Osteoporosis

Question 1

What is OP?

Answer 1

• Low bone mass
• Deterioration of bone tissue
• Disruption of bone architecture
• This leads to compromised bone strength and increase risk of fracture

Question 2

RF - non modifiable

Answer 2

• Advanced age (older 65)
• Female
• Caucasian or south asian
• FH of osteoporosis
• History of low trauma fracture (fall from standing height or less, at walking speed or less)

Question 3

RF - modifiable

Answer 3

• Low BMI - less than 21 or body weight lower than 58kg
• Premature menopause (age less 45)
• Calcium/Vitamin D deficiency
• Inadequate physical acitivity
• Smoking
• Excessive alcohol intake (more than 3 units per day)
• Iatrogenic - corticosteroids, aromatase inhibitors (used for breast cancer)

Question 4

Diagnosis of OP - how?

Answer 4

• DEXA scan - dual energy x-ray absorbtiometry of lumbar spine and hip = gold standard
• T score calculated

Question 5

What is T score?

Answer 5

Number of standard deviations from the mean bone density of a person of same gender at age of peak density (eg 25/30)

Question 6

T score cutoffs

Answer 6

• -2.5 or less = osteoporosis
• -1 to -2.4 = osteopenia
• Normal is -1 or less

Question 7

What is Z score?

Answer 7

Number of standard deviations you are away compared to BMD of someone same age and gender as you

Question 8

Z score cut offs

Answer 8

• If less than -2 should prompt evaluation for secondary osteoporosis

Question 9

Plain radiograohs and OP

Answer 9

Lack sensitibity
Rib fractures or vertebral compression without trauma could prompt evaluation

Question 10

Treatment of osteopenia

Answer 10

Risk modification eg:
* Weight bearing exercise
* Vitamin D3 supplements (800-2000IU/day)
* Limit alcohol
* Smoking cessation
* Dietary advice re calcium, supplements if needed

Question 11

Osteoporosis treatment

Answer 11

• Vitamin D +/- calcium supplementation
• 1st line - Oral bisphosphonates or IV if not tolerated
• 2nd - Denosumab or teriparatide

Question 12

Secondary causes of OP

Answer 12

• Coeliac
• Eating disorders
• Hyperparathyroidism
• Hyperthyroidism
• Multiple myeloma also lowers BMD and can causse vertebral fractures

Question 13

OP in men

Answer 13

• Rare
• Secondary causes need to be excluded
• Hypogonadism can be treated with testosterone if this is cause

Question 14

Osteomalacia vs OP

Answer 14

• Osteoporosis is painless
• Osteomalacia causes pain

Question 15

Breast cancer and osteoporosis?

Answer 15

• As breast cancer is treated sometimes with oestrogen inhibition treatment
• This can cause decreased BMD massively
• Need to be protected bone wise