility
7. Low Ca intake
8. Vit D insufficiency
9. Smoking (active/ passive)

Question 12

What are some lifestyle risk factors for falls?

Answer 12

1. Alcohol >= 3 drinks/day
2. Low BMI
3. Excess Vitamin A
4. Frequent falls

Question 13

What are some medical conditions risk factors for OP?

Answer 13

1. Genetic diseases (e.g. Cystic fibrosis)
2. Hypogonadal states (e.g. Hyperprolactinemia)
3. Endocrine disorders (e.g. Cushing’s syndrome)
4. GI disorders (e.g. IBD)
5. Hematologic disorders (e.g. Sickle cell disease)
6. Rheumatologic and autoimmune diseases (e.g. RA)
7. Neurological and musculoskeletal risk factors (e.g. Parkinson’s disease)
8. Miscellaneous conditions and disease (e.g. ESRD, CHF, HIV, AIDS)

Question 14

What are some medications risk factors for OP?

Answer 14

1. Aluminium (in antacids)
2. Anticoagulants (Heparin)
3. Anticonvulsants
4. Aromatase inhibitors
5. Barbiturates
6. Cancer chemo drugs
7. Glucocorticoids (>= 5mg/day prednisolone for >= 3 months)
8. GnRH agonists
9. Lithium, Cyclosporine A, Tacrolimus
10. MTX
11. Parenteral nutrition
12. PPI
13. SSRIs
14. Tamoxifen (pre-menopausal use)
15. TZDs
16. Thyroid hormones (in excess)