Wk 17: Osteoporosis in practice

Question 1

What is considered high in the FRAX assessment tool?

Answer 1

• 5% hip fracture

- 20% major osteoporotic

Question 2

What are the first line treatments?

Answer 2

• Oral BPs: alendronic, risedronate
• Patient eligible for risk assessment + has 10 yr probability of fracture of at least 1%
• Review after 5 yrs

Question 3

What should you do when taking oral BPs?

Answer 3

• Avoid any other med for at least 30 mins

- Avoid calcium supplements for 2 hrs

Question 4

What are the counselling points for alendronic acid/risedronate?

Answer 4

• Med red chance of breaking bone; taken once a week
• Take at least 30 mins before breakfast, glass of water, remain upright for 30 mins
• Take calcium supplements at diff time or miss morning dose on that day
• S/e: heartburn
• Maintain good dental hygiene
• Report thigh/ hip/ groin pain
• Review treatment after 5 yrs

Question 5

What is the difference when counselling ibandronate compared to alendronic acid?

Answer 5

Once monthly, 1 hrs rather than 30 mins

Question 6

Zoledronic acid

Answer 6

• 5mg annual IV infusion over 15 mins
• S/e: flu symptoms, hypocalcaemia, osteonecrosis of jaw, atypical fracture
• Review: 3 yrs
• Regular dental check up + ONJ reminder card

Question 7

Denosumab

Answer 7

• For meno women
• 60mg SC injection 6 monthly
• S/E: hypocalcaemia, UTI, rash, atypical fracture, osteonecrosis of jaw

Question 8

What supplements are given to people on osteoporotic treatment?

Answer 8

Calcium + vit D (Ergocalciferol)

Question 9

What is given for rapid correction of vit D deficiency (osteomalacia)?

Answer 9

• Loading dose 300,000 units vit d as separate weekly or daily dose over 6-10 wks
• Maintenance 800-2000 units daily

Question 10

What is a drug holiday?

Answer 10

• Stop bisphosphonates for 1-2 yrs
• After 10 yrs, drug holiday if not already
• Bis: upto 5 yrs
• Stop treatment: gradual dec BMD, inc BTM

Question 11

Which drug is not suitable for drug holidays?

Answer 11

Denosumab

• Not retained in bone
• On cessation: inc bone resorption, rapid decline in BMD, spontaneous vertebral fracture

Question 12

What are the markers of bone resorption?

Answer 12

• CTX ( dec initiation of bis + inc on cessation)

- NTX

Question 13

What are the markers of bone formation?

Answer 13

• P1NP
• Osteocalcin
• ALP