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intro to biomedical sciences IBMS > Bisphosphonates and Bone > Flashcards

Bisphosphonates and Bone Flashcards

why and how does bone remodel? how do antiresorptives work? what are the problems? how is this relevant to dentistry?

1
Q

what is bone composed of

A

water-10%
collagen-20%
mineral-70%

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2
Q

what minerals are found in bone

A

hydroxyapatite/Ca5(PO4)3(OH)

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3
Q

what are cortical bones comprised of

A

a basic unit called an osteon which goes the entire length of the bone

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4
Q

what does the osteon contain

A

concentric rings of bone tissues

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5
Q

why is the bone tissue strong

A

because of the arrangement of the collagen fibre and minerals are in different directions which means it can resist stress in different directions

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6
Q

what is contained inside a osteon

A 
lacunae containing osteocytes 
blood vessels 
haversian canal 
lamellae 
canaliculi
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7
Q

which cells take away bone

A

osteoCLAST

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8
Q

which cells remake bone

A

osteoBLAST

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9
Q

how do the osteoblasts and osteoclasts communicate with one another

A

by negative and positive feedback reactions

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10
Q

which hormones are involved in balancing bone absorption and bone formation

A

parathyroid hormone

oestrogen

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11
Q

what happens if you have hyperparathyroidism

A

dissolves bones

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12
Q

what can people with parathyroid tumours have

A

weak bones and can have high blood calcium levels

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13
Q

what other chemicals are involved in bone homeostasis

A

cytokines- inflammation
tumour factors- influences bone homeostasis
RANK-L inhibitors are more commonly prescribed and more patients take them
OPG-

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14
Q

what does RANK-L stand for

A

Receptor activator for nuclear factor kappa B ligand

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15
Q

what is a common drug which is a RANK-L inhibitor

A

denosumab- for the treatment of osteoporosis treatment-induced bone loss, metastases to bone,and giant cell tumor of bone

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16
Q

what is OPG

A

OsteoProtegerin

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17
Q

what are the stages of bone homeostasis

A
  1. the osteoblasts secrete RANK-L AND OPG
  2. the osteoclast has a receptor for the OPG molecule and the OPG has a receptor for RANK-L
    3.
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18
Q

what happens if rank-l and opg are working well

A

you get the same amount of bone formation and resorption

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19
Q

what happens if the osteoblast is only secreting RANK-L

A

we get osteoclast simulation- this is why a rank-l inhibitor may be helpful

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20
Q

what is the issue with bone homeostasis

A

can go wrong-
usually occurs with age naturally
also can be because of disease process- eg osteoporosis

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21
Q

what is osteoporosis

A

pores forming in the bone- not as much bone and the remaining bone is not as well calcified meaning it is weak

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22
Q

what is the result of osteoporosis in the long bone

A

massive pores in the bone- meaning when weight is applied stress is not applied evenly and more concentrated leading to fractured bone

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23
Q

what is a common compression fracture in the spine

A

a osteoporotic wedge fracture- causes a hunched spine

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24
Q

if you were to break a bone what could happen

A

calcium released into the blood
travels to the heart
causes heart dysrhythmia
leading to a heart attack

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25
Q

what is a distal radius fracture also known as

A

Colles fracture

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26
Q

which gender is in much more of a risk of severe osteoporosis

A

female due to the fact of menopause

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27
Q

who is at risk of osteoporosis

A

female-post menopause
elderly
long term corticosteroids

28
Q

give examples of corticosteroids

A

hydrocortisone

predisolone

29
Q

why might people take corticosteroids

A

asthma

RA

30
Q

what other diseases can we get in bones

A

bone cancer- eg breast, prostate and lung cancer can spread to the bone and metastasise
hypercalcaemia
pain
pathological fracture

31
Q

what is myeloma

A

bone cancer( cancer of the bone marrow)

32
Q

what can multiple bone metastasis lead to

A

pathological fracture- which causes pain

33
Q

what is the symptoms of hypercalcaemia in the GI tract

A

nausea
vomiting
loss of apatite
constipation

34
Q

what is the symptoms of hypercalcaemia in the CV system

A

bradycardia
cardiac arythmias
hypertension

35
Q

what is the symptoms of hypercalcaemia in the kidneys

A

kidney stones
nephrogenic diabetes insipidus
kidney failure

36
Q

what is the symptoms of hypercalcaemia in the brain

A

fatigue- mild hyperglycaemia
memory loss, depression and anxiety- moderate hypercalcaemia
extreme drowsiness coma death- severe hyperglycaemia

37
Q

what is Pagets disease

A

too much bone laid down

38
Q

What are the symptoms of Paget’s disease

A

Can get pathological fracture
As the bone is thicker leading to limb deformities
Compression of nerves
Pain

39
Q

What is osteogenesis imperfects

A

Weak bones which can break very easily

40
Q

What is the main take home message for people with osteoporosis

A 
Stay active 
Sunlight- vitamin D deficiency 
Drink sensibly and don’t smoke
Healthy balanced diet 
Hormone replacement therapy 
And bisphosphonates
41
Q

What are bisphosphonates

A

Given to people to stabilise bones and minimise effects of osteoporosis

42
Q

What are two phosphate molecules together called

A

Pyrophosphate

43
Q

What do pyrophosphate molecules bind to

A

Bone-HAP

44
Q

for how long do people need to take bisphosphonates for osteoporosis

A

oral or yearly injection

45
Q

for how long do people need to take bisphosphonates for cancer/myeloma

A

intravenous- once a week/once a month depending

46
Q

disadvantages of bisphosphonates

A

reduced activity of osteoclasts and osteoblasts
reduced healing ability
pain
dead bone
pathological fracture
can also affect other cells, keratinocytes and fibroblasts

47
Q

what is BRONJ

A

BISPHOSPHONATE RELATED OSTEONECROSIS OF THE JAW- used to be discussed a lot

48
Q

what is ARONJ

A

anti resorptive related necrosis of the jaw such as with denosumab

49
Q

what is MRONJ

A

medicated related osteonecrosis of the JAW- can get it with anti angiogenecis such as avastin sutent and zaltrap

50
Q

what is the half life of bisphosphonates

A

years- takes a long time to release from the bone

51
Q

do we advise a patient to stop taking bisphosphonates when a tooth is getting extracted

A

no as the dosage in the bone takes years to reduce

we might advise a drug holiday- haven’t been on it for long but might stop it for 6 months

52
Q

when do we review out patient if we have extracted a tooth and they are taking bisphosphonates

A 
in 8 weeks and we check for 
Exposed bone
Pain
Infection
Radiographic changes
Pus discharge
53
Q

if we find out a patient is taking bisphosphonates in the MH what follow up questions do we ask

A

Why are you taking it?
What kind of medicine are you taking?
How long have you taken it for?
Other risk factors

54
Q

what is the risk of MRONJ in osteoporosis

A

less than 0.15%

55
Q

what is the risk of MRONJ in cancer

A

3%

56
Q

what is the risk of MRONJ in myeloma

A

7%

57
Q

does alendronate have a high or low risk of MRONJ

A

low

58
Q

does zolendronate have a high or low risk of MRONJ

A

high

59
Q

what is the relative efficacy of Etidronate

A

1

60
Q

what is the relative efficacy of Clodranate

A

10

61
Q

what is the relative efficacy of Pamidronate

A

100

62
Q

what is the relative efficacy of Alendronate

A

500

63
Q

what is the relative efficacy of Risedronate

A

2000

64
Q

what is the relative efficacy of Zolendrote

A

10000

65
Q

what are the risks of MRONJ

A 
60% risk after dental extraction 
Untreated gum disease- we can help this
Untreated decay- we can help this
Poorly fitting dentures- we can help this 
Smoking
Alcohol
Steroids
(think about patients if they have rheumatoid arthritis!)

intro to biomedical sciences IBMS (35 decks)

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