2. Osteoporosis

Question 1

Name 5 risk factors for osteoporosis:

Answer 1

• Gender
• Age
• Body Size
• Ethnicity
• Family History
• Sex hormone levels
• Anorexia
• Inactive Lifestyle
• Smoking
• Excessive alcohol use

Question 2

What is Osteoporosis?

Answer 2

• Reduction in bone mass density to the point where minor trauma may result in fracture
• Bone disease where BMDT>2.5 - the lower the score, the easier for the bones to break

Question 3

What is primary osteoporosis?

Answer 3

Senile osteoporosis -

• Ageing - 50 years old in women, 65-70 in men
• Hormonal alteration - Oestrogen
• Low synthesis of vitamin D and calcium
• Decreased intestinal absorption of Ca2+

Question 4

How can being post-menopausal cause osteoporosis?

Answer 4

• Calcium and Phosphate into the intracellular spaces
• This suppresses PTH secretion
• Decrease calciferol synthesis and osteoblastic activity

Question 5

What is secondary osteoporosis?

Answer 5

Caused by ongoing treatment
e.g. Glucorticoids - induce resorption
Corticosteroids - inhibit bone formation and calcium and phosphorus
Immunosuppressants cytotoxic drugs and Li all increase bone resorption

Question 6

Name 3 Bisphosphonates: What do they do?

Answer 6

Etidronate, alendronate, risedronate - stable analogues that absorb into the bone surface

Inhibit bone resorption - When osteoclasts ingest bone containing bisphosphonates a high conc of the drug is released and causes osteoclast death

Question 7

What is HRT? and what does it do? What are the problems?

Answer 7

Hormone replacement therapy

• Effective treatment of post-menopausal bone loss and long term treatment reduces risk of fractures
• Increases risk of breast and endometrial cancer, CHD and stroke

Question 8

What is the dose for Calcium supplements? What do they do?

Answer 8

500-1000mg daily - slows post menopausal bone loss

Decreases the risk of vertebral fracture
Increases BMD does not decrease in non-vertebral fractures

Question 9

What does BMD mean?

Answer 9

Bone mineral density

Question 10

What does Calcitonin do and how is it administered best? Name 2 side effects

Answer 10

• Prevents bone loss in post menopausal women
• Intranasal spray better tolerated
• Flushing and Nausea

Question 11

What is raloxifene? What are the risks?

Answer 11

• Selective oestrogen receptor modulator(SERM)
• Raloxifenen + Ca + VitD - inc. bone mass & dec. risk fo fractures
• Risk - inc. risk of DVT

Question 12

Name an anabolic steroid used to increase BMD? What are the side-effects?

Answer 12

Stanozolol

- Fluid retention, weight gain and liver function

Question 13

Name a hormone receptor modulator and explain MOA

Answer 13

Tibolone

- Partial agonist, oestrogen, progesterone and androgen receptor