Osteoporosis

Question 1

What is osteoporosis

Answer 1

condition of skeletal fragility characterised by reduced bone mass and micro-architectural deterioration predisposing to an increased risk of fractures

WHO defines it by BMD measurement. This allows diagnosis and treatment prior to fracture.

Question 2

Presentation of Osteoporos

Answer 2

Asymptomatic
Pain or loss of height with development of kyphosis caused by fragility fractures

Features of underlying disease eg. Cushing’s syndrome

Question 3

Diagnosis of osteoporosis

Answer 3

T-score -2.5 but

Question 4

Investigations in osteoporosis

Answer 4

Renal function test
Bone profile (Calcium, Vit D, phosphate, Parathyroid hormone)

TFT
Bone turnover markers
Multiple myeloma screen (ESR, serum immunoglobulins)

Consider cortisol, testosterone, oestradiol, PSA, tTG

Question 5

Aetiology of osteoporosis

Answer 5

Endocrine (Cushing, Acromegaly, Hypopituitarism, Prolactinoma)

inflammatory (RA, Ank spondylitis, IBD)

Nutritional (Vit D, Ca and Malabsorption syndrome)

Genetic (Marfan, Osteogenesis imperfecta, Turner )

Question 6

RF for osteoporosis

Answer 6

Previous fracture
FH
Excess alcohol
Smoking
Corticosteroid treatment

Amenorrhoea for 6 months (excluding pregnancy)
Late menarche
Early menopause including surgical
Immobility
Drugs - heparin/phenytoin
Inflammatory arthritis

Inflammatory arthritis (RA, ank spondylitis)

Question 7

Consequences of osteoporosis

Answer 7

Diminished QOL due to pain and kyphosis

Decreased independence (ability to bath, dress and ambulate independently)

Increased morbidity

Increased mortality (related to hip fractures - 20% excess in following year)

Ca. 50% do not recover to previous function

Question 8

Lifestyle Management of osteoporosis

Answer 8

Reduce fragility fractures
Lifestyle:
-Calcium (1.2-1.5L/day milk)
-weight bearing exercises
-smoking cessation
-reduction of alcohol if excessive

Exercises to promote bone density and reduce falls.

Hip protectors (but poor compliance)

Question 9

Medication in osteoporosis

Answer 9

Vit D and Calcium supplement

Bisphosphonates: incorporate Ca2+ at the bone matrix. Also induce osteoclast apoptosis
Alendronic acid (70mg weekly)
Risedronate sodium
Zolendronic acid IV

Denosarmab S/C every 6 months

Selective oestrogen receptor modulators (SERM) - Raloxefine

HRT
Testosterone treatment
PTH