Osteoporosis

Question 1

What is meant by osteoporosis

Answer 1

Progressive bone disease- reduction of bone mass and density causing increased risk of fractures

Question 2

What are the risk factors of osteoporosis

Answer 2

*Postmenopausal women
*Men over 50
*Patients taking long term corticosteroids ( glucocorticoid)
Age increase
Vit d and calcium deficiency
Lack of exercise
Low BMI
Smoking and drinking
History of fractures
Early menopause

• means most significant factor

Question 3

What lifestyle changes can decrease the risk of osteoporosis

Answer 3

Increase exercise
Smoking cessation
Maintain an ideal BMI
Reduce alcohol intake

Increase the intake of vitamin D and Calcium (supplements if needed

Question 4

What is the treatment of osteoporosis

Answer 4

Review of medication is needed after 5 years ( 3 years for zoledronic)

FIRST LINE: oral bisphosphonates (alendronic acid/ risedronate sodium)

Alternative therapies:
-postmenopausal: ibandronic acid, densosumab, raloxifene, strontium
- younger menopausal women can use HRT or Tibolone
- teriparatide used in severe osteoporosis

MEN:Zoledronic acid, densosumab, teriparatide, strontium

Glucocorticoid- induced: Zoledronic acid, densosumab, teriparatide

Question 5

What is the treatment if it is glucocorticoid induced osteoporosis

Answer 5

Start prophylaxis at onset of glucocorticoid treatment in the following :

Women:
- 70 years or over
- previous fragility fractures
- large doses of glucocorticoid (prednisalone >7.5mg daily or equivalent)

Men over 70 and either :
Previous fragility fracture
Large doses of glucocorticoid

Large doses of corticosteroid for >3 months

Question 6

What are the MHRA warning of bisphosphonates

Answer 6

Atypical femoral fractures
- report any thigh, hip or groin pain

Osteonecrosis of the jaw
- report any dental pain, swelling, non-healing sores or discharge

Osteonecrosis of the external auditory canal
- report ear pain, discharge or ear infection

Question 7

What are the side effects of bisphosphonates

Answer 7

Oesophageal reactions
- REPORT AND STOP: oesophageal irritation, dysphasia, heartburn
-medication should be taken with a full glass of water whilst STANDING and should remain upright for 30 minutes after

-alendronic acid: take 30 minutes before breakfast/ other oral meals

Risendronate sodium: Take 30 minutes before breakfast or leave 2 hours before and after food/ drink if at other time in the day