Bone health Flashcards
what is osteoprosis
progressive skeletal disease characterized by low bone mass and deterioration of the bone tissue, with increase in bone fragility and fracture risk
which gender is more common female or male in osteoporosis
female
is osteoporosis asymptomatic or has symtoms
assymptomatic
where are common fracture sites in the body
neck of femur, vertebral body, distal radius, humeral neck
how much of the skeleton is remodeled each year
10%
what is normal transitioning between osteoblasts and osteoclasts
osteoclast- osteoblast numbers the same, rapid turnover and regeneration
what causes fractures?>
BREAKS IN THE INFRASTRUCTURE LEAD TO WEAKNESS CAUSING FRACUTRES
WHEN DO YOU TYPICALLY HAVE PEAK BONE MASS
LATE 20S
what factors can lead to bone loss
glucocorticoids, diet, weight, sex hormone deficiency, diseases, immobility
what is the major determinant of bone loss after the menopause?
oestrogen deficinecy
what does the fracture risk calculator do?
predicts 10 yearr fracture risk of major osteoporotic fractureses
when would you use the risk factor assessment?
over 50s, and under 50s that have history with glucocorticoid involvement and early menopause
when shouda DEXA scan be performed?
anyone who gets a fracture score of 10% or more
what does DEXA do?
measures bone density independently of anything else
what advice should you give for managing osteoporosis
high intensity strength training, low impact weight bearing, avoid alcohol, avoid smoking, fall prevention
what should post menopausal women aim for in calcium intake
1000mg
what drugs are used in the treatment of osteoporosis
calcium and vit D supplements, bisphosphonates, denosumab,, HRT, testosterone
what do calcium and vit D reduce the risk of?
non vertebral fractures
what are the guidelines for taking calcium and vit D supplements
cannot take calcium within 2 hours of oral bisphosphonates. If calcium in diet is adequate, vit D may be preferred for OP treatment
what are bisphosphonates and what do they do?
antiresorptive agents, prevent bone loss at all sites vulnerable to OP, reduce risk of hip and spine fracutre
how do bisphosphonates work chemically?
ingested by osteoclasts which lead to cell death thus inhibiting bone resorption. Slows bone growth
what T score must OP patients have to use bisphosphonates ?
less than -2.5
how long should bisphosphonates be used
5 years
how often can patients take Zoledronic acid
1 yearly IV infusion for 3 years
what is zoledronic
a bisphosphonate that can be taken IV
what is denosumab
monoclonal antibody that targets and binds with high affinity and specificity to RANKL- inhibits development and activity of osteoclasts, decreasing bone resoprtion and density
how is denosumab taken?
sub cut injections 6 monthly
what are some side effects of denosumab
hypocalcaemia, eczema, cellulitis
when is strontium ranelate used
3rd line treatment as fracture reduction risk not as high, contraindicated in thromboembolic disease, peripheral artery disedase, uncontrolled hypertension. DONT USE IF ALTERNATIVE METHOD AVAILABLE
what is teriparatide
a parathyroid hormone
what does teripatide do?
stimulates bone growth as opposed to oppresss cell death
in what patients would you use teriparatide
> 65 with T score of
what effects do corticosteroids have on bone
reduce osteoblast formation, suppress osteoblast precursors, reduce calcium absorption. Indirectly inhibit gonadal and adrenal steroid production
what si pagets disease of bone
abnormal osteoclast activity and increased osteoblast activity. bnormal bone structure with reduced strength and increased fracture risk. single or multiple sites.
what bones does pagets disease effect
long bones- femur, pelvis, lumbar spine, skull
what would you present with pagets disease
bone pain, deformity, neuropathies, raised ALP,
What imaging would you use
isotope bone scan, XR ALP raised
how would you treat pagets disease
bisphosphonates if not responding to analgesia
what is osteogenesis imperfecta
rare group of genetic disorders affecting bone due to collagen mutation, usually autosomal dominant
what can osteogenesis be confused with
non accidental injury due to fracture risk as children
