The questions answered in this podcast are listed below.
They were compiled by GPs and professional attendees at our face-to-face seminars around Australia

1. When should the first dual-energy X-ray absorptiometry (DEXA) scan be performed in someone with no obvious risk factors, given the goal of preventing a first fracture?
2. Why and when should forearm bone density be measured? Does it add anything, and when should it be taken into account?
3. How can secondary causes of bone loss, such as primary hyperparathyroidism, malabsorption and paraproteins, be ruled out?
4. Should bone turnover markers be used routinely? How useful are they in practice?
5. Is three months after starting treatment too early to check bone turnover markers?
6. For a recently post-menopausal woman with low bone density, are calcium and vitamin D alone sufficient?
7. Is menopausal hormone therapy (MHT) sufficient to prevent fractures? Is it as effective as other bone-sparing agents?
8. If a recently post-menopausal or perimenopausal woman has osteoporosis but no menopausal symptoms, what should be done?
9. How should anti-resorptive therapy be chosen in a woman in her 50s?
10. If MHT is not desired but there is significant bone loss, what are the next best options?
11. What is the youngest age at which denosumab would be prescribed?
12. If patients need to travel or adjust timing, how early before the six-monthly due date can denosumab safely be given?
13. If denosumab has to be stopped (e.g. due to side effects), what should be done next – which bisphosphonate, and for how long, given the lack of clear guidelines?
14. In day-to-day general practice, is alendronate (Fosamax) for at least 12 months a reasonable default after stopping denosumab?
15. What is the mechanism behind atypical femoral fractures and osteonecrosis of the jaw with long-term anti-resorptive therapy?
16. If a patient on bisphosphonates needs a tooth extraction, is there any point in stopping the drug beforehand?
17. Is there value in measuring bone turnover markers before dental extractions, as some dentists request?
18. For patients on denosumab who need extractions, when is the safest window around the injection, and how long (if at all) can the next dose be delayed?
19. If someone develops osteonecrosis of the jaw while on these agents, what can be done for them?
20. Is it necessary to use the same DEXA provider or machine for serial scans, and why?
21. For patients on denosumab, is it necessary to check vitamin D, calcium and renal function before every injection, or only at baseline and periodically?
22. With newer weight-loss medications, what is known so far about their effects on bone density and fracture risk?
23. How should apparent bone loss on DEXA during significant weight loss be interpreted – is it real or artefact, and how can bone turnover markers help?

Expert: Prof Bronwyn Stuckey, Endocrinologist

Host: Dr Jane Elliott AM , GP and Medical Educator

Total time: 29 mins

Recommended resource:

• Healthy Bones Australia
• Position Statement on the Management of Osteoporosis
• Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment | PubMed
• Comparison of antiresorptive effect of hormone therapy and ibandronate in postmenopausal osteoporotic women by assessing type I collagen C-telopeptide levels | PubMed
• Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial | PubMed
• Hologic DXA System