Ostoporosis

Question 1

What is osteoporosis

Answer 1

Defined as a BMD that lies 2,5 standard deviations below average

So a T score of < -2.5

Question 2

What are the risk factors for osteoporosis

Answer 2

1. Failures to achieve peak bone mass as an adult
2. Bone loss later in life
3. Genetic
4. Idiopathic

Question 3

What is primary osteoporosis

Answer 3

Aging process including the menopause

Question 4

What is secondary osteoperosis

Answer 4

Secondary to pathological condition or medication

Question 5

What age do people reach peak bone age

Answer 5

30

Question 6

What decreases bone mass

Answer 6

Smoking, poor nutrition, inactivity, alcohol

Question 7

What is primary osteoporosis type 1

Answer 7

•Post menopausal osteoporosis
• 15-20 years after menopause (55-70 years old)
• due to low oestrogen
• exclusively cancellous bone
• mainly affecting - vertebrae, distal radius

Question 8

What is primary osteoporosis type 2

Answer 8

• Senile osteoporosis
  -> 70 years old
• directly related to the aging process
• both cancellous and cortical bone
• mainly affecting - hip, pelvis, long bones and vertebrae

Question 9

What is secondary osteoporosis

Answer 9

Due to something else. Eg:

• endocrine diseases
• chronic diseases such as COPD or liver disease
• medications: corticosteroids, phenytoin
• nutritional deficiency: malnutrition, anorexia

Question 10

what is involved in a fracture risk assessment?
Including which tools can be used?

Answer 10

Assesses 10-year probability of major osteoporotic fracture risk

Frax - fracture risk tool
QFracture tool

Question 11

What are the indications for a fracture risk assessment?

Answer 11

~ all women over 65
~ all men over 75
~ those under these ages but with other risk factors

Question 12

What does DEXA stand for?

Answer 12

Dual-energy X-ray absorptiometry scan

Question 13

DEXA scan info

Answer 13

Very low dose
- most common L-spine and femur
Forearm can be used if these are not available

Question 14

What is a T-score?

Answer 14

The T-score shows how much your bone mass differs from the bone mass of an average 30 year old adult.

Question 15

What is a Z-score?

Answer 15

The Z-score compares your bone density with that of people your own age,size and sex.

Question 16

How is the score from the DEXA scan measured?

Answer 16

As a standard deviation from the mean

Question 17

How often is a DEXA scan repeated?

Answer 17

2 - 5 years depending on individual case

Question 18

What are the Advantages of CT looking at bone density?

Answer 18

Highly specific
Better accuracy
Enter in axial skeleton assessment (multi detector)

Question 19

What are the disadvantages of CT for looking at Bone density?

Answer 19

More expensive
More radiation

Question 20

What are the advantages of DEXA scanning?

Answer 20

• cheap
• widely used
• high sensitivity

Question 21

What are the disadvantages of DEXA scanning?

Answer 21

• operator dependant
  -Less accurate
• Low specificity

Question 22

What is osteopenia?

Answer 22

Bone density has begun to dwindle but is not yet considered dangerous

Question 23

What is the T - value for osteopenia?

Answer 23

Between -1 and -2 SD

Question 24

What is osteoporosis?

Answer 24

Bone density levels become critical and frequent fractures are likely.

Question 25

What is the T-value for osteoporosis?

Answer 25

T-value < -2 standard deviations

Question 26

How do osteoporotic bones show under X-ray ?

Answer 26

• Increased radiolucency
• Cortical thinning
• Altered trabecular pattern

Question 27

What is Osteomalacia and rickets?

Answer 27

Osteomalacia = soft bones
Decreased mineralisation of newly formed bone matrix

Rickets is the same condition but in children

Both increase the risk of fractures and bone deformities.

Question 28

What are the preventative measures for loss of bone density?

Answer 28

+ strength training exercises
+ diet (high calcium intake)
+ vitamin D supplements
+ medications (such as bisphosphonates)
+ stopping medications causing osteoporosis
+ bone protection for people on long-term steroids
+ reducing alcohol intake and smoking