OSTEOPOROSIS

Question 0

What is osteopenia?

Answer 0

-1 >T SCORE > -2.5

Question 1

What is osteoporosis?

Answer 1

Condition of decreased bone strength, defined as T score < -2.5 (SD from young, healthy adult of same age and gender)

Question 2

Risk factors for osteoporosis?

Answer 2

SHATTERED 
Steroid use > 5mg/day
Hyperthyroidism/hypothyroidism 
Alcohol/tobacco 
Thin BMI < 22 decreased bone mass 
Testosterone low 
Renal/liver disease 
Erosive bone disease 
Dietary low calcium/vit D

Question 3

Clinical presentation of osteoporosis?

Answer 3

Fractures - from minimal trauma
Deformity - ht loss, kyphosis or back pain
Vertebral compression fractures - point tenderness and deformity

Question 4

Ix?

Answer 4

CBE EUC LFT CRP
VIT D
screen for secondary cause - TFT, PTH testosterone, urinary cortisol

RAD
CXR- kyphosis and ht loss, fracture
BMD - DEXA

Question 5

Difference between T and Z score?

Answer 5

T score for BMD

Z score age matched for BMD

Question 6

Non- pharm management?

Answer 6

Prevent falls - optimise health, meds (reduce sedatives, antipsychotics, anti hypertensives)
Dietary supplements - Vit D, Ca supplements
Exercise to reduce bone loss - wt bearing exercises
Sun

Question 7

Pharm management?

Answer 7

Bisphosphonates (osteoclasts apoptosis -> slowing bone loss) for primary prevention with osteoporosis or after Frx.

DENOSUMAB (inhibit the maturation of osteoclasts)
SERM
PTH (if contraindicated for Bisphosphonates)
hrt

Question 16

What does PTH and CALCITONIN do to blood calcium?

Answer 16

Calcitonin tones down blood calcium.

PTH increases blood calcium.

Question 17

What are the pathways that cause osteoporosis?

Answer 17

1) inadequate peak bone mass (restricted growth when young)
2) excessive bone resorption (lack of estrogen -> increases bone resolution)
3) inadequate formation new bone