OSTEOPOROSIS

Question 1

what is osteoporosis and what causes it

Answer 1

its this bones and reduction in bone mass

with age there is increased bone resorption

in women who are postmenopausal they are at a higher risk of developing osteoporosis as they have lower oestrogen levels . low oestrogen = more bone resorption

Question 2

what are the risk factors of osteoporosis

Answer 2

smoker
low BMI
use of corticosteroids 
family hx 
females 
excess alcohol
hyperthyroidism 
chronic diseases

Question 3

what are the clinical features of osteoporosis

Answer 3

getting shorter

fractures

slouching back- Kyphosis

Question 4

what investigations are carried out for osteoporosis

Answer 4

DXA: measures bone density .

T score; If T score of -2.5 SD or below its osteoporosis

if its between -1 and -2.5 osteopenia

xray

Bindex used in primary care: portable

Question 5

what is used as an assessment for fracture risk?

Answer 5

you need to consider fracture risk in all women over 65 and all men over 75

however you can do fracture risk assessment if they have certain risk factors:

• previous fracture
• low BMI
• Family Hx
• smoking and alcohol
• kyphosis
• BMD T score of -205 SD

Question 6

should you routinely assess fracture risk in people under 50?

what about under 40’s

Answer 6

You don’t routinely assess fracture risk in under 50’s unless they have major risk factors eg, current use of glucocorticoids

for under 40’s : 7.5mg glucocorticoid

major rf

Question 7

RF’S considered in FRAX

Answer 7

• age
• sex
• bmi
• smoking and alcohol
• glucocorticoids
• rheumatoid arthritis

Question 8

non drug management of osteoporosis

Answer 8

• calcium 700-1200mg daily
• vitamin d
• weight bearing exercise
• stop alcohol and smoking

Question 9

pharmacological treatment for osteoporosis , who gets it?

primary and secondary

Answer 9

first line is oral bisphosphonates eg alendrotnic acid 70mg once weekly

or risedronate sodium

THEN

IV bisphosphonate ibandronic acid zolendronic acid

Question 10

bisphosphonate mechanism of action

Answer 10

bisphosphonate causes osteoclast apoptosis .

it inhibits bone resorption

it binds to the hydroxyapatite crystals in the bone

Question 11

alendrotnic acid and risedronate sodium dose, counselling , cautions ?

Answer 11

alendrotnic acid 70mg once weekly 30 mins before food in the morning , sit upright and take with plenty of water. stay upright for another 30 mins

risedronate sodium 35mg weekly 30 mins before food in the morning or 2 hours after food during the day, sit upright

caution it can cause oesophageal irritation and heartburn

Question 12

osteonecrosis of the jaw and ear Canal

Answer 12

advice pt on dental hygiene and dental check ups

risk of ONJ and ONEC in its who take IV bisphosphonate

Question 13

3rd line osteoporosis how does it work and dose/route

Answer 13

Denosumab is a monoclonal antibody which inhibits osteoclast formation to therefore decrease resorption

binds to cytokine RANKL

DENOSUMAB IS INJECTED SC 60MG EVERY 6 MONTHS

Question 14

Hypocalcaemia with denosumab

Answer 14

Denosumab is also associated with osteonecrosis of the jaw and hypcalcaemia: occurs usually in the first weeks on treatment

therefore need calcium plasma monitoring

Question 15

HRT for osteoporosis

Answer 15

HRT shouldn’t be used for first line prevention in over 50’s

can be used for early and post menopause

HRT increases the risk of VTE

HRT used as prophylaxis in early menopause to prevent post menopause osteoporosis

Question 16

what’s used for secondary prevention

Answer 16

1. oral bisphosphonate
2. Raloxifine : selective oestrogen receptor modulator
3. Teriparatide: recombinant parathyroid hormone , given sc , max 24 months or can cause cancer