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MODULE 5 ORAL SURGERY > BONE BIOLOGY BISPHOSPHONATES > Flashcards

BONE BIOLOGY BISPHOSPHONATES Flashcards

1
Q

What regulates bone turnover?

A

parathyroid hormone
calcitriol
calcitonin
sex hormones
GH
thyroid hormone
cortisol

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2
Q

role of osteoblasts

A

produce bone

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3
Q

role of osteoclasts

A

resorb bone

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4
Q

5 phases in bone remodeling

A
  1. activation
  2. osteoclast recruitment and resorption
  3. reversal
  4. osteoblast recruitment and bone formation
  5. termination - quiescence
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5
Q

list 2 genetic abnormalities of bone

A

osteogenesis imperfecta
osteopetrosis

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6
Q

list 5 non-genetic abnormalities of bone

A

osteoporosis
glucocorticoid-induced osteoporosis
hyperparathyroidism
Pagets disease
fibrous dysplasia

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7
Q

what bones does OI affect? and its aetiology

A

whole skeleton
collagen defect

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8
Q

what is osteopetrosis?

A

osteoclastic bone resorption defect

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9
Q

who does pagets disease commonly present in?

A

elderly

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10
Q

how may a mandible present on a DPT of someone with OI?

A

thin and narrow

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11
Q

how may a DPT present in a pt with osteopetrosis?

A

marble bone disease - bone is dense and sclerotic (dentition cant erupt)

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12
Q

what is a sequestrum

A

section of necrosed bone detached from healthy tissue

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13
Q

what happens to bone following xLA

A

physiological osteoclastic bone resorption

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14
Q

following xLA where is the greatest amount of bone loss?

A

horizontal dimension
facial aspect ridge

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15
Q

how long does the bone remodeling process take?

A

6 months

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16
Q

definition of atrophic mandible

A

height < 15mm

17
Q

list 4 drug groups affecting bone remodelling

A

bisphosphonates
denosumab and anti-angiogenic drugs
steroids
NSAIDs

18
Q

bisphosphonate action

A

bind avidly to exposed bone mineral around resorbing osteoclasts = high levels in the resorption lacunae

19
Q

why are bisphosphonates maintained in the bone for long periods of time

A

they aren’t metabolised

20
Q

describe the term anti-angiogenic

A

effect vasculature of area which inhibits bone remodeling

21
Q

2 classes of bisphosphonates and give example for each

A

non-nitrogen containing - clodronate
nitrogen containing - alendronate

22
Q

list 4 main conditions treated with bisphosphonates

A

multiple myeloma
breast cancer
osteoporosis
prostate cancer

23
Q

according to the SDCEP guidelines, what classifies a pt as being low risk in relation to bisphosphonates and MRONJ?

A
  1. not yet started taking
  2. taking bisphosphonates for prevention or management of osteoporosis
24
Q

according to SDCEP guidelines, what classifies a pt as being high risk in relation to MRONJ?

A
  1. previous diagnosis of MRONJ
  2. taking bisphosphonates as part of the management of a malignant condition
  3. other non-malignant condition of the bone - PAGETS DISEASE
  4. under the care of a specialist for rare condition - OI
  5. concurrent use of systemic corticosteroids or other immunosuppressants
  6. coagulopathy, chemotherapy, radiotherapy
25
Q

when would you review a low risk pt?

A

4 weeks

26
Q

what is the 3 criteria for MRONJ?

A
  1. current or previous tx with bisphosphonates, antiangiogenic drugs or RANKL inhibitors
  2. exposed bone in the maxillofacial region/ bone that can be probed that has persisted for more than 8 weeks
  3. no history of radiation therapy to the jaws
27
Q

signs and symptoms of MRONJ

A

area of necrotic exposed bone
internal/ external discharging fistulas
pain
painless
loose teeth
bony sequestrae
mobile teeth
paraesthesia

28
Q

why does overlying mucosa to necrotic bone die

A

no periosteal supply

29
Q

trade name for denosumab?

A

Prolia

30
Q

when is optimal time for pt taking denosumab to receive xLA? and why

A

just before next injection - lowest impact on bone turnover

31
Q

how quick does denosumab work?

A

within 6 hours the osteoclast function is inhibited
lasts for 6 months

32
Q

corticosteroid action

A

anti-inflammatory
delay healing in strong doses

33
Q

2 examples of corticosteroids?

A

prednisolone
hydrocortisone

34
Q

what conditions may high dose steroids be used to treat?

A

COPD
autoimmune diseases

35
Q

2 examples of NSAIDs?

A

ibuprofen
diclofenac

36
Q

can NSAIDs impact bone healing?

A

yes - avoid following bone augmentation surgery for dental implants as they interfere with production of prostaglandins

37
Q

name drugs that affect absorption of calcium from the stomach

A

anti-seizure drugs - carbamazepine, phenytoin and long term PPIs

38
Q

what group of drugs increase renal excretion of calcium?

A

diuretics

39
Q

what type of drugs increase androgen and oestrogen levels?

A

drugs for breast and prostate cancer

MODULE 5 ORAL SURGERY (7 decks)

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