Osteoporosis

Question 1

What is osteoporosis, and how does it differ from osteopenia?

Answer 1

Condition where there is a reduction in the density of the bones. Osteopenia = less severe form of osteoporosis

Question 2

Name 3 risk factors for developing osteoporosis

Answer 2

• Older age
• Female (post-menopausal)
• Reduced mobility and activity
• Low BMI (<18.5 kg/m2)
• Rheumatoid arthritis
• Alcohol and smoking
• Long term corticosteroids
• Other medications i.e. SSRIs, PPIs, anti-epileptics and anti-oestrogens (oestrogen = protective against osteoporosis)

Question 3

What is the FRAX tool?

Answer 3

Prediction of the risk of a fragility fracture over the next 10 years

Question 4

1) What scan is used to measure bone mineral density (BMD)?
2) How does this scan measure BMD?
3) BMD can be measured with T scores. T scores represent the number of SDs below the mean for a healthy young adult their bone density is. A T score of what is considered to be osteoporosis?
4) A T score of what is considered osteopenia?
5) The Z score is a T score adjusted for which 3 factors?

Answer 4

1) DEXA (dual-energy xray absorptiometry) scan
2) Brief xray scans that measure how much radiation is absorbed by the bones
3) T score of <2.5
4) T score from -1 to -2.5
5) Age, gender, ethnicity

Question 5

1) Name 2 lifestyle changes that can be made that benefits osteoporosis
2) What drugs are 1st line treatment for osteoporosis?
3) How do these drugs work?
4) Name 2 side effects of these drugs
5) Give an example of a bisphosphonate

Answer 5

1) Increase activity and exercise, healthy weight, adequate Ca and vitD (can be supplemented), avoiding falls, stop smoking, reduce alcohol consumption
2) Bisphosphonates
3) Interfere with osteoclasts, reducing their activity and preventing bone reabsorption
4) Reflux and oesophageal erosion, atypical fractures (i.e. femoral), osteonecrosis of the jaw and external auditory canal
5) Risedronate, zoledronic acid, alendronate

Question 6

Other medical options:
1) How does denosumab work?
2) How does strontium ranelate work?
3) What does this drug increase the risk of?
4) What other drugs can be used?

Answer 6

1) Monoclonal antibody that blocks osteoclasts activity
2) It’s a similar element to calcium, it works by stimulating osteoblasts and blocks osteoclasts
3) Increases DVT, PE and MI risk
4) Drugs that increase oestrogen i.e. hormone replacement therapy (HRT) or raloxifene (selective oestrogen receptor modulator which blocks oestrogen on breasts and uterus, but stimulates it on bone)

Question 7

Name a typical injury in osteoprorsis

Answer 7

• Distal radius fracture
• Proximal humerus fracture
• Femoral neck fracture

Question 8

If a man presents with a fragility fracture, it’s important to test the levels of what?

Answer 8

Testosterone

Question 9

What is characteristic of osteoporotic blood test?

Answer 9

Normal - normal calcium, ALP, PTH and phosphate

Question 10

Following a fragility fracture in women over a certain age, a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate - what is this age?

Answer 10

> 74 (75 or older)