Osteoporosis Guidelines (Mar 2024)

Question 1

Who to investigate?

3 points

Answer 1

1. > 50yo with minimally traumatic fracture (presumed Dx)
2. > 50yo 1+ major risk factors
3. Minimally traumatic vertebral # (presumed Dx)

Question 2

DEXA scan interpretation

4 points

Answer 2

• T-score -1 = normal
• T-score -1 — -2.5 = osteopenia
• T-score <-2.5 = osteoporosis

Z-score <-2 = likely 2ry OP

Question 3

Utility of FRAX score

3 points

Answer 3

MOF >10% -> refer for DXA
Restratifying risk after DXA:
* T-score <-2.5
* T-score -1.5 to -2.5 + MOF >20% + hip # >3%

MOF = major osteoporotic fracture

Question 4

Utility of population screening?

Answer 4

Nil

Insufficient evidence

Question 5

Pillars of management

7 points

Answer 5

1. Calcium + vit D supplementation
2. Weight bearing exercise
3. Reducing falls risk
4. Bisphosphonates
5. Denosumab
6. Hormone therapy
7. Recombinant PTH

Question 6

Calcium + vit D supplementation

4 points

Answer 6

• RDI Ca 1300mg/d
• Vit D supplementation aiming >50nmol/L
• Long-term (>6yrs) supplementation benefits bone maintenance + muscle function in general health elderly
• Addition of protein intake in frail/instutionalised elderly

Question 7

Weight bearing exercise

3 points

Answer 7

• Frequency: 2x/wk
• Type: moderate impact (>50), balance and movement in different directions
• Supervision in frail/institutionalised

Question 8

Bisphosphonates 1

4 points

Criteria, examples, mechanism

Answer 8

• 10+ yrs post menopausal + osteopenia
• Established osteporosis (BMD or fracture criteria)
• Alendronate (1x/wk), risedronate (1x/wk), zoledronate (1x/yr)
• Inhibit osteoclasts (induce apoptosis)

Question 9

Bisphosphonates 2

5 points

Adverse effects

Answer 9

• GI: irrtation, ulcers, perforation, strictures, oesophageal erosions
• **Pre-existing UGI conditions CONTRAINDICATE PO bisphosphonates
• ONJ: <1-10/10,000 alendro/risedro, 1.7/10,000 zoledro
• AFF: 3.2-50/100,000, increased hazard ratio >8yrs (compared 3-5yrs)
• NO change to fracture union at 4 wks

AFF: atypical fracture of the femur

ONJ: osteonecrosis of jaw

Question 10

Denosumab 1

3 points

Mechanism, indication,

Answer 10

• Inhibit RANKL -> RANK -> osteoclast activation
• 1st line resorptive therapy

Question 11

Denosumab 2

Adverse effects

Answer 11

Hypocalcaemia in CKD IV-V (incl. dialysis)

Question 12

Romosozumab

Question 13

HRT