Osteoporosis and Fragility Fractures

Question 1

What is a fragility fracture?

Answer 1

Fractures cuased by falls or trauma from standing height or less

Question 2

What can be used to screen osteoporosis risk?

Answer 2

• Q fracture
  
  • Estimates 10 year fragility fracture risk
  • Patients 30-99 yrs
• FRAX
  
  • Estimates 10 year fragility fracture risk
  • Patients 40-90 yrs

Question 3

What patients should receive a multifactorial risk assessment for falls?

Answer 3

• Two or more falls in the past 12 months
• PResentation for medical attention with a fall
• Difficulty with walking or balance

Question 4

What should be covered in a multifactorial risk assessment and management plan?

Answer 4

1. Enquire about the history of the falls
2. Consider the impact of co-morbidities
3. Review medications
4. Perform an examination
5. Perform a lying and standing BP
6. Perform a ‘get up and go’
7. Assessment of home hazards by OT

Question 5

Give examples of things you would want to find out when enquiring about a history of the falls?

Answer 5

• How did they fall?
• What exactly happened?
• How many falls in the past year?
• Did you black out or just go down?

Question 6

The withdrawal of what medications can reduce the risk of falls?

Answer 6

• Psychotropic medications
  
  • Antidepressants
  • Antipsychotics
  • Sedatives

Question 7

What should the examination focus on regarding falls?

Answer 7

• Vision
• HR and rhythm
• Muscle strength
• Neurological impairment
• Knee exam
• Peripheral sensation
• Feet/footwear

Question 8

Describe a get up and go test?

Answer 8

• Ask patient to rise from a standard armchair
• Walk a fixed distance across the room
• Turn and walk back to the chair and sit down

Question 9

What are the most common bone problems found in elderly people?

Answer 9

• Osteoporosis
• Vitamin D deficiency

Question 10

What can be used to assess bone density in patietns with a high FRAX/Q fracture score?

Answer 10

DXA scanning

Question 11

A 56-year-old woman attends the rheumatology clinic for follow up of her rheumatoid arthritis after a recent flare-up which was treated with oral prednisolone. When assessing the patient, her fracture risk assessment tool (FRAX) score was found to be 11%.

What is the most appropriate next step of management in regards to her FRAX score?

Answer 11

DEXA scan

Question 12

How do you treat cerebral oedema as a complication of brain mets?

Answer 12

IV dexamethasone

Question 13

What is the initial first line treatment for hypercalcaemia?

Answer 13

IV saline

Question 14

T anc z score interpretation

Answer 14