Osteoporosis

Question 1

Osteoporosis occurs most commonly in who? (3)

Answer 1

1. Postmenopausal women
2. Men over 50 years of age
3. Patients taking long-term oral corticosteroids

Question 2

Some diseases are known to be associated with osteoporosis such as (2)

Answer 2

RA

Diabetes

Question 3

Risk factors for osteoporosis include age, low BMI, lack of physical activity, vitamin D deficiency and low calcium intake and what else? (5)

Answer 3

1. Cigarette smoking
2. Excess alcohol intake
3. Family history of hip fractures
4. Previous fracture at site characteristic of osteoporotic fractures.
5. Women only: early menopause.

Question 4

What lifestyle changes should patients with osteoporosis be encouraged to make? (4)

Answer 4

1. Increase level of physical activity.
2. Stop smoking.
3. Maintain a normal BMI (20-25)
4. Reduce alcohol intake
5. Dietary intake of calcium and vitamin D should be adequate

Question 5

What drugs are considered first-line for most patients with postmenopausal osteoporosis due to their broad spectrum of anti-fracture efficacy?

Answer 5

Oral bisphosphonates, alendronic acid and risedronate sodium are considered as first-line choices for most patients with postmenopausal osteoporosis due to their broad spectrum of anti-fracture efficacy.

Question 6

What alternative options are there for women who are intolerant of oral bisphosphonates or in whom they are contra-indicated.

Answer 6

Intravenous bisphosphonates (ibandronic acid or zoledronic acid), denosumab, or raloxifene hydrochloride are alternative options in women who are intolerant of oral bisphosphonates or in whom they are contra-indicated.

Question 7

The use of HRT for osteoporosis is generally restricted to which patient group?

Answer 7

The use of HRT for osteoporosis is generally restricted to younger postmenopausal women with menopausal symptoms who are at high risk of fractures.

Question 8

Why is the use of HRT for osteoporosis generally restricted to younger postmenopausal women with menopausal symptoms who are at a high risk of fractures?

Answer 8

The use of HRT for osteoporosis is generally restricted to younger postmenopausal women with menopausal symptoms who are at high risk of fractures. This is due to the risk of adverse effects such as cardiovascular disease and cancer in older postmenopausal women and women on long-term HRT therapy.

Question 9

Teriparatide is a recombinant protein form of parathyroid hormone consisting of the first (N-terminus) 34 amino acids, which is the bioactive portion of the hormone. Its use is reserved for what patient group? How long is treatment limited to?

Answer 9

Teriparatide is reserved for postmenopausal women with severe osteoporosis at very high risk for vertebral fractures. Its duration of treatment is limited to 24 months.

Question 10

Glucocorticoid therapy is associated with bone loss and increased risk of fractures. The greatest rate of bone loss occurs when?

Answer 10

Glucocorticoid therapy is associated with bone loss and increased risk of fractures. The greatest rate of bone loss occurs early after initiation of glucocorticoids and increases with dose and duration of therapy.

Question 11

Glucocorticoid therapy is associated with bone loss and increased risk of fractures. The greatest rate of bone loss occurs early after initiation of glucocorticoids. What impact do duration of therapy and dosage have on bone loss?

Answer 11

Glucocorticoid therapy is associated with bone loss and increased risk of fractures. The greatest rate of bone loss occurs early after initiation of glucocorticoids and increases with dose and duration of therapy.

Question 12

Women aged 70 years or over, or with a previous fragility fracture, or taking large doses of glucocorticoids (prednisolone ≥___mg daily or equivalent) are at high risk of fractures and should be assessed for prophylactic bone-protection .

Answer 12

Women aged 70 years or over, or with a previous fragility fracture, or taking large doses of glucocorticoids (prednisolone ≥7.5 mg daily or equivalent) are at high risk of fractures and should be assessed for prophylactic bone-protection .

Question 13

What are the recommended first-line treatments for osteoporosis in men?

Answer 13

Oral bisphosphonates, alendronic acid or risedronate sodium are recommended as first-line treatments for osteoporosis in men. Intravenous zoledronic acid or denosumab are alternatives in men who are intolerant of oral bisphosphonates or in whom they are contra-indicated; teriparatide is an additional option.

Question 14

Men having long-term therapy utilizing what for prostate cancer have an increased fracture risk?

Answer 14

Men having long-term androgen deprivation therapy for prostate cancer have an increased fracture risk. Fracture risk should be assessed when starting this therapy. A bisphosphonate can be offered to men with confirmed osteoporosis; denosumab is an alternative if bisphosphonates are contra-indicated or not tolerated.

Question 15

There is some evidence to suggest that patients can benefit from a bisphosphonate-free perioid as their therapeutic effects last for some time after cessation of treatment.

Bisphosphonate treatment should be reviewed after _ ______ of treatment with alendronic acid, risedronate sodium or ibandronic acid, and after _ _____ of treatment with zoledronic acid.

Answer 15

Bisphosphonate treatment should be reviewed after 5 years of treatment with alendronic acid, risedronate sodium or ibandronic acid, and after 3 years of treatment with zoledronic acid.