Osteoporosis

Question 1

Causes of Osteoporosis

Answer 1

history of glucocorticoid use
rheumatoid arthritis
alcohol excess
history of parental hip fracture
low body mass index
current smoking

Question 2

Less important causes of OA

Answer 2

sedentary lifestyle
premature menopause
Caucasians and Asians
endocrine disorders: hyperthyroidism, hypogonadism (e.g. Turner's, testosterone deficiency), growth hormone deficiency, hyperparathyroidism, diabetes mellitus
multiple myeloma, lymphoma
gastrointestinal disorders: inflammatory bowel disease, malabsorption (e.g. Coeliac's), gastrectomy, liver disease
chronic kidney disease
osteogenesis imperfecta, homocystinuria

Question 3

Medications that may worsen osteoporosis- OTHER than glucocorticoids

Answer 3

SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole

Question 4

Ix for osteoporosis

Answer 4

History and physical examination
Blood cell count, sedimentation rate or C-reactive protein, serum calcium,
albumin, creatinine, phosphate, alkaline phosphatase and liver transaminases
Thyroid function tests
Bone densitometry ( DXA)

Question 5

For all patients suspected, what are the MINIMUM bloods which should be ordered

Answer 5

full blood count
urea and electrolytes
liver function tests
bone profile
CRP
thyroid function tests

Question 6

Osteoporosis : DEXA scan

What is the T score

Answer 6

Based on bone bass of young reference population

Question 7

T scores of -1.0 meaning

Answer 7

means bone mass of one standard deviation below that of young reference population

Question 8

Z score meaning

Answer 8

Z score is adjusted for age, gender and ethnic factors

Question 9

T score and their indications for osteoporosis

Answer 9

> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis

Question 10

Bone protection given to patients on long-term steroids

Answer 10

Calcium and vitamin D replete