Osteoporosis

Question 1

What are the non-modifiable risk factors for osteoporosis?

Answer 1

Advanced age (>65 years)
Female gender
Caucasian or south Asians
Premature osteoporosis (age<45)
Family history of osteoporosis-genetic
History of low trauma fracture (fall from
standing height or less, at walking speed or
less)

Question 2

What are the modifiable risk factors for osteoporosis?

Answer 2

Low body weight
Calcium/vitamin D deficiency
Inadequate physical activity
Cigarette smoking
Excessive alcohol intake (>3 drinks/day)
Iatrogenic: e.g. corticosteroids, aromatase
inhibitors

Question 3

What medications can cause osteoporosis?

Answer 3

Heparin
PPI
Anti epileptics
Steroids

Question 4

What investigations should be done to rule out other causes of low impact fractures?

Answer 4

Vit D
U&Es-kidneys
Parathyroid and thyroid hormones
BM- diabetes
Warfarin
Testosterone
Medications
LFTs- hepatitis
Xray- cancer

Question 5

How is a diagnosis of osteoporosis made?

Answer 5

DEXA scan shows bone density- gives a T score

FRAX- Shows 10 yr chance of hip fracture and 10 yr chance of major osteoporotic fracture

Question 6

What T score value indicates osteoporosis

Answer 6

less than -2.5

Question 7

How is osteopenia treated?

Answer 7

Focus on risk modification:
Weight bearing exercise
Vit D
Limiting alcohol
Smoking cessation

Question 8

How is osteoporosis treated?

Answer 8

Vit D and Ca supplements
1st line- oral bisphosphonates
2nd line- Denosumab or teriparatide

Question 9

What bisphosphonates can be given and by what route?

Answer 9

Alendronate- oral
Risedronate- oral
Zoledronic acid- IV

Question 10

What is the biggest complication of bisphosphonates?

Answer 10

Osteonecrosis- of jaw and bones in external auditory canal.

Too much bisphosphonate hardens bone and causes fracture.