Osteoporosis (1)

Question 1

What is this?

What is its pre-condition?

What are its risk factors?

What is it characterised by?

Answer 1

➊ Reduction in bone density, making bone weaker and more prone to fractures

➋ Osteopenia

➌ • Elderly
• Female
• Anorexia (BMI < 19)
• Long-term steroids
• Menopause (Oestrogen promotes bone formation)
• Prolonged immobility, Alcohol, Smoking
• RA

➍ Fragility fractures

Question 2

FRAX Tool:
What is it?

What would make its score more accurate?

If results show a high risk, what should then be done?

Answer 2

➊ Tool to assess risk of fragility fracture over next 10 yrs

➋ Including the BMD (can be done w/o it however)

➌ DEXA scan

Question 3

Bone Mineral Density/BMD:
What’s used to measure this?
→ Which part of the body is used here?

What are the 2 scores given? What does each mean?
→ Which of these is the more important measurement?

What do the T score levels indicate?

Answer 3

➊ DEXA scan
→ Hip

➋ • Z score - No. of standard deviations of bone density below mean for their age
• T score - No. of standard deviations of bone density below mean for a healthy, young adult
→ T score

➌ • -1 to -2.5 - Osteopenia
• < -2.5 - Osteoporosis

N.B. Bone profile will be normal in these pts.

Question 4

Management:
What lifestyle advice should be given?

What’s the 1st line medical option?
→ How does it work?
→ What are its key SEs?

What else may be given?

What are the other 2nd line medical options?

Answer 4

➊ • Reduce risk factors - e.g. smoking cessation, reduce alcohol, better diabetic control
• Diet - adequate vit D, calcium, protein
• Exercise

➋ Bisphosphonates e.g. Alendronate, Zoledronic acid
→ Reduces osteoclast activity, therefore preventing bone reabsorption
→ Reflux, Oesophageal ulcers, Jaw osteonecrosis

➌ Calcium and Vit D supplements in those deficient

➍ • HRT in menopausal women
• Denosumab - matures osteoclasts
• Raloxifene - has oestrogenic effects
• Teriparatide (a parathyroid hormone) - stimulates bone growth