Osteoporosis

Question 1

What is the clinical definition of osteoporosis?

Answer 1

Bone mineral density of less than 2.5SD

Question 2

What are the risk factors of osteoporosis?

Answer 2

Female gender
Asians and white people
Low BMI
Smoking
Alcohol
Family history
Corticosteroid use
Rheumatoid arthritis

Question 3

What medications can worsen osteoporosis?

Answer 3

PPI’s
Glitazones
Antiepileptics
SSRIs

Question 4

What investigations are used for osteoporosis?

Answer 4

FBC
TFT
Bone profile
LFT
DEXA (if score <2.5SD give treatment)
U&amp;E

FRAX or Qfracture can assess the risk of having another fracture in the next 10 years

Question 5

What is the management of patients at risk of having corticosteroid-induced osteoporosis?

Answer 5

If >65 or had a previous fragility fracture, offer bone protection

If <65, offer a DEXA scan. Discharge if 0, if 0- -1.5, repeat the DEXA scan in 1-3 years, if -1.5 and below, offer bone protection

Question 6

Outline the FRAX score

Answer 6

International
For patients aged 40-90

Results:
Low risk: reassure
Medium risk: offer DEXA scan
High risk: offer bone protection

Question 7

Outline the QFracture score

Answer 7

UK only
For patients aged 30-99
Includes a larger group of risk factors

Question 8

How do bisphosphonates work?

Answer 8

Inhibit osteoclasts by encouraging osteoclast apoptosis

Question 9

What are the uses of bisphosphonates?

Answer 9

Prevention/treatment of osteoporosis
Paget’s disease
Hypercalcaemia
Pain from bony metastases

Question 10

What are the adverse effects of bisphosphates?

Answer 10

Oesophageal reactions: oesophagitis, ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures
Hypocalcaemia

Question 11

What is the guidance you should tell patients when taking bisphosphonates?

Answer 11

Tablets should be swallowed whole with plenty of water while sitting or standing

To be given on an empty stomach 30 mins before breakfast

Patients should stand or sit upright 30mins after taking it

Question 12

What is the management of osteoporosis?

Answer 12

Vitamin D and calcium supplementation
Bisphosphonates, alendronate first line
Those who cannot tolerate alendronate, give risedronate or etidronate

Question 13

If patients cannot tolerate bisphosphonates what do you give them?

Answer 13

Strontium ranelate and raloxifene