osteoporosis

Question 1

presumptive diagnosis of osteoporosis

Answer 1

all individuals over the age of 50 who sustain a fracture from minimal truam a

Question 2

diagnositc investigations

Answer 2

bone mineral density scan using at least two skeletal sites
should be measured to determine baseline

Question 3

how to perform a BMD scan

Answer 3

total hip is the preferred site, forearm BMD can be used if the total hip or lumbar spine cannot be assessed
repeat BMD measurements should be performed on the same machine because BMD measurements are not standardised between machines and facilities

Question 4

T score

Answer 4

the numer of standard deviatons by which the patients BMD varies for the young adult mean for their sex, as measured by DXA

Question 5

how to interpret the T score

Answer 5

relative fracture risk doubles for each standard devation decrease in T score

Question 6

Z-score

Answer 6

the numer of standard deviatons a person’s BMD varies from the age and sex matched BMD
a Z score below -2 warrants investgation for secondary cause of low bone density

Question 7

lifestyle modifications

Answer 7

adequate calcium and protein intake
adequate but safe exposure to sunlight as a source of vitamin D
healthy BMI
cessation of smoking
avoidance of excessive alcohol consumption

Question 8

exercise

Answer 8

individuals over 50 should participate regularly in progressive resistance training and balance training exercises

Question 9

treatment

Answer 9

bisphosphonates
denosumab
hormone therapy - oestrogen replacement therapy or SERM

Question 10

SERMs may be useful for

Answer 10

women with a prior history of breast cancer

Question 11

indications to medicate for osteoporosis

Answer 11

T score < -2.5 in patients over 70
or minimal trauma fracture in patients > 50
or in corticosteroid induced osteoporosis: T score < -1.5

Question 12

denosumab

Answer 12

monoclonal antibody
reversibly inhibits bone resorption by reducing osteoclast formation and increasing osteoclast apoptosis
can be used in chronic kidney disease (unlike bisphosphonates)
6 monthly subcut injection

Question 13

bisphosphonates

Answer 13

inhibit osteoclasts
avialable as orals or zoledronic acid which is a 15 minute IV infusion once per year

Question 14

common sites for osteopororsis fracture

Answer 14

vertebral bodies
distal radius
proximal humerus
pelvis
proximal femur

Question 15

modifiable risk factors than increase the risk for minimal trauma fracture

Answer 15

falls and factors that increase the risk of falls
drugs that affect bone homeostasis or density
lifestyle and nutrition factors
disorders that affect bone homeostasis or density

Question 16

preventing falls

Answer 16

improving vision
adjusting drug therapy
minimising household risks
providing aids for daily living
minimising periods of immobilisation
promoting exercise

Question 17

calcium intake advice

Answer 17

intake should ideally be achieved from dietary sources
calcium suppliments cause bloting and constipation
three servings of dairy products are recommended each day
dairy is also a good source of protein, which may independently contribute to bone health

Question 18

calcium drug of choice

Answer 18

calcium carbonte is a reasonable first line choice
calcium citrate does not require gastric acidity for absoprtion, so may be better abserobed in people taking a proton pump inhibitor

Question 19

investigations for common secondary causes of osteoporosis

Answer 19

serum calcium concentration
serum phosphate concentraton
serum alkaline phosphatase concentration
serum 25-hydroxyvitamin D concentration
liver biochemistry
kidney function

Question 20

how to work up a patient following minimal trauma fracture

Answer 20

DXA scan, treat if osteopaenic or osteoporotic
if within the normal range, consider further investigations based on patient history and clinical examination

Question 21

DXA scan screening

Answer 21

measure BMD in patients with significant risk factors for practure, and in patients 70 or older

Question 22

delaying denosumab dosage

Answer 22

increased incidence of multiple spontaneous vertebrl fractures if stopped or delayed by more than 4 weeks