Osteoporosis in GP

Question 1

What are the non-modifiable risk factors for osteoporosis and fragility fractures?

Answer 1

• Parental hip fracture
• Coeliac disease
• Myeloma
• Menopause aged ≤42
• Women >65 and men >75
• Chronic disease eg diabetes, connective tissue diseases, IBD, endocrine diseases, chronic liver disease, neurological disease, CKD 3-5 and asthma
• Medications eg PPIs, long term SSRI usage, TZDs, anti-epileptics, Depo-Provera for >2 years, GnRH analogues in men (prostate cancer), aromatase inhibitors (breast cancer)

Question 2

What are the modifiable risk factors for osteoporosis and fragility fractures?

Answer 2

• Use of oral glucocorticoids
• Alcohol consumption of >3.5 units a day
• Low BMI (<18.5)
• Smoking

Question 3

What is the FRAX tool?

Answer 3

Assesses fracture risk in next 10 years for age 40-90

Question 4

What is the QFracture tool?

Answer 4

Assesses absolute fracture risk over 1-10 years for ages 30-99

Question 5

What type of exercise is recommended for people at risk of osteoporosis?

Answer 5

Weight bearing exercise

Question 6

What results of a DEXA scan indicates osteopenia?

Answer 6

T score between -1 to -2.5 SD below that of a young adult

Question 7

What is the first line drug treatment for osteoporosis?

Answer 7

Oral bisphosphonates (Alendronic acid)

Question 8

How do you take a bisphosphonate?

Answer 8

On an empty stomach, at least 30 mins before food with a large glass of plain water. Take while sitting or standing upright and do not lie down for 30 minutes

Question 9

What are the common side effects of bisphophonates?

Answer 9

• Dyspepsia
• Bowel upset
• Heartburn
• Difficulty swallowing
• Osteonecrosis of the jaw
• Atypical fracture of the femur

Question 10

How long should a patient be treated with alendronic acid before review?

Answer 10

5 years

Question 11

What QFracture score is considered to be high risk?

Answer 11

Women = 11.1%
Men = 2.6%

Question 12

What is the daily recommended calcium intake?

Answer 12

700mg