osteoporosis guidelines

Question 1

osteoporosis - risk factors that get MBS funding for DEXA (10)

Answer 1

endocrine
- premature menopause
- hypogonadism
- hyperthyroidism
- hyperparathyroidism
- chronic glucocorticoid use - over 7.5mg/ day , over 3 months
- anti-androgen therapy
gen med
- rheumatoid arthritis
- CKD
- Chronic liver disease
- coeliac disease, malabsorption

Question 2

osteoporosis - medications associated with risk (5)

Answer 2

neuropsych - SSRI, antipsychotics, antiepileptics
chronic PPI use
thiazolidenediones

Question 3

osteoporosis ix - MBS funded DEXA indications (3)

Answer 3

any age > 70 years
over 50 or post menopausal + any of
* minimal trauma fracture
* presence of risk factors

Question 4

osteoporosis ix - indications for falls risk assessment (3)

Answer 4

2 falls in 12 months
difficulty walking
balance issues

Question 5

osteoporosis ix - indications for spinal xray (3)

Answer 5

loss of height >= 3cm
kyphosis
unexplained back pain

Question 6

osteoporosis ix. - when to repeat a DEXA scan, what intervals (3)

Answer 6

considering therapy cessation (do at 5-10 years)
last scan > 2 years, and concerned about osteoporosis
patients at high risk (eg glucocorticoid therapy) - annual

Question 7

osteoporosis - diagnostic criteria (2)

Answer 7

either of

• minimal trauma # in hip or spine + age >50
• T-score <= -2.5

Question 8

osteoporosis management - indications for medical treatment (4)

Answer 8

• age ≥50 and minimal trauma fracture in hip or spine
• age ≥ 50, minimal trauma fracture elsewhere, T-score ≤ -1.5
• T-score ≤ -2.5
• High 10 year risk of fracture on risk calculator

Question 9

osteoporosis management - when to consider cessation of medical treatment

Answer 9

T-score > -2.5 and no fractures in 5-10 years

Question 10

osteoporosis management - allied health assessments prior to medical therapy, why

Answer 10

dental assessment, risk of jaw osteonecrosis

Question 11

osteoporosis management

• recommended exercise programs
• exercise that doesn’t help

Answer 11

best - high intensity resistance and balance training

not great - leisure walking, swimming, cycling

Question 12

osteoporosis management - indications for calcium supplements, dosage

Answer 12

institutionalised individuals - target 5-600mg/day
confirmed osteoporosis, dietary calcium intake < 1.3g/day - target 1.3g/day
and vit d <50nmol/l

Question 13

osteoporosis management

- lifestyle changes that are not exercise or calcium related (4)

Answer 13

• implement falls reduction strategies (OT)
• no smoking
• no ETOH
• education and psychosocial support

Question 14

osteoporosis management - medical treatment options

IV, oral bisphosphonate and mab dosage regime

Answer 14

IV
zoledronic acid 5mg IV, 15 min infusion every 6 months

PO
risedronate 150mg PO monthly
risedronate 35mg PO weekly
alendronate 70mg PO weekly

SC
denosumab 60mg SC 6 monthly