Osteoporosis

Question 1

1/ What is osteoporosis?
2/ What is the definition of OP?
3/ What is the goal of tx?

Answer 1

1/ decrease bone mass + deterioration of bone architecture leading to decrease bone mineral density and increase in fracture risk

Definition is BMD T score < or equal to -2.5

2/ decrease BMDensity and reduce the risk of fracture

Question 2

What is a fragility fracture?

Answer 2

fall from standing height or fracture from a mechanism not expected to cause a fracture in normal circumstances

Question 3

Who is at average risk of OP?
What should be done?
How often?

(Source Redbook)

Answer 3

Postmenopausal women (aged ≥45 years)
Men aged ≥50 years

Clinical assessment of risk factors & preventative advice

Every 12 months

Question 4

1/ Who is at increased risk of OP? (i.e. what are the risk factors for OP?)
(Source Redbook)

2/ What should be done?

3/How often?

Answer 4

1/ Aged >60 years for men and >50 years for women plus any of:

family history of fragility fracture

smoking

high alcohol intake (>4 standard drinks per day for men and >2 for women)

low body weight (body mass index [BMI] <20kg/m2)

low levels of physical activity†

vitamin D deficiency <50 nmol (screening for vitamin D not indicated just for risk assessment)*

recurrent falls

immobility (to the extent that person cannot leave their home or cannot do any housework)

2/ Dual X-ray absorptiometry (DXA) to measure bone mineral density (BMD)

Investigate for causes of secondary osteoporosis

3/ optimal timing for repeating DXA scans unknown
repeat only if going to change mx

Question 5

Medical conditions that may cause secondary osteoporosis?

Source Redbook

Answer 5

• endocrine disorders (eg hypogonadism, Cushing syndrome, hyperparathyroidism, hyperthyroidism)-
• premature menopause
• anorexia nervosa or amenorrhea for 45 years of age
• inflammatory conditions (eg rheumatoid arthritis)
• malabsorption (eg coeliac disease)
• chronic kidney or liver disease
• multiple myeloma and monoclonal gammopathies
• human immunodeficiency virus (HIV) and its treatment
• Type 1 and type 2 diabetes mellitus

Question 6

How long are omen with baseline T-score >–1.0 take to transition to osteoporosis?

Answer 6

May take longer than 15 years to transition to osteoporosis

Question 7

1/ Who is at high risk of further fracture?
(Source Redbook)

2/ What should be done?

3/How often?

Answer 7

1/Patients aged >45 years who have sustained a low-trauma fracture

Postmenopausal women, and older men with a vertebral fracture. Such fractures should be ruled out if clinically suspected (eg from loss of height >3 cm, kyphosis, back pain)

2/DXA scan
investigate secondary causes of osteoporosis

3/ repeat in 2 years if increased risk of OP
medication
repeat DXA not required in pt’s with confirmed OP

Question 8

Some anti-osteoporotic drugs are available on the Pharmaceutical Bene ts Scheme for people without
an existing fracture, this includes:

(Ref NPS website)

Answer 8

Those at high risk because they are ≥ 70 years and have a BMD T-score ≤ –3.0 (primary prevention)

People who are taking a glucocorticoid and meet certain criteria

Question 9

Medications that may cause secondary osteoporosis including:

Answer 9

drugs,
»especially corticosteroids (eg 7.5 mg for >3 months)
»anti-epileptic
»aromatase inhibitors
»anti-androgen
»excessive thyroxine
»possibly selective serotonin reuptake inhibitors (SSRIs)