Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Reduced bone mass leading to bone fragility and increased fracture risk

Question 2

What is the primary cause of osteoporosis? (2)

Answer 2

Menopause

Age

Question 3

What is the secondary cause of osteoporosis? (9) [SHATTERED]

Answer 3

Steroid use
Hyperthyroid, hyperparathyroid
Alcohol, smoking
Thin (BMI <18.5)
Testosterone low
Early menopause
Renal or liver failure
Erosive/ inflammatory bone disease
Dietary Ca low, malabsorption

Question 4

What are the clinical presentations for osteoporosis? (4)

Answer 4

Asymptomatic until fracture

• NoF fracture (hip)
• Colles/ Smith’s fracture (wrist)
• Stopping posture, shorter (vertebra)

Question 5

How would you investigate osteoporosis? (3)

Answer 5

DEXA bone scan
X-ray
FRAX

Question 6

What does a DEXA score 0 to -1 mean?

Answer 6

Normal

Question 7

What does a DEXA score -1 to -2.5 mean?

Answer 7

Osteopenia

Question 8

What does a DEXA score -2.5 or less mean?

Answer 8

Osteoporosis

Question 9

What are some of the factors assessed in the FRAX tool? (8)

Answer 9

• Age
• Weight
• Previous fracture
• Parent fractured hip
• Current smoking
• Glucocorticoids
• RA
• Alcohol > 3units/ day

Question 10

How would you treat osteoporosis non-pharmacologically? (5)

Answer 10

Stop smoking
Alcohol
Regular weight-bearing exercise
Vit D supplements
Ca rich diet (dairy)

Question 11

How would you treat osteoporosis pharmacologically? (2)

Answer 11

Bisphosphates
1st line - alendronic acid
Denosumab (mab to RANK ligand)

Question 12

What advice should you give on taking bisphosphonates? (3)

Answer 12

Swallow pill w plenty of water
Sit upright > 30 mins after taking
Wait 30 mins before eating or other drugs

Question 13

How do bisphosphonates work?

Answer 13

Inhibit bone resorption by inhibiting osteoclast activity