Osteoporosis

Question 1

Pathophysiology of osteoporosis

Answer 1

Reduced bone density due to increased osteoclast activity outweighing osteoblast activity

Question 2

Types of osteoporosis

Answer 2

Type 1: Postmenopausal (↓ oestrogen), Type 2: Senile (>70), Type 3: Secondary (e.g. chronic disease)

Question 3

Risk factors for osteoporosis

Answer 3

Age, female gender, postmenopause, low BMI, low Vit D/calcium, smoking, alcohol, immobility, steroids, SSRIs, PPIs, AEDs, CKD, RA, hyperthyroidism

Question 4

Who should be assessed for osteoporosis?

Answer 4

All women ≥65, men ≥75, age ≥50 with risk factors or fragility fracture, long-term steroids

Question 5

Tools used to assess fracture risk

Answer 5

FRAX, QFracture

Question 6

Gold standard test for osteoporosis

Answer 6

DEXA scan (T-score used for diagnosis, femoral neck most important site)

Question 7

Define fragility fracture

Answer 7

Fracture from standing height at walking speed or slower

Question 8

Common fragility fracture sites

Answer 8

Spine, hip, wrist, pelvis, ribs, arm

Question 9

Primary prevention of osteoporosis

Answer 9

Lifestyle changes, assess at-risk people early, use FRAX to calculate 10-year fracture risk

Question 10

Lifestyle advice in osteoporosis

Answer 10

Weight-bearing exercise, healthy weight, stop smoking/alcohol, ensure adequate calcium and Vit D intake

Question 11

Recommended calcium and Vit D doses

Answer 11

Calcium: 1000mg/day, Vit D: 400–800 IU/day

Question 12

First-line pharmacological treatment

Answer 12

Bisphosphonates (e.g. alendronate weekly PO, zoledronic acid IV yearly)

Question 13

Bisphosphonate precautions

Answer 13

Take on empty stomach, stay upright 30 mins, undertake any dental work needed before starting

Question 14

Bisphosphonate side effects

Answer 14

Oesophagitis, atypical femoral fractures, osteonecrosis of jaw and external auditory canal

Question 15

Other treatment options for osteoporosis

Answer 15

Denosumab, HRT (postmenopausal women)