Osteoporosis

Question 1

What is the consequence of excessive bone resorption?

Answer 1

Osteoporosis

Question 2

What are the consequences of spinal osteoporosis?

Answer 2

• Back pain
• Height loss
• Dorsal kyphosis (stooping)
• Restrictive lung disease
• Protruding belly with an upper abdominal crease causing bloating and nausea

Question 3

Who is at risk of osteoporosis?

Answer 3

• Previous fragility fracture and FH
• Low BMI < 19
• Use of steroids
• Rheumatoid arthritis
• Older age
• Lifestyle: smoking, alcohol+, immobility
• Comorbidities like Diabetes, Malabsorption eg coeliac disease, Inflammatory Bowel
  Disease, Thyroid Disease, COPD, Malignancy - Drugs eg anticonvulsants, long term heparin etc

Question 4

What is the FRAX score?

Answer 4

The fracture risk assessment tool
- Used in osteoporosis

Question 5

What are the pharmacological treatments available for osteoporosis?

Answer 5

• Vitamin D + calcium (Adcal)
• Bisphosphonates
• SERM (Raloxifene)
• HRT
• Denosumab
• Injections like teriparatide and romosozumab

Question 6

How is Denosumab work?

Answer 6

It’s anti-RANK-L
- Leads to reduction in formation function, and survival of osteoclasts (stops resorption of bone)

Question 7

What are atypical femoral fractures?

Answer 7

Fractures caused by stress or insufficiency
- An uncommon complication of long-term bisphosphonate use

Question 8

What is a ‘frozen bone’ in osteoporosis?

Answer 8

When there is a decreased rate of bone turnover

Question 9

What are some side effects of bisphosphonates?

Answer 9

• Osteonecrosis (worse with IV)
• GI upset (diarrhoea)
• Hypocalcaemia
• bone and joint pain
• kidney issues
• Dysphagia

Question 10

How do bisphosphonates cause osteonecrosis of the jaw?

Answer 10

The suppressed bone turnover results in bones unable to mount a healing response to teeth extractions especially the molars