Osteoporosis

Question 1

What is osteoporosis?

Answer 1

A skeletal condition characterised by:
- low bone mass
- deterioration of bone tissue
- disruption of bone architecture
Leading to compromised bone strength + increased risk of fracture

Question 2

How is bone mineral density measured?

Answer 2

• Using DEXA scan (dual energy x-ray absorptiometry)
• a type of x ray that measures how much radiation is absorbed by the bones
• the femoral neck reading is most important

Question 3

Diagnosis of osteoporosis

Answer 3

• DEXA of lumbar spine + hip (gold standard)
• T score: number of standard deviation from the man bone density of person of the same gender at age of peak density (<2.5 = osteoporosis)

Question 4

What is the T score?

Answer 4

The number of standard deviations from the mean bone density of persons of same gender at age of peak density

Question 5

What do different T score values mean?

Answer 5

• Normal: more than -1
• osteopenia: -1 to -2.5
• oesteoporosis: < -2.5
• severe osteoporosis: < -2.5 and a fracture

Question 6

Risk factors of osteoporosis

Answer 6

• increasing age
• female
• menopause
• Caucasian or south Asian
• family history
• history of low trauma fracture
• calcium or vitamin D deficiency
• smoking + excessive alcohol
• long term corticosteroids
• low BMI
• inadequate physical activity

Question 7

What is type 1 primary osteoporosis?
Who does it affect?

Answer 7

Due to increased in osteoclast number
Loss of oestrogen after menopause
Affects post menopausal women

Question 8

What is type 2 primary osteoporosis?
Who does it affect?

Answer 8

Loss of oestoblast function
Loss of oestrogen + androgen
Affects older men + women

Question 9

What is secondary osteoporosis?

Answer 9

Due to :
- drug therapy
- metabolic bone diseases
- malnutrition/weightlessness
Leads to:
- damaged bone remodelling
- causing porous appearance
- results from incomplete filling of oestoclast resorption bays

Question 10

Causes of secondary osteoporosis

Answer 10

• coeliac disease
• eating disorders
• hyperparathyroidism
• hyperthyroidism

Question 11

Management of osteopenia

Answer 11

Focussed on risk modification;
- weight bearing exercises
- vitamin D supplements 800-2000 IU/day
- limiting alcohol
- smoking cessation

Question 12

Management of oesteoporosis

Answer 12

• address reversible risk factors
• Vitamin D + calcium supplements
• 1st line: oral bisphosphonates e.g. alendronic acid
• 2nd line: denosumab or teriparatide

Question 13

What are adverse drug reactions of bisphosphonates?

Answer 13

• reflux + oesophageal erosions
• atypical fractures
• osteonecrosis of jaw + external auditory canal

Question 14

What advice should be given to patients when taking bisphosphonates?

Answer 14

• taken on empty stomach with full class of water
• sit upright for 30 mins after before moving or eating

Question 15

Who should be assessed for osteoporosis?

Answer 15

• anyone one long term steroid use
• anyone with previous fragility fracture
• 50+ with risk factors
• all women 65+
• all men 75+