Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Condition where there is reduced density of bones.

Question 2

What is osteopenia?

Answer 2

Reduced density of bones not as bad as osteoporosis.

Question 3

What is this a presentation of?

Older, slender female with rheumatoid arthritis, smoker and drinker, on long term corticosteroids.

Answer 3

Osteoporosis

Question 4

What is the FRAX score and what does it consider?

Answer 4

Prediction of risk of fragility fracture over the next 10 years (assess osteoporosis risk).
Considers age, BMI, co-morbidities, smoking, alcohol, and family history.

Question 5

How is bone mineral density measured and what are the two scores?

Answer 5

1. DEXA scan - measures how much energy is absorbed by the bone.
2. Measured at the hip
3. Z-score - number of standard deviations below mean for age
4. T-score - number of standard deviations below mean for healthy younger adult

Question 6

What are the T-score ranges in the WHO classification of osteoporosis?

Answer 6

1. Normal >-1
2. Osteopenia -1 to -2.5
3. Osteoporosis

Question 7

What are the age cut-offs for FRAX score in men vs women?

Answer 7

Men >75
Women >65
Young patients if they have risk factors

Question 8

What lifestyle changes should be considered in those with osteoporosis?

Answer 8

Activity, healthy weight, adequate calcium/vitamin D intake, avoid falls, stop smoking, reduce alcohol consumption.

Question 9

What is the first line treatment for osteoporosis and how do they work?

Answer 9

Bisphosphonates - interfere with osteoclasts and reduce their activity, preventing reabsorption of bone.

Question 10

What are the side effects associated with osteoporosis first line treatment and how are they resolved?

Answer 10

1. Reflux and oesophageal erosions (take on empty stomach sat upright for 30 mins)
2. Atypical fractures, osteonecrosis of the jaw and external auditory canal

Question 11

What are the other medical options for osteoporosis and how do they work?

Answer 11

1. Denosumab - monoclonal Ab against osteoclasts
2. Strontium ranelate - stimulates osteoblasts and blocks osteoclasts
3. Raloxifene - selective oestrogen reuptake receptor modulator (stimulates in bone, blocks in breast and uterus)
4. HRT

Question 12

When should osteoporosis patients be followed up and how?

Answer 12

1. Low risk - within 5 years for assessment

2. If on bisphosphonates - FRAX and DEXA after 3-5 years