Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Progressive bone disease that results in low bone mass. It is measures by bone mineral density

Question 2

Do corticosteroids make osteoporosis worse?

Answer 2

Yes, they can cause osteoporosis

Question 3

What are some risk factors of osteoporosis

Answer 3

Post menopausal women

Men over 50

Long term corticosteroid use

Age

Less vitamin C and D intake

Lack of exercise and physical activity

Alcohol

Low BMI

Question 4

What can you do to improve osteoporosis

Answer 4

Increase exercise

Stop smoking

Maintain normal BMI

Reduce alcohol

Increase Vitamin C and D

Question 5

What are the drugs involved in treatment

Answer 5

Bisphosphonates

HRT

Raloxifene

Strontium

Question 6

What is the treatment for post menopausal osteoarthritis

Answer 6

Alendronic acid or Risedronate

Question 7

What if alendronic acid and risedronate are contraindicated in post menopausal women

Answer 7

Ibandronic acid

Denosumab

Raloxifene

Question 8

What is the first line treatment in men

Answer 8

Alendronic acid

Risedronate

Question 9

If the osteoporosis is due to glucocorticoid therapy then what should you do after the glucocorticoid therapy has stopped?

Answer 9

Review the need to continue bone protection

Question 10

How do the bisphosphonates work?

Answer 10

Absorbed into the hydroxyapatite crystals in the bone, slowing both their rate of dissolution and reducing rate of bone turnover

Question 11

What is the MHRA advice for bisphosphonates

Answer 11

1) Atypical femoral fracture - report any thigh pain, hip or groin pain during treatment

2) Osteonecrosis of the jaw - jaw bone starved of blood - maintain good check ups

3) Osteonecrosis of the external auditory canal - report any ear pain or discharge from the ear or ear infection

Question 12

Side effects of alendronic acid

Answer 12

Oesophageal reactions

Stop and seek medical advice if any new symptoms like dysphagia, heartburn and pain on swallowing

Question 13

Counselling on how to take alendronic acid

Answer 13

Take ONCE a week

Swallow whole

Take doses with lots of water

Take whilst sitting or standing

Take on empty stomach at least 30 mins before breakfast or any meal

Stand or sit upright for at least 30 mins after administration

Question 14

What is used in severe osteoporosis for men and post menopausal women at increased risk of fractures when other treatments are contraindicated

Answer 14

Stontium

Question 15

Should strontium be initiated by specialist

Answer 15

Yes

Question 16

Contraindications of strontium

Answer 16

Cerebrovascular disease

DVT

Ischaemic Heart disease

Immobilisation

Uncontrolled hypertension

Question 17

What drug does not help with the vasomotor symptoms of menopause

Answer 17

Raloxifene

Question 18

When is HRT used for osteoporosis

Answer 18

In young menopausal women who are at high risk of fractures

Question 19

Why is HRT not used in older women

Answer 19

Risk of cardiovascular disease and cancer

Question 20

What HRT do you give to women with a uterus

Answer 20

COMBINED HRT - oestrogen and progesterone

REDUCES CHANCES OF ENDOMETRIAL CANCER

Can also give tibolone

Question 21

What do you give to women without a uterus

Answer 21

Oestrogen only

Question 22

What do you give women with endometriosis

Answer 22

Combined HRT