Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Osteoporosis is a condition characterized by a significant reduction in bone density, making bones weaker and more prone to fractures. Osteopenia is a less severe decrease in bone density.

Question 2

How is osteoporosis diagnosed?

Answer 2

Osteoporosis is diagnosed using a DEXA scan, which measures bone mineral density (BMD) and provides a T-score. A T-score of less than -2.5 indicates osteoporosis.

Question 3

What is the T-score in osteoporosis diagnosis?

Answer 3

The T-score represents the number of standard deviations a patient’s bone density is from the average for a healthy young adult.

• Normal: T-score > -1
• Osteopenia: T-score between -1 and -2.5
• Osteoporosis: T-score < -2.5
• Severe Osteoporosis: T-score < -2.5 plus a fracture

Question 4

What are the key risk factors for osteoporosis?

Answer 4

• Older age
• Post-menopausal women
• Low BMI
• Low calcium or vitamin D intake
• Alcohol and smoking
• Chronic diseases (e.g., CKD, hyperthyroidism)
• Long-term corticosteroids use
• Family history of fractures

Question 5

What are the key age groups that should be assessed for osteoporosis?

Answer 5

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

Question 6

What tools can be used to assess the risk of osteoporosis?

Answer 6

• QFracture tool (preferred by NICE)
• FRAX tool (may underestimate risk in some patients)

Question 7

What is the first step in managing osteoporosis?

Answer 7

Address reversible risk factors, including increasing physical activity, maintaining a healthy weight, stopping smoking, and reducing alcohol consumption.

Question 8

What are the calcium and vitamin D recommendations for osteoporosis management?

Answer 8

• Calcium: At least 1000mg/day
• Vitamin D: 400-800 IU/day

Question 9

What is the first-line treatment for osteoporosis?

Answer 9

Bisphosphonates, which inhibit osteoclast activity to reduce bone resorption. Examples include:

• Alendronate (70mg weekly)
• Risedronate (35mg weekly)
• Zoledronic acid (5mg yearly, IV)

Question 10

What are important side effects of bisphosphonates?

Answer 10

• Reflux and oesophageal erosions
• Atypical femoral fractures
• Osteonecrosis of the jaw (regular dental checkups recommended)
• Osteonecrosis of the external auditory canal

Question 11

How should oral bisphosphonates be taken to reduce side effects?

Answer 11

Take on an empty stomach with a full glass of water and remain upright for 30 minutes afterward to minimize reflux risk.

Question 12

How often should bisphosphonate treatment be reassessed?

Answer 12

Reassess after 3-5 years. If the T-score is above -2.5, consider stopping treatment; continue for high-risk patients.

Question 13

What are specialist treatments for osteoporosis when bisphosphonates are unsuitable?

Answer 13

• Denosumab (monoclonal antibody targeting osteoclasts)
• Romosozumab (targets sclerostin)
• Teriparatide (parathyroid hormone analogue)
• Raloxifene (SERM)
• Strontium ranelate (stimulates osteoblasts and blocks osteoclasts)

Question 14

What are the risks of strontium ranelate?

Answer 14

Increases the risk of venous thromboembolism and myocardial infarction.

Question 15

What are the risks of raloxifene?

Answer 15

Increases the risk of venous thromboembolism but does not affect the uterus or breast tissue.