Osteoporosis

Question 1

define

Answer 1

this is a progressive systemic skeletal disease characterised by low bone mass and deterioration of bone tissue, with increased risk of fragility fractures

Question 2

where does bone undergo remodelling?

Answer 2

at bone remodelling unit which contributes to calcium homeostasis and skeletal repair

Question 3

bone remodelling

Answer 3

• osteoclast appear on a previously inactive surface and begin to resorb the bone
• osteoclasts are replaced by osteoblasts that fill in the cavity with osteoid that is mineralised
• resorption cavity is filled with new bone

Question 4

what happens in osteoporotic during the remodelling cycle?

Answer 4

increased resorption over formation leads to loss of bone

Question 5

causes of bone loss

Answer 5

sex hormone deficiency (post-menopause oestrogen deficiency)
weight
genetics
diet
immobility
disease
drugs (glucocorticoids and aromatase inhibitors)

Question 6

myeloma presentation

Answer 6

OP

Question 7

common fracture sites?

Answer 7

neck of femur
vertebral body
distal radius
humeral neck

Question 8

test to asses bone density

Answer 8

DEXA scan

Question 9

who should be referred for a DEXA scan?

Answer 9

over 50 with low trauma fractures or other risk factors

Question 10

what is the T score in a DEXA scan

Answer 10

difference between your measurement and that of a young healthy adult

Question 11

what is the Z score in a DEXA scan?

Answer 11

difference between your measurement and someone of the same age

Question 12

what score is used on a DEXA scan if the patient is younger than 20?

Answer 12

Z score

Question 13

diagnosis on DEXA scan

Answer 13

Normal= BMD within 1 SD of the young adult reference mean
osteopenia (low mass)= BMD >1SD of young adult mean but <2.5 SD below this value
osteoporosis= BMD 2.5 or more SD below the young adult mean
severe osteoporosis BMD of 2.5 or more SD below with fragility fracture

Question 14

secondary endocrine causes of osteoporosis

Answer 14

hyperthyroidsim
hyperparathyroidism
Cushing’s disease

Question 15

secondary GI causes of osteoporosis

Answer 15

Coeliac’s disease
IBD
chronic liver disease
chronic pancreatitis

Question 16

secondary respiratory causes of osteoporosis

Answer 16

CF

COPD

Question 17

other secondary causes

Answer 17

chronic kidney disease

Question 18

lifestyle management for OP

Answer 18

strength training
low impact weight bearing
avoidance of alcohol and drugs
fall prevention
diet should include calcium

Question 19

pharmacological options for OP

Answer 19

calcium and vitamin D
bisphosphonates
zoledronic acid
denosumab
teriparatide

Question 20

when should calcium supplements be taken?

Answer 20

not within 2 hours of oral bisphosphonates

Question 21

examples of bisphosphonates

Answer 21

aldendronate

risedreonate

Question 22

action of bisphosphonates

Answer 22

ingested by osteoclasts causes cell death and inhibits bone resorption- filling of resorption sites

Question 23

T score for bisphosphonates to be used

Answer 23

-2.5 or if prolonged steroid use and -1.5

Question 24

adverse of bisphosphonates

Answer 24

osteonecrosis of the jaw
oesophageal calcium
consider bone holiday

Question 25

how often is zoledronic acid administered?

Answer 25

once yearly infusion for 3 years

risks acute phase reaction with first infusion

Question 26

when should zoledronic acid be considered

Answer 26

intolerant to bisphosphonates or unable to comply with regime

Question 27

action of denosumab

Answer 27

monoclonal antibody that inhibits development and activity of osteoclasts decreasing resorption

Question 28

how is denosumab administered?

Answer 28

SC every 6 months

Question 29

adverse of denosumab

Answer 29

hypocalcaemia
eczema
cellulitis

Question 30

describe teriparatide

Answer 30

parathyroid hormone that stimulates bone growth (anabolic agent)

Question 31

how do corticosteroids predispose to OP

Answer 31

cause reduction in osteoblast activity, suppression of osteoblast precursors, reduction in calcium absorption, inhibition of gondal and adrenal steroid production

Question 32

is BMD partially reversible on steroid cessation?

Answer 32

yes