Osteoporosis

Question 1

What is osteoporosis?

Answer 1

A skeletal condition characterised by low bone mass, deterioration of bone tissue, and disruption of bone architecture.
- Leads to compromised bone strength and increased risk of fracture

Question 2

What are the non modifiable risk factors for osteoporosis?

Answer 2

• Advanced age (>65)
• Female
• Caucasian or South Asian
• Family history

Question 3

What are the modifiable risk factors for osteoporosis?

Answer 3

• Low body weight (less than 58kg)
• Premature menopause
• Calcium/vit D deficiency
• Inadequate physical activity
• Cigarette smoking
• ## Excessive alcohol intake

Question 4

What drugs cause osteoporosis?

Answer 4

• Corticosteroids

- Aromatase inhibitors

Question 5

What imaging is best to diagnose OP?

Answer 5

DEXA (xray) scan of the lumbar spine and hip is the gold standard

Question 6

What is T score?

Answer 6

Compares the patients bone density of people of the same gender at peak density (25yo)

T score:
Normal = -1 or over
Osteopenia = Between -1 and -2.5
Osteoporosis = Less than -2.5

Question 7

What is the Z score?

Answer 7

Compares bone mineral density to an age and gender matched population

Question 8

What does a Z score of

Answer 8

Evaluation for secondary causes of secondary osteoporosis

Question 9

What lifestyle measures can help with OP?

Answer 9

• Quit smoking and reduce alcohol
• Weight bearing exercise
• Balance exercises
• Calcium and vitamin D rich diet or supplementation
• Home based fall prevention programme

Question 10

What first line pharmacological management is there for OP?

Answer 10

Bisphosphonates - alendronic acid, IV if oral not tolerated

Calcium and vitamin D supplementation

Question 11

How should you tell the patient to take bisphosphonates?

Answer 11

Swallow pills with plenty of water and remain upright for 30 minutes, wait 30 minutes before eating or other drugs.

Question 12

What are the side effects of bisphosphonates?

Answer 12

• Photosensitivity
• GI upset
• Oesophageal ulcers (stop if dysphagia, abdo pain, jaw osteonecrosis)

Question 13

What are the second line drugs for osteoporosis?

Answer 13

Denosumab (biannually injection) or teriparatide (recombinant PTH)

Question 14

What are some risk factors for secondary osteoporosis? SHATTERED

Answer 14

S - Steroid use >5md/day prednisolone
H - Hyperthyroidism/Hyperparathyroidism/Hypercaliuria
A - Alcohol and tobacco use
T - Thin
T - Testosterone deficiency
E - Early menopause
R - Renal or liver failure
E - Erosive/Inflammatory bone disease (myeloma/RA)
D - Dietary low Ca/Malabsorption, DM type 1