osteoporosis

Question 1

what is osteoporosis

Answer 1

progressive bone disease
- reduction in bone mass and density
- increased risk of fractures

Question 2

risk factors of osteoporosis

Answer 2

postmenopausal women
men > 50
patients taking long term oral corticosteroids (glucocorticoids)
vit D and calcium deficiency
age increase
smoking & drinking
low BMI
lack exercise
history of fractures
early menopause

Question 3

lifestyle changes

Answer 3

increase exercise
smoking cessation/reduce alcohol
maintain ideal BMI
increase intake of vit D and calcium - supplement

Question 4

osteoporosis treatment

Answer 4

review need for medication after 5 years (3 years for zoledronic)

1st line:
oral bisphosphonates - alendronic ibandronic, zoledronic acid, risedronate sodium

alternative therapy:
postmenopausal - denosumab, raloxifene, strontium, teriparatide, HRT tibolone

younger menopausal - HRT or tibolone

strontium and teriparatide in severe osteoporosis

raloxifene when other treatments are c/i or unsuitable

men - zoledronic acid, denosumab, teriparatide, strontium

glucocorticoid induced - zoledronic acid, denosumab, teriparatide

Question 5

glucocorticoid-induced osteoporosis - when to start prophylaxis

Answer 5

start prophylaxis at onset of glucocorticoid treatment in:

women:
70 or over
previous fragility fracture
large doses of glucocorticoids

men:
70 or over
previous fragility fracture
large doses of glucocorticoids

large doses of corticosteroids > 3 months

Question 6

bisphosphonate MHRA warnings

Answer 6

atypical femoral fractures
- report thigh, hip, groin pain

osteonecrosis of jaw
- report dental pain, swelling, discharge

osteonecrosis of external auditory canal
- report ear pain, discharge, infection

Question 7

bisphosphonates SEs, cautionary label, interactions

Answer 7

oesophageal reactions
- REPORT and STOP - oesophageal irritation, dysphagia, heartburn

medication should be taken with full glass of water whilst standing and remain upright for 30 mins after

alendronic acid - take 30 mins before breakfast/other oral meds

risedronate sodium - take 30 mins before breakfast or 2 hours before and after food/drink if at other time of day

leave 30 mins b/w bisphosphonates and calcium supplements/antacids - to avoid decreased absorption

leave 30 mins b/w bisphosphonates and food/drink to avoid decreased absorption

avoid NSAID - GI irritation