Osteoporosis

Question 1

Definition

Answer 1

Disease characterised by low bone mass and deterioration of bone tissue with an increase in susceptibility to fracture

Question 2

Risk Factors - 7

Answer 2

Endocrine diseases - DM, hyperthyroidism
GI conditions causing malabsorption e.g. IBD, coeliac
CKD
Menopause
Low BMI
Age
Oral corticosteroids

Question 3

Presentation - 2

Answer 3

Symptomless and often goes undiagnosed until has a fragility fracture

FF is characterised as a fracture following a fall from standing height or less

Question 4

Types - Primary and Secondary

Answer 4

PRIMARY
- increase in osteoclast function or decrease in osteoblast function with age

SECONDARY
- caused by steroid taking, malnutrition or prolonged immobilisation which all affects bone remodelling

Question 5

Differentials - 4

Answer 5

Bone cancer - will have bone pain and cancer red flags

Multiple myeloma - will have bone pain, anaemia, infections, bleeding

Osteomalacia - would have proximal muscle weakness

Pagets disease - will have deformity

Question 6

Investigations - 3

Answer 6

• DXA scan to measure bone mineral density
• Calculate 10 year fragility fracture risk using Qfracture calculator
• Take serum vitamin D and calcium and assess intake of both

Question 7

Management - 4

Answer 7

Bisphosphonates

Oral vitamin D (colecaciferol) and Calcium

Consider HRT for younger postmenopausal women

Advise - regular exercise, balanced diet, less alc, no smoking

Question 8

What is mechanism of action of bisphosphonates

Answer 8

inhibition of osteoclast activity