Osteoporosis and Osteomalacia MCQs

Most common cause of pathological fracture is osteoporosis . In India, however the most common cause is Nutritional deficiencies. Reference- Rockwood and green’s adult fracture 8ᵗʰ edition, page-671

Osteoporotic pathological fracture has good prognosis because it follows natural process of bone healing but with some delay. But pathological fracture of malignant lesion has very poor potential for healing and usually ends up in nonunion. Reference- Rockwood and green’s adult fracture 8ᵗʰ edition, page-678

In this case, we have to get an x-ray to rule out an atypical fracture. One of the complications of prolonged bisphosphonate therapy is the development of atypical fractures. Atypical fractures occurs after drug usage of more than 5-7 year It occurs due to the defective remodeling of bones, resulting from osteoclast suppression by bisphosphonates. These fractures are commonly seen in the sub-trochanteric region of the femur. These are called atypical fractures because they involve the lateral cortex and not the medial cortex of bone as is typically seen. Reference: Koval's Handbook of fracture's 5th edition, page no. 375

FRAX score is related to osteoporosis FRAX is Fracture Risk Assessment Score It was a questionnaire based scoring system developed by WHO to calculate the 10-year risk of major fractures in patients with osteoporosis. Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 2016

Phosphate levels will be reduced in osteomalacia. The biochemical changes in osteomalacia are: Calcium - ↓ / N PTH - ↑ Serum PO 4 - ↓ Alkaline Phosphatase (ALP) - ↑ Serum Vit D - ↓ Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 312

Pathological fractures occurs in a bone which is already weakened by an underlying pathology MC cause worldwide: Osteoporosis MC cause in India : Nutritional causes MC local cause: Malignancy MC bone involved: Thoracic vertebra Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 4

Alendronate is generally given orally in a dose of 70 mg/week. Patient is advised to take 6–8 oz of water and not to lie down for at least half an hour as these can cause gastritis and esophagitis. Reference: Manish Kumar Varshney, 1 st edition, Page no. 84.

Osteoprotegerin(OPG) is a member of the TNF receptor family but it is secreted and acts like a cytokine. OPG has bone protective properties by inhibiting osteoclast development and activation. Osteoprotegerin is a decoy receptor which binds and thereby opposes RANK ligand. RANK ligand is the primary agent that activates osteoclasts and causes bone resorption. Hence, the loss of OPG will result in excessive bone resorption by osteoclasts causing osteoporosis. Reference: Manish kumar varshney, 1 st edition, Page no. 67.