osteoporosis

Question 1

how do you assess risk of fragility fractures in patients with osteoporosis?

Answer 1

FRAX or QFracture to assess patients 10 year risk of developing fracture

Question 2

what does FRAX measure?

Answer 2

valid for patients 40-90yo

age, sex, weight, height
previous fracture, parental fracture
current smoking
glucocorticoids
RA
secondary osteoporosis
alcohol intake

Question 3

who should be assessed for osteoporosis?

Answer 3

all women 65+
all men 75+

younger patients assessed if:
previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
FH hip fracture
other causes of secondary osteoporosis
low bmi <18.5
smoking
alcohol intake >14 units/week

Question 4

what does QFracture measure?

Answer 4

used in patients 30-99yo
larger group of risk factors involved eg CVD, hx falls, CLD, RA, DM2, TCA

Question 5

when is it recommended to arrange DEXA scan to assess bone mineral density?

Answer 5

before starting treatment that may have rapid adverse effect on bone density - sex hormone deprivation for treatment for breast/prostate ca

<40yo w major risk factor eg hx of multiple fragility fracture, major osteoporotic fracture, current/recent use of high dose oral/systemic glucocorticoids (>7.5mg pred for 3 months or longer)

Question 6

what are the results of FRAX assessment + recommendations if done without a BMD measurement?

Answer 6

low risk- reassure + give lifestyle advice

intermediate risk - offer BMD test

high risk- offer bone protection treatment

Question 7

what are the results and advice of FRAX assessment if done with a BMD measurement?

Answer 7

reassure
consider treatment
strongly recommend treatment

Question 8

when should you reassess a patient’s risk of fragility fractures?

Answer 8

if original calculated risk was in region intervention threshold for a proposed treatment + only after a minimum of 2 years

or when there has been a change in person’s risk factors