Osteoporosis

Question 1

What is the definition of osteoporosis?

Answer 1

Decreased bone density by at least 2.5 standard deviations below young adult mean value.

Question 2

What does osteopenia refer to?

Answer 2

Less severe decrease in bone density

Question 3

What does osteomalacia refer to?

Answer 3

Decreased mineralisation

Question 4

The T-score is the number of ______ _____ the patient is from an average healthy young adult

Answer 4

standard deviations

Question 5

What measures the T-score of the femoral neck?

Answer 5

DEXA scan

Question 6

What does a T-score of -1 mean?

Answer 6

The bone mineral density is 1 standard deviation below the average for healthy young adults

Question 7

What is the T score range for osteopenia?

Answer 7

-1 to -2.5

Question 8

What is the T score range for osteoporosis?

Answer 8

Less than -2.5

Question 9

What is the T score for severe osteoporosis?

Answer 9

Less than -2.5 plus a fracture

Question 10

What does DEXA stand for?

Answer 10

Dual-energy x-ray absorptiometry (type of X-ray, measure how much radiation is absorbed by the bones indicating how dense it is)

Question 11

What is a Z-score?

Answer 11

The number of standard deviations away the patient it from the average of their age, sex and ethnicity

Question 12

What are risk factors for osteoporosis?

Answer 12

Older age
Post-menopausal women
Reduced mobility and activity
Low BMI
Low calcium or vitamin D intake
Alcohol
Smoking
History of fractures (personal or family)
Chronic diseases eg CKD, hyperthyroidism, RA)
Long term corticosteroids
Certain medications

Question 13

What mnemonic can help remember the risk factors for osteoporosis?

Answer 13

SHATTERED

Steroids
Hyperthyroid/ hyperparathyroid
Alcohol and smoking
Thin (decreased BMI)
Testosterone low
Early menopause
Renal / liver failure
Erosive and inflammatory disease
DMT1 or malabsorption

Question 14

What are symptoms of osteoporosis?

Answer 14

Fractures, often:

Proximal femur
Colles’ (wrist, fall on outstretched hand)
Compression vertebral crush (may cause kyphosis/ “widow stoop”)

Question 15

What hormone is protective against osteoporosis?

Answer 15

Oestrogen
Drops significantly after menopause

Question 16

Tamoxifen is a selective oestrogen receptor modulator and used to treat breast cancer. It block oestrogen receptors in b____ t_____ but stimulates oestrogen receptors in the u_____ and b____

Answer 16

breast tissue
uterus and bones

Question 17

Tamoxifen helps prevent osteoporosis but increases the risk of e______ c____

Answer 17

endometrial cancer (stimulates oestrogen in uterus)

Question 18

What can be used to assess the 10 year risk of a major osteoporotic fracture and a hip fracture?

Answer 18

QFracture tool

(or FRAX tool)

Question 19

Patients above __% on the QFracture percentage are considered for a DEXA scan.

Answer 19

10%

Question 20

Who do NICE recommend assessing (using QFracture tool)?

Answer 20

Anyone on long-term corticosteroids
Anyone with a previous fragility fracture
Anyone 50+ with risk factors
All women 65+
All men 75+

Question 21

The first step in management is addressing reversible risk factors. How are these managed?

Answer 21

Increase physical activity
Maintain healthy weight
Stop smoking
Reduce alcohol consumption

Question 22

The second step in management is addressing the insufficient intake of ______ and inadequate v____ _ by giving supplements

Answer 22

calcium (at least 1000mg), vitamin D (400-800 IU)

Question 23

What is the first line treatment in osteoporosis?

Answer 23

Bisphosphonates

Question 24

How do bisphosphonates work?

Answer 24

Interfering with how osteoclasts attach to the bone, reducing their activity and decreasing the reabsorption of bone.

Question 25

What are side effects of bisphosphonates?

Answer 25

Reflux and oesophageal erosions
Atypical fractures
Osteonecrosis of jaw and external auditory canal

Question 26

When are oral bispohosphonates taken?

Answer 26

On empty stomach with full glass of water.
patient should then sit upright for 30 mins before moving or eating to reduce risk of reflux or oesophageal erosions.

Question 27

What are some other options when bisphosphonates are not suitable?

Answer 27

HRT
monoclonal antibodies that target osteoclasts/osteoblasts
Synthetic PTH