Osteoporosis is an ever increasing popular topic to get questioned about –

Firstly, you need to rule out reversible causes,

1. Ask about symptoms of hyperthyroidism
2. Ask about symptoms of hypercalcaemia (hyperparathyroid)
3. Ask about symptoms of hypogonadism
4. Ask about drug intake (steroids in particular, methotrexate, azathioprine, cyclosporine, phenytoin, phenobarbitone, carbamazepine)
5. Ask about symptoms of myeloma (bone pain, hyperviscosity)

Then exacerbating causes,

1. Ask about calcium intake
2. Ask about amount of sunlight received each day
3. Ask about visual acuity (increased risk of falls)
4. Ask about home situation re stairs, rugs, bathroom alterations

Then ask about possible therapeutic interventions,

1. History of reflux? (relative contraindication to bisphosphanates – although one study showed a decreased rate with risedronate and the once weekly aledronate is also supposed to be better)
2. Consideration of HRT/ normal or half-dose?
3. Consideration of Raloxifene?
4. Possiblity of intravenous bisphosphanate? i.e. can the patient come to hospital for regular treatment?
5. Correction of other factors that may predispose the patient to falling?
6. History of prostate cancer/ OSA which may be contraindications for male HRT