osteoporosis

Question 1

criteria for younger patients to be assessed for osteoporosis

Answer 1

previous fragility fracture
current use or frequent use of glucocorticoid
history of falls
family history of hip fracture
causes of secondary hypothyroidism
low BMI
smoking
alcohol

Question 2

when should a DEXA scan be offered before calculating the fragility risk score

Answer 2

> 50 with a history of fragility fracture
< 40 with major risk factor for fragility

Question 3

interpreting FRAX result

Answer 3

QFracture: > 10% then arrange DEXA
FRAX: orange zone= DEXA scan

Question 4

when should patients be started on a bisphosphonate before a DEXA scan

Answer 4

> 75 years with a fragility fracture
post-menopausal woman and men >50 taking prednisolone- also start on bisphosphonate

Question 5

DEXA scan results

Answer 5

T score > -1.0= normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis

Question 6

management of patients at risk of corticosteroid induced osteoporosis

Answer 6

> 65 offer bone protection
< 65 offer DEXA scan

Question 7

management of osteoporosis

Answer 7

first !! check calcium levels and correct before starting bisphosphonates
bisphosphonates
- oral: alendronate
- IV: zoledronate- first line after hip fracture
denosumab second line

Question 8

adverse effects of bisphosphonates

Answer 8

oesophageal rections
osteonecrosis of the jaw
risk of atypical stress fractures
hypocalcaemia