Osteoporosis

Question 1

What is the WHO definition of osteoporosis? and what type of fractures can it lead to?

Answer 1

Bone mineral density (BMD) of less than 2.5 standard deviations below the young adult mean density

Osteoporosis can lead to fragility fractures. These are fractures that occur as result of mechanical forces that don’t normally lead to a fracture

Question 2

What are some risk factors for osteoporosis?

Answer 2

Age 
Female
Corticosteroid use
Rheumatoid arthritis
Smoking
Alcohol
Low BMI
Previous Hx of fragility fracture
Hx of falls
Family Hx of hip fracture
Causes of secondary osteoporosis e.g. Cushing's disease, hyperthyroidism, chronic renal disease, cancer

Question 3

How is actual bone mineral density (BMD) assessed?

Answer 3

Dual-energy X-ray absorptiometry (DEXA) scan

DEXA scan looks at the hip and lumbar spine. If either have a T score of < -2.5 (SD) then treatment is recommended

Question 4

What do the DEXA scan T scores indicate?

Answer 4

> -1.0 = normal

-1.0 to -2.5 = osteopenia

Question 5

What clinical prediction tools does NICE recommend using to assess a patients 10 year risk of developing a fracture?

Answer 5

FRAX:
Estimates the 10 year risk of fragility fracture
Valid for patients aged 40-90yrs old
Assesses the following risk factors: age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, alcohol intake

QFracture:
Estimates the 10-year risk of fragility fracture
Can be used for patients aged 30-99yrs old
Includes a larger group of risk factors e.g. cardiovascular disease, Hx of falls, chronic liver disease, rheumatoid arthritis, T2DM and tricyclic antidepressants

Question 6

When should risk of fragility fractures be assessed?

Answer 6

In all women aged >65 and all men aged >75

Younger patients should be assessed if they have any of the risk factors for osteoporosis

Question 7

How may a patient with osteoporotic vertebral fractures typically present?

What clinical signs may this patient present with?

Answer 7

Asymptomatic
Acute back pain
Breathing difficulties and GI problems - changes in shape of vertebrae leads to compression of organs e.g. lungs, heart, intestine
Hx of falls/trauma

Loss of height due to compression of spinal vertebrae
Kyphosis
Localised tenderness on palpation of spinous process at fracture site

Question 8

What is the management for osteoporosis?

Answer 8

1st line = bisphosphonate e.g. alendronate
If can’t tolerate alendronate due to GI problems, offer other bisphosphonate such as risedronate or etidronate

If can’t tolerate bisphosphonate then can give strontium ranelate or raloxifene

Offer Vitamin D and Calcium supplements