Osteoporosis

Question 1

Definition of osteoporosis

Answer 1

• Osteoporosis is a condition where there is a reduction in the density of the bones.
• Osteopenia refers to a less severe reduction in bone density than osteoporosis.

Question 2

Risk factors for osteoporosis (remember SHATTERED)

Answer 2

• Steroids (long term corticosteroids)
• Hyperthyroidism, HPT, HIV
• Alcohol and smokingOlder age
• Thin (low BMI <18.5kg/m²)
• Testosterone low
• Early menopause (Post-menopausal women)
• Renal/liver failure
• Erosive/inflammatory bone disease (RA, myeloma)
• Dietary (low calcium, malabsorption)
• Female
• Reduced mobility and activity
• Other medications (SSRIs, PPIs, anti-epileptics, anti-oestrogens)

Question 3

FRAX Tool

Answer 3

• Predicts risk of fragility fracture over next 10 years
• Involves information including age, BMI, co-morbidities, smoking, alcohol and FHx
• Can enter bone mineral density from DEXA for more accurate result
• Gives 10 year probability of major osteoporotic fracture and hip fracture

Question 4

Bone mineral density (BMD)

Answer 4

• Measures using DEXA scans
• Can be measaured at any location but reading at hip is key for classification and management of osteoporosis
• Represented as T scores and Z score
• Z score is the number of standard deviations below mean for their age
• T score is number of standard deviations below mean for healthy young adult

Question 5

Assessing for osteoporosis

Answer 5

• FRAX
  
  • In women aged >65
  • Men aged >75
  • Younger patients with risk factors
• FRAX without BMD will suggest:
  
  • Low risk - reassure
  • Intermediate risk - offer DEXA and recalculate
  • High risk - offer treatment
• FRAX outcome with BMD will suggest:
  
  • Treat
  • Lifestyle advice and reassure

Question 6

Management of osteoporosis

Answer 6

• Lifestyle changes
  
  • Activity and exercise
  • Maintain healthy weight
  • Adequate calcium intake
  • Adequate vitamin D
  • Avoiding falls
  • Stop smoking
  • Reduce alcohol consumption
• Bisphosphonates
  
  • Interfere with osteoclasts and reduce their activity
  • Can cause reflux, oesophageal erosions, osteonecrosis of the jaw or external auditory canal and atypical fractures
• Other medications include:
  
  • Denoxumab
  • Strontiu ranelate
  • Reloxifene
  • HRT
• FRAX and DEXA scan after 5 years if no bisphosphonates
• FRAX and DEXA scan after 3-5 years if bisphosphonates and consider treatment holiday of BMD improved