Osteoporosis, Paget's Disease, Osteomalacia

Question 1

As you age osteoclast activity increases, whereas osteoblast activity is not keeping up

Question 2

What would lead to bone loss?

Answer 2

Sex hormone deficiency
body weight
Genetics
Diet
Immobility
Diseases
Drugs especially glucocorticoids, aromatase inhibitors

Question 3

Common sites of fracture in osteoporosis?

Answer 3

Wedge-shaped vertebral fracture –> kyphosis
Femur neck
Distal radius

Question 4

Who to assess for this risk?

Answer 4

Anyone over 50 yo with significant risk factor

Anyone below with significant clinical risk factor
- Early menopause
- On long-term glucocorticoids

Question 5

Medication

Answer 5

CalciumVitD supplements

*Anti-resorptives:
Bisphosphonates (slowing bone resorption by preventing osteoclast activity through killing them)

Zoledronic Acid (infusion once yearly)

Denosumab (anti-resorptive monoclonal antibody, stop bone destruction process - SC 6 monthly)

*Anabolic agents:
Teriparatide - recombinant parathyroid hormone
Consider if severe osteoporosis
Follow up with anti-resorptive

Romosozumab - humanised monoclonal antibody that inhibits sclerostin, which is an endogenous inhibitor to osteocytes
Monthly SC for 12 months
Contraindicated if high CVS risk
Follow up with anti-resorptive

Question 6

When to treat?

Answer 6

more than -2.5 T score
or more than -1.5 T score but on long-term steroids

Question 7

What do corticosteroids do to bone?

Question 8

Paget’s disease of bone

Answer 8

Unclear aetiology
Affects long bones, pelvis, lumbar spine and skull predominantly

bone pain, deformity, deafness, compression neuropathies

Question 9

Osteogenesis Imperfecta

Answer 9

Rare genetic disorders

Secondary to mutations of type 1 collagen genes