8: Disorders of bone health including osteoporosis

Question 1

What is osteoporosis?

Answer 1

Low bone mass leading to increase in bone fragility, risk of pathological fracture

Question 2

A ___ effect often occurs with several fractures occuring in sequence in people with osteoporosis.

Answer 2

domino

Question 3

Who tends to get osteoporosis?

Answer 3

Elderly women

Question 4

Where do pathological fractures commonly occur in osteoporosis?

Answer 4

Neck of femur

Vertebral body

Distal radius

Humeral neck

Question 5

What percentage of hip fracture patients die within a year?

Answer 5

20%

Question 6

Your risk of fracture (increases / decreases) as you get older.

Answer 6

increases

Question 7

Patients with spinal fractures develop a thoracic (kyphosis / lordosis).

Answer 7

thoracic kyphosis

Question 8

At which sites does bone remodelling occur?

Answer 8

Bone remodelling sites

I appreciate this isn’t very helpful

Question 9

What minerals are stored in bone?

Answer 9

Calcium

Phosphate

Question 10

Which cells

a) resorb
b) form bone?

Answer 10

a) Osteoclasts

b) Osteoblasts

Question 11

The new bone formation by osteoblasts is then mineralised with what?

Answer 11

Calcium

Phosphate

Question 12

Osteoporotic bone has a reduced (mass / density).

Answer 12

both

Question 13

Osteoporosis has a large ___ component.

Answer 13

genetic

Question 14

People who are very (underweight / overweight) can develop osteoporosis.

Answer 14

underweight

Question 15

Which hormones affect bone mass?

Answer 15

PTH and Calcitonin

Sex hormones

Question 16

At what age is peak bone mass usually obtained?

Answer 16

Around 25

Question 17

When do women experience a sudden drop in bone mass?

Answer 17

Menopause

Question 18

Once bone mass has dropped below the __ threshold, pathological fracture is more likely.

Answer 18

fracture threshold

Question 19

What are some non-modifiable risk factors for fragility fracture?

Answer 19

Age

Gender

Ethnicity

PMX fracture

FX

Menopause

Other diseases e.g Coeliac

Question 20

What are some modifiable risk factors for fragility fracture?

Answer 20

BMD

Alcohol

Weight

Smoking

Physical activity

Question 21

What calculators can be used to determine risk of fragility fracture?

Answer 21

QFracture

WHO calculator

Question 22

People with a QFracture score of more than 10% should be referred for what?

Answer 22

DEXA scan

Question 23

Who is assessed for osteoporosis?

Answer 23

Anyone >50 with risk factors

Anyone <50 with lots of risk factors

Question 24

What does a DEXA scan determine?

Answer 24

BMD

Bone mineral density

Question 25

What are the BMD thresholds for a) normal bone mass b) osteopenia c) osteoporosis d) severe osteoporosis?

Answer 25

**Normal -** BMD within 1 standard deviation of mean **Osteopenia** - BMD \> 1 SD below adult mean **Osteoporosis** - BMD \> 2.5 SDs below adult mean **Severe osteoporosis** - " with fragility fracture

Question 26

What are some secondary causes of osteoporosis?

Answer 26

**Hyperthyroidism** **Hyperparathyroidism** **Cushing's** **Coeliac** **IBD**

Question 27

What is the daily recommended intake of calcium?

Answer 27

**700mg in normal people** **1.0g per day in those with osteoporosis**

Question 28

What drugs are used to treat osteoporosis?

Answer 28

**Calcium & Vitamin D supplementation** **Oral biphosphonates** or **IV zoledronic acid** - inhibits osteoclasts **Denosumab** - inhibits osteoclasts **Teriparatide** - recombinant PTH, promotes bone growth

Question 29

Deficiency of which a) vitamin b) mineral can cause osteoporosis?

Answer 29

**Vitamin D** **Calcium**

Question 30

How do biphosphonates work?

Answer 30

**Reduce osteoclast number and activity** **Bone resorption slowed down**

Question 31

What is an example of an a) oral b) IV bisphosphonate?

Answer 31

a) **Oral** - aldendronate b) **IV** - zoledronic acid

Question 32

How should biphosphonates be taken?

Answer 32

**30 mins before breakfast with a glass of water**

Question 33

What is an IV biphosphonate used in those who can't tolerate biphosphonates?

Answer 33

**Zoledronic acid**

Question 34

How often is zoledronic acid administered?

Answer 34

**Once a year**

Question 35

What agents can be used to block the receptors controlling osteoclast activity?

Answer 35

**Biologic agents** e.g **denosumab**

Question 36

What is teriparatide? How does it work?

Answer 36

**Analogue parathyroid hormone** **Stimulates bone growth rather than stopping bone loss**

Question 37

In terms of DEXA scans, what is a a) T score b) Z score?

Answer 37

**T score** - **BMD compared to that of a young, healthy adult** ## Footnote **Z score - BMD compared to normal for age, sex and ethnicity**

Question 38

Below which T score following a DEXA scan should osteoporosis be treated with drugs?

Answer 38

**\< 2.5**

Question 39

If a patient with osteoporosis is using steroid, below which T score should they be started on drugs?

Answer 39

**\< 1.5**

Question 40

Which type of drug accelerates osteoporosis by affecting calcium metabolism?

Answer 40

**Steroids**

Question 41

In patients using steroids long-term, what should you consider giving them?

Answer 41

**Calcium supplements**

Question 42

What is Paget's disease?

Answer 42

**Abnormal bone turnover** Waves of osteoclast \> osteoblast activity

Question 43

Which liver enzyme is commonly raised in Paget's disease?

Answer 43

**ALP**

Question 44

How is Paget's disease treated?

Answer 44

**Analgesics** if no relief **Biphosphonates**

Question 45

What is osteogenesis imperfecta?

Answer 45

**Genetic disorder causing fragility fractures**

Question 46

What are some odd signs of osteogenesis imperfecta?

Answer 46

**Blue sclerae** **Malformed dental arches**

Question 47

What causes blue sclerae and dentinogenesis imperfecta in patients with OI?

Answer 47

**Collagen abnormalities**

Question 48

How does osteogenesis imperfecta present?

Answer 48

**Fragility fractures in childhood**