Osteoporosis

Question 1

What % of F over 50 will have an osteoporotic fracture in their lifetime

Answer 1

1/3

Question 2

What % will die after a hip fracture?

Answer 2

33%

Question 3

WHO definition of OP

Answer 3

Bone mineral density >2.5SD below that of a young adult male

Question 4

What T value is classed as osteopaenia?

Answer 4

1-2.5

Question 5

When does bone mass peak?

Answer 5

20-30

Question 6

When do women have an accelerated bone loss phase?

Answer 6

After menopause (because O deficiency)

Question 7

What are the stages of bone remodelling

Answer 7

Activation osteoclasts
Aggregation + adherence of osteoclasts
Osteoclastic breakdown bone matrix, releasing Ca, minerals + active GF

Question 8

RF OP (9)

Answer 8

F
Previous fragility fracture 
Maternal Hx hip fracture 
Current smoker 
Alcohol intake >3units/day
Glucocorticoids >3m at 5mg/day 
Low Ca + vit D defic 
Genetics
Low BMI <19

Question 9

2’ causes of OP (9)

Answer 9

RA
Hyperthyroidism
Steroid induced 
Cushings 
Premature menopause 
Chronic malabsorption 
COPD
Prolonged bed rest
CLD

Question 10

OP on xray

Answer 10

Bone appears > radiolucent than norm w/ looser zones

Question 11

Sx OP (4)

Answer 11

Fragility fractures
Back pain
H loss
Kyphosis

Question 12

How to work out the 10 year risk fractures

Answer 12

FRAX tools

Question 13

Ix OP

Answer 13

Bloods
DEXA
Whole spine Xray
CTX levels

Question 14

What is a T score

Answer 14

Av 25 y/o BMD

Question 15

What is a Z score

Answer 15

Age matched control

Question 16

Indications DEXA (6)

Answer 16

Low impact fracture 
Steroid Tx 3> months 
Early menopause 
Hip fracture either parents 
Conditions which affect bones
BMI <18

Question 17

Mx OP

Answer 17

Vit D + co-admin Ca

Bisphosphonates = mainstay

Question 18

How do bisphosponates work

Answer 18

Inhibit osteoclastic bone resorption

Question 19

How long do pt receive bisphosphonates for

Answer 19

3-5y

Question 20

Most commonly prescribed bisphosphonate

Answer 20

Alendronate

Question 21

Indications alendronate

Answer 21

Fragility fracture
Over 75
Post menopausal

Question 22

Sites benefited - alendronate (3)

Answer 22

Hip
Vertebral
Non-vertebral

Question 23

Cautions - alendronate (3)

Answer 23

UGI SE

Poor bio-availability

Question 24

Cautions - bisphosphonates (4)

Answer 24

Renal impairment
Planned dental extraction
Osteonecrosis of the jaw
Atypical femoral fracture

Question 25

E.g of an IV bisphosphonate

Answer 25

Zoledronic acid

Question 26

Indications zoledronic acid (2)

Answer 26

Intolerant of PO bisphosphonate

Question 27

Sites benefited - zoledronic acid (3)

Answer 27

Hip
Vertebra
Non-vertebral

Question 28

Specific caution zoledronic acid

Answer 28

Ensure Vit D = replete

Question 29

Drug class - Denosumab

Answer 29

Monoclonal AB to rank L

Question 30

How is Denosumab taken

Answer 30

6 monthly injection

Question 31

Indications denosumab (2)

Answer 31

Intolerant of PO bisphos

Renal impairment

Question 32

Sites benefited - denosumab (3)

Answer 32

Hip
Vertebral
Non -vertebral

Question 33

Cautions denosumab (4)

Answer 33

Ensure Vit D replete
Atypical femoral fractures
Osteonecrosis of the jaw
Caution in those at high risk of infections

Question 34

What type of med is Raloxifene

Answer 34

Selective O receptor modulation

Question 35

Indications raloxifene (2)

Answer 35

2’ prevention PM women w/ vert fracture

Reduces risk O +ve breast Ca

Question 36

Site benefited - raloxifene (1)

Answer 36

Vertebral

Question 37

Caution - raloxifene

Answer 37

VTE

Question 38

What type of med is Teriparatide

Answer 38

Anabolic - directly stimulates osteoblastic bone formation

Question 39

Indications teriparatide (2)

Answer 39

Severe OP

Tx failure

Question 40

Site benefited - teriparatide

Answer 40

Vertebral

Question 41

Caution. - teriparatide

Answer 41

Hypercalcaemia