Rheumatology 16 - Osteoporosis + Osteomalacia

Question 1

define osteoporosis

Answer 1

loss of bone density

Question 2

risk factors for osteoporosis

Answer 2

old
female 
underweight 
alcohol, smoking
long term steroids 
SSRIs, PPIs, anti-epileptics

especially post menopausal

Question 3

diagnosing osteoporosis

Answer 3

FRAX scoring - % risk of # in next 10 years

then mineral density DEXA scoring

Question 4

DEXA scoring

Answer 4

T score (vs the young adult)

• 1 or less osteopenia
• 2.5 or less osteoporosis

Question 5

when to perform FRAX asessment

Answer 5

women 65+
men 75+
younger with RFs

Question 6

managing osteoporosis

Answer 6

lifestyle changes, vit D, reduce risk factors

calcichewD3 if doubly deficient

bisphosphonates

Question 7

4 key risks of bisphosphonates

Answer 7

reflux, oesophageal erosions
atypical fractures
osteonecrosis of jaw
osteonecrosis of ear canal (hearing loss)

Question 8

example bisphosphonate regime and how to take

Answer 8

alendronate 70mg once weekly

take on an empty stomach
sitting upright for 30 mins after using

can eat after this time is up

Question 9

follow up for oseoporosis patients

Answer 9

consdier denosumab if BP not suitable
HRT if early menopause

try treatment holiday if BMD improved (1-3 years off BP)

Question 10

define osteomalacia

Answer 10

defective bone mineralisation due to lack of vitamin D

Question 11

presentation of osteomalacia

Answer 11

fatigue
bone pain
muscle weakness+pain
abnormal fracture

Ricket’s in kids

risk factors high - indoor life, colder climate, darker skin

Question 12

testing for vit D deficiency / osteomalacia

Answer 12

serum 25 hydroxyvitamin D

less than 25 - deficient

less than 50 - insufficient

also screen calcium, phosphate, ALP, PTH
x ray

Question 13

treating osteopenia

Answer 13

50,000 IU once weekly for 6 weeks

20,000 IU BW 7 weeks

4000 IU daily

Question 14

treating vit D insufficiency

Answer 14

800 IU daily