Bone disease Flashcards
What is osteoporosis characterised by?
Low bone mass and microarchitectural deterioration of bone tissue, causing fragility and increased fracture risk
What are the two main types of bone?
80% cortical bone, 20% trabecular
When does a person have peak bone mass?
Age of 30
For each of the following systems give examples of conditions/treatments which might cause secondary osteoporosis
a) endocrine (3)
b) GI (4)
c) respiratory (2)
d) maligancy (2)
e) iatrogenic (1)
a) hyperparathyroidism, Cushing’s, thyrotoxicosis
b) malabsorptive states e.g. coeliac, IBD, liver disease, pancreatitis
c) COPD, cystic fibrosis
d) myeloma, bone mets
e) long term steroids
What are the DEXA cut-off scores for a) osteopenia and b) osteoporosis?
a) -1.0 to -2.5
b) <=-2.5
What lifestyle modifications should be encouraged in treatment of osteoporosis? (4)
strength training
low impact weight bearing exercise
avoid excess alcohol/smoking
1000mg/day calcium intake in post menopausal women
When should osteoporosis be treated?
T score less than -2.5, or -1.5 if on long term steroids
Aside from Vit D + calcium supplementation, what are the main treatment options? (5)
Bisphosphonates (alondronate 1st line) Strontium ranelate Raloxifene Denosumab Teriparatide
What is teriparatide?
Recombinant PTH
What is the drug class of raloxifene?
Selective oestrogen receptor modulator
What is the use of strontium ranelate limited by?
Increased risk of cardiovascular events and VTE; contraindicated in patients at risk of these
How do bisphosphonates work?
Inhibition of osteoclasts
Potential adverse effects of bisphosphonates?
Oesophageal problems- oesophagitis, ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal humeral shaft (alendronate)
How should bisphosphonates be taken?
Swallowed whole with plenty of water; on an empty stomach at least 30 mins before eating breakfast/taking another tablet; patient must not lie down for 30 minutes after taking
What are the main risk factors for osteoporosis? (4)
History: of glucocorticoid use, RA, alcohol excess
Low body mass
Current smoking
Advancing age and female sex
