MSRA: Osteoporosis + Bisphosphonates

Question 1

How do we assess fracture risk?

Answer 1

For all post menopausal women and men 50+
(Can consider risk assessment if younger than 50 with risk factors e.g corticosteroid use
FRAX tool
Low risk: reassure and lifestyle advice
Intermediate risk: DEXA then reassess
High risk: Treat

Question 2

What are the T score results of a DEXA scan?

Answer 2

+1 to -1: Normal
- 1.1 to -2.5: Osteopenia
- 2.5 or worse: Osteoporosis

Question 3

How do we assess following fragility fractures?

Answer 3

If 75+, assume underlying osteoporosis and treat
If younger than 75 - DEXA

Question 4

What are the indications for bisphosphonate therapy?

Answer 4

Pain from bone mets
Hypercalcaemia
Paget’s Disease
Prevention and treatment of osteoporosis
High dose oral corticosteroids (more than 7.5mg Pred for 3 months or longer)

Question 5

What are the side effects of bisphosphonates?

Answer 5

Oesophageal/gastric irritation
Osteonecrosis of the jay
Atypical femoral fractures
Hypocalcaemia

Question 6

How do we assess for a bisphosphonate holiday?

Answer 6

Review at 3-5 years
If 75+ or hip or spine fracture - continue
Everyone else - DEXA - if confirms osteoporosis then continue
If not - stop - and reassess with DEXA in 2 years

Question 7

What are the contraindications to the use of bisphosphonates?

Answer 7

eGFR less than 35

Question 8

What advice should be given to patients for how to take bisphosphonates?

Answer 8

Empty stomach
Lots of water
With no other medication
Stay upright for 30 minutes