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Y3(M) - Geriatrics > Bone Health > Flashcards

Bone Health Flashcards

1
Q

What are the 2 types of bone that make up the body?

A

Cortical bone
Trabecular bone

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2
Q

What are the functions of bone?

A

Structural support
Attachment of muscles for locomotion
Storage
Haematopoiesis
Protection
Aids respiration

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3
Q

What is the role of bone in storage?

A

Stores:
Ca2+
Phosphate
Acts as a buffer for the blood

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4
Q

What are the determinants of bone health?

A

Genetics
Calcium
Vitamin D
Physical activity
Smoking
Alcohol
Hypogonadism
Malnutrition
Drugs

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5
Q

What medications often negatively impact bone health?

A

Corticosteroids
Anticonvulsants
Long term PPIs
Statins

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6
Q

What are some anticonvulsants that can negatively impact bone health?

A

Phenytoin
Carbamazepine
Sodium valproate
Gabapentin
Levetiracetam

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7
Q

How much calcium does the average adult need a day?

A

700mg per day

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8
Q

What affects calcium levels in the body?

A

Diet
Intestinal absorption
Skeletal resorption
Urinary excretion

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9
Q

What are the main sources of dietary calcium?

A

Dairy
Nuts
Leafy vegetables like broccoli

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10
Q

Why is calcium needed for bone health?

A

Needed to form strong hydroxyappetite crystals to give strength too the bone

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11
Q

How is vitamin D metabolised in the body?

A

Sunlight activates the cholesterol precursor of vitamin D in the skin

This then gets converted to inactivated Vitamin D in the liver (25-hydroxyVitamin D)

Then kidneys activate 25-hydroxyVitamin D into active vitamin D

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12
Q

What are the risks for developing Vitamin D deficiency?

A

+65yrs
Low/no sun exposure
Darker skin
Malabsorption
Severe liver disease
End stage renal failure
Pregnancy
Obesity
Mediations

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13
Q

How can you prevent developing vitamin D deficiencies?

A

Supplements
Adequate sunlight exposure

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14
Q

How many international units should a person take when taking vitamin D supplements?

A

400 IU

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15
Q

What are the risks of having vitamin D deficiency?

A

Osteoporosis
Osteomalacia
Rickets (Children)
Fragility fractures
Muscle weakness

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16
Q

How can Hyperparathyroidism cause osteomalacia or osteoporosis?

A

PTH increases osteoclast activity

17
Q

How much exercise should people over 65+ get to help reduce the risk of developing vitamin D deficiency?

A

150mins moderate intensity exercise every week
Muscle strengthening twice per week

18
Q

What is the definition of osteoporosis?

A

Decreased bone mass with altered bone architecture and increased skeletal fragility

19
Q

How do you diagnose osteoporosis?

A

Fragility fracture
And/or
T score < -2.5 from DEXA scan

20
Q

What is the definition of a fragility fracture?

A

Fracture that occurs due to mechanical forces that doesn’t usually cause fractures

Bones typically squash down on itself

21
Q

Who do you screen for osteoporosis?

A

65+ and all men 75+
Anyone with risk factors
Previous fragility fractures
Glucocorticoids
Hx of falls
Low BMI
Smoking
High alcohol intake (14 units +)

22
Q

What is the process of screening for osteoporosis?

A

Do DEXA scan ( T score < -2.5 = osteoporosis)
Use WHO FRAX score if cant do DEXA scan

23
Q

How do you manage osteoporosis?

A

Vitamin D + Ca2+ (need to replenish)
Bisphosphonates

Normally enough above

SERMs
Parathormone
Biologics

24
Q

What are some bisphosphonates given for osteoporosis?

A

Allendronic acid
Zolendronic acid

25
Q

How is allendronic acid taken?

A

Once per week on empty stomach
Patient should stay sat up straight when taking it

26
Q

How often is zolendronic acid taken?

A

Once a year

27
Q

What are some side effects bisphosphonates?

A

Oesophagitis
Osteonecrosis of the jaw

28
Q

What is a biologic that can be given for treating osteoporosis?

A

Romosozumab

29
Q

When are biologics given over bisphosphonates to treat osteoporosis?

A

If they have renal impairment

Y3(M) - Geriatrics (7 decks)

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