Osteoporosis

Question 1

Define osteoporosis?

Answer 1

Metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone tissue

Question 2

What is the risk of fracture related to?

Answer 2

Age, bone mineral density, falls, bone turnover

Question 3

Investigations for osteoporosis?

Answer 3

Q fracture,
Prodigy scan,
DEXA (dual energy X-ray absorptiometry)

Question 4

Rate of women who have osteoporosis

Answer 4

1 in 2 women over 50 will have an osteoporotic fracture before they die

1 in 5 in men

Question 5

Endocrine causes of osteoporosis?

Answer 5

Thyrotoxicosis,
Hyper and hypoparathyroidism,
Cushings,
Hyperprolactinaemia, 
Hypopituitarism, 
Early menopause

Question 6

Rheumatic causes of osteoporosis?

Answer 6

Rheumatoid arthritis,
Ankylosing spondylitis,
Polymyalgia rheumatica

Question 7

Gastroenterological causes of osteoporosis?

Answer 7

IBD, Primary biliary cholangitis, chronic alcohol hepatitis, alcoholic cirrhosis, viral cirrhosis, chronic pancreatitis, coeliac disease, whipped disease, short gut syndrome and ischaemic bowel

Question 8

Medication which cause osteoporosis?

Answer 8

Steroids, PPI, enzyme inducting antiepileptic medications, aromatase inhibitors, warfarin

Question 9

What score is used to decide if someone should get treatment?

Answer 9

T score from DXA

Question 10

If a patient with osteoporosis has a T score of above -1, what should their treatment be?

Answer 10

This is normal:

Reassure, lifestyle advice

Question 11

If a patient with osteoporosis has a T score of -1 to -2.5, what should their treatment be?

Answer 11

This is Osteopenia:
Lifestyle advice,
Treat if previous fracture

Question 12

If a patient with osteoporosis has a T score of below -2.5, what should their treatment be?

Answer 12

Lifestyle advice,

Offer treatment

Question 13

Investigations for osteoporosis?

Answer 13

Fracture risk assessment and fracture reduction,
DEXA scan,
FRAX or
QFracture

Question 14

When are you referred for a DEXA scan?

Answer 14

If you have a score of >10% fracture risk at any site over the next years bases on FRAX or QFracture

Question 15

Side effects of HRT

Answer 15

Increased risk of blood clots,
Increased risk of breast cancer with extended use into late 50s/ early 60s,
Increased risk of heart disease and stroke

Question 16

Treatment for osteoporosis?

Answer 16

HRP,
SERM (selective oEstrogne Receptor Modulator),
Bisphosphonates,
Teriparatide,
Denosumab

Question 17

Side effects of SERM

Answer 17

Hot flushes (if close to menopause),
Increased clotting risk,
Lack of protection at hip site

Question 18

First line treatment for osteoporosis?

Answer 18

Oral bisphosphonates

Question 19

What is advised before commencing bisphosphonates treatment?

Answer 19

Adequate renal function,
Adequate calcium and vitamin D status,
Good dental health and hygiene

Question 20

How do bisphonates work?

Answer 20

Nitrogen containing bisphosphonates inhibits osteoclasts

Question 21

Types of bisphosphonates

Answer 21

Alendronate,
Risedronate,
Raloxifene

Question 22

Side effects of bisphosphonates

Answer 22

Oesophagitis,
Iritis/ uveitis,
Atypical femoral shaft fractures,
Osteonecrosis of the jaw

Question 23

How does denosumab work in osteoporosis?

Answer 23

Monoclonal antibody against RANKL, this reduces osteoclastic bone resorption

Question 24

If a patient has renal impairment would you prescribe denosumab or bisphosphonates?

Answer 24

Denosumab

Question 25

Side effects of denosumab?

Answer 25

Allergy/ rash,
Symptomatic hypocalcaemia (if given when Vit D deficient),
Osteonecrosis of the jaw,
Atypical femoral shaft fractures

Question 26

Side effect of Teriparatide?

Answer 26

Injection site irritation,
rarely hypercalcaemia,
Allergy,
Cost