osteoporosis & osteopenia

Question 1

define osteoporisis

Answer 1

a condition where there is a reduction in the density of the bones.d

Question 2

define osteopenia

Answer 2

refers to a less severe reduction in bone density than osteoporosis.

Question 3

impact of reduced bone density

Answer 3

makes bone less strong and more prone to fractures

Question 4

pathophysiology of osteoporosis and osteopenia

Answer 4

results from:
- increased bone breakdown by osteoclasts
and
- decreased bone formation by osteoblasts.

Question 5

3 main causes of osteoporosis and osteopenia

Answer 5

1. oestrogen deficiency
2. glucocorticoids
3. ageing

Question 6

how does oestrogen deficiency cause osteoporosis

Answer 6

increased number of remodelling units, leading to a premature arrest of osteoblastic activity.

Question 7

how do glucocorticoids cause osteoporosis

Answer 7

they induce a high rate of turnover initially and the prolonged use of them leads to a reduced turnover rate and a net loss due to reduced synthesis by osteoblasts.

Question 8

how does ageing cause osteoporosis

Answer 8

Increased bone turnover leads to a weak bone structure.

Question 9

signs and symptoms of osteoporosis

Answer 9

• Back pain (due to collapsed vertebra)
• Loss of height over time
• A stooped posture
• Fragility (unexpected) fractures

Question 10

risk factors of osteoporosis/osteopenia

Answer 10

SHATTERED FAMILY

Steroid use
Hyperthyroidism/hyperparathyroidism
Alcohol and smoking
Thin (BMI<22)
Testosterone deficiency
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease
Diabetes
FAMILY history

Question 11

gold standard investigation for osteoporosis

Answer 11

DEXA Scan

Question 12

what does a DEXA scan do

Answer 12

Measures bone mineral density using X-rays to measure how much radiation is absorbed by the bone.

The measurement is usually taken from the femoral head.

Question 13

how to interpret a DEXA scan

Answer 13

Z-score – The number of standard deviations the patient is from the average for their age, sex, and ethnicity

T-score – The number of standard deviations the patient is away from an average healthy, young adult.

The T-score is used to make the diagnosis.

Question 14

other investigations for osteoporosis

Answer 14

1. X-ray for suspected fractures
2. MRI of the spine to assess for vertebral fractures
3. Blood tests to exclude metabolic causes and assess vitamin D, calcium, and hormone levels.
4. FRAX score

Question 15

first line treatment for osteoporosis

Answer 15

biphosphonates

Question 16

what does a FRAX score do

Answer 16

10 year prob of a major osteoporotic/hip fracture

uses info (BMI, co-morbidities, smoking, alcohol, FHx)

Question 17

second line treatment for osteoporosis

Answer 17

Denosumab - (monoclonal Ab that blocks activity of osteoclasts – binds to RANK-ligand)

Question 18

other treatment options for osteoporosis

Answer 18

Address reversible factors (obesity, smoking, alcohol)

Calcium and vitamin D supplements – if needed

HRT - especially for pre menopausal women