Osteoporosis

Question 1

What is used to calculate fragility fracture risk score

Answer 1

QFracture
and
FRAX

Question 2

How do we confirm osteoporosis

Answer 2

DEXA scan

Dual energy xray absoptiometry

Question 3

What are risk factors of osteoprosis

Answer 3

Female
Over 50
Menopause
Hx of fractures
Oral glucocorticoids for 3+ months
Smoking
Alcohol
Low BMI
Ca/Vit D deficiency
Physical inactivity

Question 4

5 life stylechanges for osteoporosis

Answer 4

Eat balanced diet
Increase intake of Ca and Vit D
Increase excercise
Smoking cessation
Reduce alcohol intake

Question 5

What is 1st line for osteoporosis

Answer 5

Oral bisphosphonates

Alendronic
Ibandronic
Zolendronic
Risedronate sodium

Question 6

When to review need for medication

Answer 6

After 5 years

3 years for zolendronic acid

Question 7

What is used in severe osteoporosis

Answer 7

Strontium
And
Teriparatide

Question 8

What is used in younger postmenopausal women

Answer 8

HRT
And
Tibolone

Question 9

What is used when all other treatments are unsuitable

Answer 9

Raloxifene

Question 10

Aside from 1st line, what drugs can men use

Answer 10

Strontium
Denosumab
Teriparatide

Question 11

Which drugs are used in glucocorticoid induced osteoporosis

Answer 11

Teriparatide
Denosumab

Question 12

when do we start prophylaxis at onset of glucocorticoid treatment in women

Answer 12

Age 70 or over
previous fragility fracture
Large doses of glucocorticoids

Question 13

When do we start prophylaxis at onset of glucocorticoid treatment in men

Answer 13

Age 70 and over
7.5mg or more per day of pred - equivalent over 3 weeks
FRAX probability of major hip fracture exceeding threshold

Question 14

What side effect should be reported and stopped in bisphosphonates

Answer 14

Oesophageal reactions

Ulcers, erosions, oesophagitis

Question 15

What are the administration instructions for alendronic acod

Answer 15

Full glass water
Standing or upright for 30 mins after
30 mins before food and other meds

Question 17

What are the administration instructions for risedronate sodium

Answer 17

Full glass water
Standing/upright for 30 mins after
30 mins before food OR leave 2hrs before and after food/drink

Question 18

Why is the 30 mins after taking bisphosphonate important?

What can interact

Answer 18

Food drinks decrease absorption

Calcium supplements or antacids can also decrease

NSAIDs risk of GI Irritation - exacerbate oesophageal side effect

Question 19

MHRA bisphosphonate

Answer 19

1. Atypical femoral fractures
   Report thigh hip groin pain
2. Osteonecrosis of the jaw
   Report dental pain swelling non healing sores or discharge
3. Osteonecrosis of the external auditory canal
   Report ear pain discharge or ear infection