What is osteoporosis?
Low bone mass leading to increase in bone fragility, risk of pathological fracture
A ___ effect often occurs with several fractures occuring in sequence in people with osteoporosis.
Who tends to get osteoporosis?
Where do pathological fractures commonly occur in osteoporosis?
Neck of femur
What percentage of hip fracture patients die within a year?
Your risk of fracture (increases / decreases) as you get older.
Patients with spinal fractures develop a thoracic (kyphosis / lordosis).
At which sites does bone remodelling occur?
Bone remodelling sites
I appreciate this isn’t very helpful
What minerals are stored in bone?
b) form bone?
The new bone formation by osteoblasts is then mineralised with what?
Osteoporotic bone has a reduced (mass / density).
Osteoporosis has a large ___ component.
People who are very (underweight / overweight) can develop osteoporosis.
Which hormones affect bone mass?
PTH and Calcitonin
At what age is peak bone mass usually obtained?
When do women experience a sudden drop in bone mass?
Once bone mass has dropped below the __ threshold, pathological fracture is more likely.
What are some non-modifiable risk factors for fragility fracture?
Other diseases e.g Coeliac
What are some modifiable risk factors for fragility fracture?
What calculators can be used to determine risk of fragility fracture?
People with a QFracture score of more than 10% should be referred for what?
Who is assessed for osteoporosis?
Anyone >50 with risk factors
Anyone <50 with lots of risk factors
What does a DEXA scan determine?
Bone mineral density
What are the BMD thresholds for
a) normal bone mass
d) severe osteoporosis?
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
What are some secondary causes of osteoporosis?
What is the daily recommended intake of calcium?
700mg in normal people
1.0g per day in those with osteoporosis
What drugs are used to treat osteoporosis?
Calcium & Vitamin D supplementation
Oral biphosphonates or IV zoledronic acid - inhibits osteoclasts
Denosumab - inhibits osteoclasts
Teriparatide - recombinant PTH, promotes bone growth
Deficiency of which
can cause osteoporosis?
How do biphosphonates work?
Reduce osteoclast number and activity
Bone resorption slowed down
What is an example of an
b) IV bisphosphonate?
a) Oral - aldendronate
b) IV - zoledronic acid
How should biphosphonates be taken?
30 mins before breakfast with a glass of water
What is an IV biphosphonate used in those who can’t tolerate biphosphonates?
How often is zoledronic acid administered?
Once a year
What agents can be used to block the receptors controlling osteoclast activity?
What is teriparatide?
How does it work?
Analogue parathyroid hormone
Stimulates bone growth rather than stopping bone loss
In terms of DEXA scans, what is a
a) T score
b) Z score?
T score - BMD compared to that of a young, healthy adult
Z score - BMD compared to normal for age, sex and ethnicity
Below which T score following a DEXA scan should osteoporosis be treated with drugs?
If a patient with osteoporosis is using steroid, below which T score should they be started on drugs?
Which type of drug accelerates osteoporosis by affecting calcium metabolism?
In patients using steroids long-term, what should you consider giving them?
What is Paget’s disease?
Abnormal bone turnover
Waves of osteoclast > osteoblast activity
Which liver enzyme is commonly raised in Paget’s disease?
How is Paget’s disease treated?
if no relief
What is osteogenesis imperfecta?
Genetic disorder causing fragility fractures
What are some odd signs of osteogenesis imperfecta?
Malformed dental arches
What causes blue sclerae and dentinogenesis imperfecta in patients with OI?
How does osteogenesis imperfecta present?
Fragility fractures in childhood