Osteoporosis

Question 1

OP

Answer 1

Progressive bone disease
Increase risk of fracture
Postmenopausal women/men >50 years
Long term oral CCS

Question 2

Risk factors

Answer 2

Age
Low BMI <19
Cig smoking, excess alcohol
Lack of Physical activity
Vit D def, calcium
Early menopause

Question 3

Treatment of postmenopausal OP

Answer 3

Oral bisphosphonates
1st line - alendronic acid/risedronate
If C/I - ibandronic, denosumab
HRT - restricted to younger post menopausal women

Question 4

Glucocorticoid induced OP

Answer 4

Greatest risk - early initiation

Oral bisphosphonates - both prophy/treatment

Question 5

OP in men

Answer 5

1st line - oral bisphosphonates

Question 6

MOA of bisphosphonates/side effects and counselling

Answer 6

Promotes osteoblast production

Side effects
Oesophageal reactions
Heartburn, retrosternal pain, pain on swalling - discontinue and report

Counselling
Swallow whole, take on an empty stomach - 30 mins before breakfast (no meds) sitting or standing, and remain upright for at least 30 minutes

Question 7

MHRA warnings of bisphosphonates

Answer 7

Osteonecrosis of the jaw/ear - during treatment, maintain good oral hygiene/reg dental check up (greater with IV)
Report any ear pain, discharge or infection during treatment
Atypical femoral fracture - report any thigh, hip or groin pain

Question 8

Dose:

Answer 8

10mg daily (women/men) or 70mg weekly (post menopausal) - women have more choice