Osteoporosis

Question 1

What are the risk factors for osteoporosis?

Answer 1

Age > 50y
Female Sex

SHATTERED FAMILY
S - Steroid use
H - Hyperthyroidism and hyperparathyroidism
A - Alcohol and smoking
T - Thin (BMI < 22)
T - Testosterone deficiency
E - Early menopause
R - Renal/liver failure
E - Erosive/inflammatory bone disease
D - Diabetes
FAMILY history

Question 2

What are some medications which can worsen osteoporosis?

Answer 2

SSRI, antiepileptics, PPIs, glitazones, long term heparin, aromatase inhibitors

Question 3

What are investigations to exclude osteoporosis mimics?

Answer 3

FBC, UEs, LFTs, Bone profile, CRP, TFTs, Vitamin D levels, Urinary free cortisol, testosterone and Bence-jones protein

Question 4

What are investigations to exclude osteoporosis mimics?

Answer 4

FBC, UEs, LFTs, Bone profile, CRP, TFTs, Vitamin D levels, Urinary free cortisol, testosterone and Bence-jones protein

Question 5

What are the investigations to confirm osteoporosis?

Answer 5

• DEXA scan (gold standard). Measures absorption of X ray by the bone
• X-rays if fractures are suspected
• MRI spine to look for vertebral fractures

Question 6

What are the T and Z scores?

Answer 6

T score - Based on bone mass of young reference population. Less than -2.5 is diagnostic of osteoporosis. A score of -1.0 to -2.5 indicates osteopenia
Z-score is adjusted for age, gender and ethnic factors.

Question 7

What are some scoring systems to assess 10 year fracture risk?

Answer 7

FRAX or Qfracture

Question 8

What are the lifestyle advice for osteoporosis?

Answer 8

• Reduce risk factors eg, smoking and poor diabetic control.
• Diet (adequate vit D, calcium and protein)
• Regular weight bearing exercise

Question 9

What are the first line treatments for osteoporosis

Answer 9

Bisphosphonates (alendronic acid, risedronate).
Patient needs to sit up for at least 30mins after taking drug.
Can add calcium and vitamin D if deficient

Question 10

What are the side effects of bisphosphonates?

Answer 10

• Oesophageal ulceration
• Hypocalcaemia,
• Bone and joint pain,
• Atrial fibrillation,
• Osteonecrosis of the jaw,
• Atypical stress fracture.

Question 10

What are the investigations to confirm osteoporosis?

Answer 10

• DEXA scan (gold standard)
• X-rays if fractures are suspected
• MRI spine to look for vertebral fractures

Question 11

What are some second line pharmacological treatments for osteoporosis?

Answer 11

• Denosumab (monoclonal antibody)
• Raloxifene (used in post menopausal women)
• HRT
• Teriparatide (PTH)
• Strontium ranelate (reduces rate of bone turnover and stimulates bone growth)

Question 12

What bones are at the greatest risk of fragility fractures and why?

Answer 12

Spine (most common), scapulae and ribs as they are full of spongy bone.

Question 13

What are some conditions which can cause osteoporosis?

Answer 13

• Turners syndrome,
• Hyperprolacinaemia
• Klinefelter syndrome,
• Cushing’s syndrome
• Diabetes mellitus

Question 14

What is the interaction of oestrogen with bones?

Answer 14

Oestrogen normally inhibits bone reabsorption. So reduced oestrogen causes reduced bone density

Question 15

What is osteomalacia?

Answer 15

Defective bone mineralisation caused by a vitamin D deficiency - causes a lack of calcium and phosphate

Question 16

What is osteomalacia?

Answer 16

Defective bone mineralisation caused by a vitamin D deficiency - causes a lack of calcium and phosphate

Question 16

what is the presentation of osteomalacia?

Answer 16

Fatigue, bone pain, muscle weakness, muscle aches and pathological fractures

Question 17

What are the investigations and treatment for osteomalacia?

Answer 17

Investigations: Serum 25-hydroxyvitamin D (others include bone profile, LFTs, PTH)
Treatment: Colecalciferol