Osteoporosis

Question 1

What is osteoporosis?

Answer 1

A bone defect characterized by reduced bone mineral density and increased porosity

Question 2

What are the types of osteoporosis?

Answer 2

Type I (Post-menopausal): Exacerbated bone loss after menopause

Type II (Senile): Bone loss due to ageing

Secondary Osteoporosis: Caused by conditions like steroids, alcohol, and chronic diseases.

Question 3

What are the risk factors for osteoporosis?

Answer 3

(1) Steroid use
(2) Alcohol
(3) Smoking
(4) Low estrogen
(5) Early menopause
(6) Low calcium, inactivity
(7) Chronic diseases
(8) Vitamin D deficiency

Question 4

What is the SHATTERED acronym for osteoporosis?

Answer 4

S: Steroid use

H: Hyperthyroidism
hyperparathyroidism

A: Alcohol, smoking

T: Thin (BMI<22) Testosterone deficiency

E: Early menopause

R: Renal/liver failure

E: Erosive bone disease

D: Diabetes

Question 5

What is the pathophysiology of osteoporosis?

Answer 5

Bone resorption (osteoclast activity) exceeds bone formation (osteoblast activity), leading to decreased bone density and increased fragility

Question 6

What is the gold standard for diagnosing osteoporosis?

Answer 6

DEXA scan (T ≤ -2.5)

Question 7

What is the first-line pharmacological treatment for osteoporosis?

Answer 7

Oral bisphosphonates (e.g., alendronic acid, risedronate) for T-score ≤ -2.5

Question 8

What supplements should be given if calcium or vitamin D is deficient?

Answer 8

Calcium and/or vitamin D supplements

Question 9

How do bisphosphonates work?

Answer 9

Reduce osteoclastic resorption of bone

Question 10

What are the common side effects of bisphosphonates?

Answer 10

Oesophagitis, dysphagia

Question 11

What are second-line treatments if bisphosphonates are not tolerated?

Answer 11

Zoledronic acid (IV, annual)

Denosumab (monoclonal antibody reducing osteoclast activity)

Question 12

What is Teriparatide used for?

Answer 12

Stimulate bone growth in severe osteoporosis, reducing fracture risk

Question 13

What is the FRAX tool used for?

Answer 13

Assesses the 10-year osteoporotic fracture risk, helping determine the need for treatment

Question 14

What is the T-score range for osteopenia?

Answer 14

T-score between -1.0 and -2.5 indicates osteopenia

Question 15

Osteopenia meaning?

Answer 15

low bone density

Question 16

What T-score defines severe osteoporosis?

Answer 16

T-score of -2.5 or lower with a fragility fracture defines severe osteoporosis

Question 17

What is the primary prevention strategy for osteoporosis?

Answer 17

Building peak bone mass through \

(1) exercise
(2) healthy diet (high in calcium and vitamin D)
(3) sunlight exposure

Question 18

What are the side effects of bisphosphonates?

Answer 18

(1) Oesophageal ulcers
(2) Atrial fibrillation
(3) osteonecrosis of the jaw
(4) Atypical stress fractures.

Question 19

What is a commonly used supplement in osteoporotic patients?

Answer 19

Calcium + Vitamin D

Question 20

How is osteoporosis diagnosed on a bone density scan?

Answer 20

Osteoporosis is diagnosed when patients have a T-score of less than 2.5 standard deviations below the mean.

A score of between -1 and -2.5 indicates osteopenia

Question 21

What is the main bone protection therapy following a vertebral fracture?

Answer 21

Bisphosphonates

Question 22

What is the mechanism of action of bisphosphonates?

Answer 22

They are incorporated into osteoclast cells and interfere with cell function, causing cells to be non-functional and apoptose

Question 23

Bone [Blank] occurs at a greater rate than bone [Blank] in osteoporosis?

Answer 23

Bone Resorption occurs at a greater rate than bone formation in osteoporosis.

Question 24

A T score of less than [Blank] on dual-energy x-ray absorptiometry (DEXA) scan indicates osteoporosis?

Answer 24

-2.5

Question 25

Why should patients sit up before taking bisphosphonates?

Answer 25

Reduce the risk of developing an oesophageal ulcer

Question 26

What is the first line of medical treatment to treat osteoporosis?

Answer 26

Bisphosphonates are first line and tend to be given weekly

Question 27

Which subgroup of osteoporosis patients can get raloxifene?

Answer 27

Postmenopausal women

Question 28

Which organ is mainly responsible for excretion of bisphosphonates?

Answer 28

Kidneys

Question 29

[Blank] activity exceeds [Blank] activity in osteoporosis?

Answer 29

1. Osteoclast
2. Osteoblast

Question 30

What is the FRAX tool used for osteoporosis?

Answer 30

Provides a 10-year risk of osteoporotic fracture, which helps decide when to offer bisphosphonates:

Low risk - Bisophosphonates not yet needed.

High risk - Bisphosphonates needed.

Medium risk - Perform DEXA to decide if bisphosphonates are needed.

Question 31

Bone mineral density is [Blank] in osteoporosis?

Answer 31

Low

Question 32

How do bisphonates work?

Answer 32

They inhibits osteoclast activity

Question 33

Which site is most commonly affected by osteoporotic fractures?

Answer 33

Vertebral fractures

Question 34

What is the mechanism of action of Raloxifene?

Answer 34

Raloxifene binds to oestrogen receptors and exerts the same protective action that oestrogen performs on bones by inhibiting osteoclastic action

Question 35

Which patients at risk of osteoporosis should be assessed using a FRAX score?

Answer 35

All women aged over 65 should be assessed and men aged over 75.

Younger patients should be evaluated if they have risk factors e.g. a previous fragility fracture or frequent use of oral corticosteroids