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Endocrine Week 4 2017/18 > 8: Disorders of bone health including osteoporosis > Flashcards

8: Disorders of bone health including osteoporosis Flashcards

1
Q

What is osteoporosis?

A

Low bone mass leading to increase in bone fragility, risk of pathological fracture

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2
Q

A ___ effect often occurs with several fractures occuring in sequence in people with osteoporosis.

A

domino

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3
Q

Who tends to get osteoporosis?

A

Elderly women

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4
Q

Where do pathological fractures commonly occur in osteoporosis?

A

Neck of femur

Vertebral body

Distal radius

Humeral neck

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5
Q

What percentage of hip fracture patients die within a year?

A

20%

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6
Q

Your risk of fracture (increases / decreases) as you get older.

A

increases

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7
Q

Patients with spinal fractures develop a thoracic (kyphosis / lordosis).

A

thoracic kyphosis

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8
Q

At which sites does bone remodelling occur?

A

Bone remodelling sites

I appreciate this isn’t very helpful

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9
Q

What minerals are stored in bone?

A

Calcium

Phosphate

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10
Q

Which cells

a) resorb
b) form bone?

A

a) Osteoclasts

b) Osteoblasts

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11
Q

The new bone formation by osteoblasts is then mineralised with what?

A

Calcium

Phosphate

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12
Q

Osteoporotic bone has a reduced (mass / density).

A

both

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13
Q

Osteoporosis has a large ___ component.

A

genetic

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14
Q

People who are very (underweight / overweight) can develop osteoporosis.

A

underweight

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15
Q

Which hormones affect bone mass?

A

PTH and Calcitonin

Sex hormones

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16
Q

At what age is peak bone mass usually obtained?

A

Around 25

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17
Q

When do women experience a sudden drop in bone mass?

A

Menopause

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18
Q

Once bone mass has dropped below the __ threshold, pathological fracture is more likely.

A

fracture threshold

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19
Q

What are some non-modifiable risk factors for fragility fracture?

A

Age

Gender

Ethnicity

PMX fracture

FX

Menopause

Other diseases e.g Coeliac

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20
Q

What are some modifiable risk factors for fragility fracture?

A

BMD

Alcohol

Weight

Smoking

Physical activity

21
Q

What calculators can be used to determine risk of fragility fracture?

A

QFracture

WHO calculator

22
Q

People with a QFracture score of more than 10% should be referred for what?

A

DEXA scan

23
Q

Who is assessed for osteoporosis?

A

Anyone >50 with risk factors

Anyone <50 with lots of risk factors

24
Q

What does a DEXA scan determine?

A

BMD

Bone mineral density

25
Q

What are the BMD thresholds for

a) normal bone mass
b) osteopenia
c) osteoporosis
d) severe osteoporosis?

A

Normal - BMD within 1 standard deviation of mean

Osteopenia - BMD > 1 SD below adult mean

Osteoporosis - BMD > 2.5 SDs below adult mean

Severe osteoporosis - “ with fragility fracture

26
Q

What are some secondary causes of osteoporosis?

A

Hyperthyroidism

Hyperparathyroidism

Cushing’s

Coeliac

IBD

27
Q

What is the daily recommended intake of calcium?

A

700mg in normal people

1.0g per day in those with osteoporosis

28
Q

What drugs are used to treat osteoporosis?

A

Calcium & Vitamin D supplementation

Oral biphosphonates or IV zoledronic acid - inhibits osteoclasts

Denosumab - inhibits osteoclasts

Teriparatide - recombinant PTH, promotes bone growth

29
Q

Deficiency of which

a) vitamin
b) mineral

can cause osteoporosis?

A

Vitamin D

Calcium

30
Q

How do biphosphonates work?

A

Reduce osteoclast number and activity

Bone resorption slowed down

31
Q

What is an example of an

a) oral
b) IV bisphosphonate?

A

a) Oral - aldendronate
b) IV - zoledronic acid

32
Q

How should biphosphonates be taken?

A

30 mins before breakfast with a glass of water

33
Q

What is an IV biphosphonate used in those who can’t tolerate biphosphonates?

A

Zoledronic acid

34
Q

How often is zoledronic acid administered?

A

Once a year

35
Q

What agents can be used to block the receptors controlling osteoclast activity?

A

Biologic agents

e.g denosumab

36
Q

What is teriparatide?

How does it work?

A

Analogue parathyroid hormone

Stimulates bone growth rather than stopping bone loss

37
Q

In terms of DEXA scans, what is a

a) T score
b) Z score?

A

T score - BMD compared to that of a young, healthy adult

Z score - BMD compared to normal for age, sex and ethnicity

38
Q

Below which T score following a DEXA scan should osteoporosis be treated with drugs?

A

< 2.5

39
Q

If a patient with osteoporosis is using steroid, below which T score should they be started on drugs?

A

< 1.5

40
Q

Which type of drug accelerates osteoporosis by affecting calcium metabolism?

A

Steroids

41
Q

In patients using steroids long-term, what should you consider giving them?

A

Calcium supplements

42
Q

What is Paget’s disease?

A

Abnormal bone turnover

Waves of osteoclast > osteoblast activity

43
Q

Which liver enzyme is commonly raised in Paget’s disease?

A

ALP

44
Q

How is Paget’s disease treated?

A

Analgesics

if no relief

Biphosphonates

45
Q

What is osteogenesis imperfecta?

A

Genetic disorder causing fragility fractures

46
Q

What are some odd signs of osteogenesis imperfecta?

A

Blue sclerae

Malformed dental arches

47
Q

What causes blue sclerae and dentinogenesis imperfecta in patients with OI?

A

Collagen abnormalities

48
Q

How does osteogenesis imperfecta present?

A

Fragility fractures in childhood

Endocrine Week 4 2017/18 (10 decks)

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