Osteoporosis

Question 1

FRAX

Answer 1

Can not use when on treatment

Age
 Sex
 Race
 BMI (height / weight)
 Personal history of
fragility fracture
 Parental history of hip
fracture
 Current smoking
 Glucocorticoid therapy
 Rheumatoid arthritis
 Secondary
osteoporosis
 Alcohol (>3 units/day)
 Femoral neck BMD

Question 2

Work-up for secondary causes of osteoporosis

Answer 2

- CBC
 Metabolic profile (total protein,
albumin, calcium, creatinine, LFT’s,
alkaline phosphatase, electrolytes)
 24 hour urinary calcium level
 25-hydroxyvitamin D level
 Thyroid stimulating hormone level

Second Tier
Celiac panel
 IgA EMA (antiendomysial antibodies)
or
 IgA tTg (tissue transglutaminase)
 Serum protein electrophoresis

Question 3

DXA in obesity

Answer 3

Can measure forearm

Question 4

Z-score

T-score

Answer 4

T score makes Dx

Question 5

When to screen less than 65?

Answer 5

1. FRAX to determine risk (9.3% risk of
major fracture is the same as a 65yo
woman with no risk factors)
2. Medical history of a fragility fracture
3. Body weight <127 pounds
4. Medical causes of bone loss
(medications or diseases)
5. Parental history of a hip fracture
6. Current smoker
7. Alcoholism
8. Rheumatoid arthritis

Question 6

lifestyle changes

Answer 6

 Calcium 1000-1200 mg/day
 Vitamin D 600-800 IU/day
 Vitamin D level of 20-30ng/ml (50-75nmol/L)
 Regular weight-bearing, musclestrengthening
exercise
 Fall prevention (vision, hearing, safety at
home)
 Avoidance of smoking

Question 7

Who to treat

Answer 7

Patients with T-score between -1.0 and -
2.5 and:
 10-year hip fracture risk >3% (FRAX)
 10-year any major osteoporosis-related
fracture (forearm, hip, shoulder, clinical
spine) probability of >20% (FRAX)
 Secondary causes associated with high
risk of fracture (e.g. steroid use,
immobility) (NOF only)

Question 8

Raloxifene

Answer 8

 No increase or decrease in coronary events
compared to placebo
 No early harm
 Reduced risk of breast cancer (HR 0.56)
 No effect on overall mortality
 No effect on stroke
 Slight increased risk of fatal stroke
 Increased risk of VTE

Question 9

Denosumab

Answer 9

By inhibiting RANKL, it reduces the
differentiation, activation and survival
of osteoclasts and slows bone
resorption

Question 10

Bisphos

Answer 10

osteonecrosis of jaw
atypical femur fractures

alendronate
zoledronic acid (yearly)

Question 11

PTH analogue

Answer 11

Abaloparatide
Teriparatide

NOT to be used in patients with:
 Paget’s disease of the bone
 Prior external beam or implant radiation
therapy involving the skeleton
 History of bone metastasis
 History of skeletal malignancy
 Preexisting hypercalcemia
 Children or pregnant women