Osteoporosis

Question 1

Osteoporosis

Answer 1

Progressive bone disease
Increases risk of fractures
Occurs mostly in postmenopausal women, men over 50 y/o,patients taking long term oral corticosteroids(glucocorticoids)

Question 2

Risk factors of osteoporosis

Answer 2

Age, low BMI, cigarette smoking, excess alcohol, lack of physical activity, vitamin D deficiency, low calcium intake, family history of hip fractures, early menopause, rheumatoid arthritis and diabetes

Question 3

Aim of treatment, what else do we recommend they do?

Answer 3

To prevent fractures through medication and lifestyle changes

Increase physical activity

Stop smoking

Maintain BMI 20-25

Reduced alcohol intake

Increase dietary intake of vitamin d and c

Question 4

Postmenopausal osteoporosis treatment

Answer 4

Oral Bisphophonates (alendronic acid and risedronate sodium) are 1st line

Alendronic acid and risedronate reduce fractures

If both contraindicated, give ibandronic acid,denosumab or raloxifene

HRT- restricted to younger postmenopausal women due to adverse cardiovascular effect as and cancer in older postmenopausal women on long term HRT

Question 5

Glucocoid induced

Answer 5

• they cause bone loss and increased fractures
• Greatest rate of bone loss occurs early after initiation of the glucocorticoid and increases with dose and duration
• prophylaxis and treatment of glucorticoid induce osteoporosis are the same,oral bisphosphonates,alendronic acid or risedronate

Question 6

Osteoporosis in men

Answer 6

1st line- oral bisphosphonates, alendronic acid and risedronate)

Question 7

Drug action of. Bisphosphonates

Answer 7

Absorbed onto hydroxyapatite crystals in the bone,slowing both their rate of growth and dissolution and therefore reducing the rate of bone turnover

Question 8

MHRA - Bisphophonates

Answer 8

Mainly for patients taking long term 2 years + and especially cancer patients

1)Atypical femoral fracture - report any thigh or groin pain during treatment with Bisphophonates (MHRA)

2) Osteonecrosis of the jaw (Jaw bone is starved of blood)- maintain good oral hygiene, routine dental check ups and report any oral symptoms to MHRA. Risk of osteonecrosis greater with IV than Oral

3)Osteonecrosis of external auditory canal - report any ear pain,discharge from ear or an ear infection during treatment with bisphosphonates

Question 9

Side effects of Bisphophonates?

Answer 9

Alendronic acid - Oesophageal reactions

• take 30 mins before a meal or drugs and sit up right
• seek medical advice of new or worsening heartburn,pain on swallowing

Question 10

Counselling doses for alendronic acid

Answer 10

All are 70mg

Men- 10mg OD for 7 days ( now they’re all just 70mg OW)

Women - 70mg OW

• swallow whole and oral solution swallowed as a single 100ml dose
• take doses with plenty of water while sitting up right or standing
• take on empty stomach at least 30 mins before breakfast or any other meal
• stand or sit upright for at least 30 mins after