Osteoporosis

Question 1

What is osteoperosis?

Answer 1

Metabolic bone disease characterised by low bone mass and mirco architectural deterioration of the bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.Clinically diagnosed with a DXA bone scan that has to be 2.5 SDs below a healthy man

put simply thin bones with increased fracture risk

Question 2

What are some good ways of identifying fracture risks?

Answer 2

FRAX assessment tool
Q fracture
Prodigy scanner
DXA scans

Question 3

Who gets osteoperosis

Answer 3

1 in 2 woman over 50
1 in 5 men over 50
50 year old woman has a 17% risk of a hip fracture
If you suffer one vertebral fracture you are five times more likely to have another

Question 4

What are some endocrine causes of osteoperosis

Answer 4

Thyrotoxicosis
Hyper and hypoparathyroidism
Cushings
Hyperprolactinaemia
Hypopituitarism
Early menopause

Question 5

What are some rheumatic causes of osteoperosis

Answer 5

Rheumatoid arthritis
Ankolysing spondylitis
Polymyalgia rheumatica

Question 6

What are some GI causes of osteoperosis

Answer 6

UC and crohns

Liver diseases:PBC, alcoholic cirrhosis, viral cirrohsis, CAH?

Question 7

What medications cause osteoperosis

Answer 7

Steroids, 
PPI,
Enzyme inducting antiepileptic medications
Aromatase inhibitors
GnRH inhibitors
Warfarin

Question 8

How are osteoperotic fractures prevented?

Answer 8

Minimise risk fractures
Ensure good calcium and vitamin D status
Falls prevention strategies
Medications

Question 9

When you should treat osteoperosis

What do SIGN guidlines reccomend for treatment

Answer 9

When T score is below 2.5

Fracture risk assessment and fracture reduction
Referral for DXA scanning based on FRAX score of >10%.

Question 10

How is HRT used to treat osteoperosis

Answer 10

Reduces falling levels of oestrogen
Comes with side effects such as increased risk of blood clots
Increased risk of breast cancer
Increased risk of heart disease and stroke

Question 11

How is SERMS used to treat osteoperosis

Answer 11

It is a selective oestroen receptor modualtor. Comes with side effects:
Hot flushes
Increased clotting risk
Lack of hip protection

Question 12

How is Bisphosphanate used to treat osteoperosis

Answer 12

Typically first ine of treatment in oral form.
Adequate renal function must be required
Good dental hygeine is advised

Side effects include oesophagitis
Iritis/uveitis
ONJ
Atypical femoral shaft fractures

Question 13

How is Denosumab used to treat osteoperosis

Answer 13

Monoclonal antibody that disruots the RANKL ligand which assists in the bone reabsorbtion. Given as a subcutaneous injection every 6 months and is safer for patients with renal impairment

side effects inclde rash
Hypocalcaemia
ONJ?
Atypical femoral shaft fractures?

Question 14

How is Teriparatide used to treat osteoperosis

Answer 14

Form of parathyroid hormone

side effects include injection site ittitation
rarely hypercalcaemia
Allergy
Cost