Osteoporosis

Question 1

What are the underlying processes contributing to osteoporosis?

Answer 1

• Over-activity of osteoclasts
  
  • Increased RANKL/RANK
• Under-activity of osteoblasts
  
  • Decreased calcitriol, PTH, IL-6

Low bone density and micro-architectural defects

Question 2

What are the risk factors for osteoporosis?

Answer 2

• Old age, female sex, white, post-menopausal
• Smoking
• EtOH abuse
• Prolonged immobilisation
• Low calcium intake
• Vitamin D deficiency
• Glucocorticoid excess

Question 3

What is the gold-standard diagnostic test for osteoporosis?

Answer 3

Dexa-scan

(<2.5 indicates osteoporosis)

Question 4

What are the management principles for people with oseteoporosis?

Answer 4

• Lifestyle changes
  
  • Smoking cessation, alcohol reduction, calcium and Vit D-rich diet
• Pharmacological therapy
  
  • Women
    
    • Bisphosphonates
    • Raloxifene or denosumab
  • Men
    
    • Bisphosphonates +/- testosterone +/- zoledronic acid