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RB Y2 MSK Revision > Bone Health and Osteoperosis > Flashcards

Bone Health and Osteoperosis Flashcards

1
Q

osteoporosis

A

condition in which bone density decreases due to reduced osteoblast activity, resulting in reduced bone mineral density, increased porosity and brittle bones which fracture easily

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2
Q

where are common fracture sites

A

neck of femur, vertebral body, distal radius and humeral neck

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3
Q

epidemiology of osteoporosis

A

increase in fractures in the elderly, partially due to poort stability and gait

women

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4
Q

why are women more prone to osteoporosis

A

lower peak bone mass, and accelerated loss of bone during the menopause

increased longevity

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5
Q

why is there an increase in osteoporosis post menopause

A

oestrogen promotes the activity of osteoblasts, there are lower levels post menopause

OCP can be used as prevention

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6
Q

name some secondary causes of osteoporosis

A
  • Endocrine e.g. hyperthyroidism, hyperparathyroidism, Cushing’s disease
  • G.I. e.g. coeliac, IBD, chronic liver disease, chronic pancreatitis
  • Respiratory e.g. COPD
  • Chronic kidney disease
  • High alcohol intake
  • Smoking
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7
Q

pathology of osteoporosis

A

bone undergoes constant remodelling, this contributes to calcium homeostasis and also skeletal repair

in osteoporosis there is reduced osteoblast activity

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8
Q

how much of the adult skeleton is remodelled every year

A

around 10%

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9
Q

type 1 and 2 osteoporosis

A

type 1 is post menopausal, due to increased osteoclastic activity

type 2 is osteoporosis of old age/steroids/alcohol/malnutrition/RA

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10
Q

describe the changes in bone mass with age

A

increase until peak around 30

slow rate of bone loss starts at around 40

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11
Q

what factors is peak bone mass influenced by

A

genetics (70-80%)

body weight

sex hormones

diet

exercise

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12
Q

what factors is bone loss influenced by

A

sex hormone deficiency (post menopause)

body weight

genetics

diet

immobility

diseases

drugs (eg steroids, aromatase inhibitors)

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13
Q

who is therapeutic intervention targeted at

A

those with a high risk of a low impact fracture

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14
Q

clinical risk factors for fragility fractures

A

Non-modifiable:

  • Age
  • Gender
  • Ethnicity
  • Previous fracture
  • FH
  • Early menopause (≤45 years)

Modifiable:

  • BMD
  • Alcohol
  • Weight
  • Smoking
  • Physical inactivity

Also, co-existing diseases and pharmacological risk factors.

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15
Q

QFracture risk calculator pros and cons

A
  • Incudes more variables e.g. dementia, PD, medications
  • Allows smoking and alcohol to be given in quantities
  • Considers history of falls/nursing home residence
  • However, doesn’t include BMD
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16
Q

WHO FRAX risk calculator pros and cons

A
  • Takes into account bone mineral density (DEXA scan)
  • Gives a prediction of 10-year risk of major osteoporotic fracture or hip fracture
  • However, underestimates vertebral fracture risk, assigns the same level of risk to all secondary causes, and there is a lack of clarity regarding the algorithm and the population used
17
Q

who should have their fracture risk assessed

A

anyone >50 with risk factors

anyone <50 with very strong clinical factors eg early menopause, steroids

18
Q

when to refer for DEXA from fracture risk calculator?

A

anyone with a 10 year risk assessment for any osteoporotic fracture of at least 10%

19
Q

bone mineral density scan

A

predicts fracture risk independently of other risk factors

DEXA scans are the most widely used

20
Q

normal BMD T score

A

within 1 SD of adult reference mean

21
Q

osteopenia BMD T score

A

BMD 1-2.5 SD below young adult mean

there is a risk of later osteoporotic fracture, so offer lifestyle advice

22
Q

osteoporosis BMD T score

A

≥2.5 SD below young adult mean

severe osteoporosis = “” with fragility fracture

23
Q

what is used in BMD scans if the patient is under 20

A

only the Z score is reported

24
Q

management of osteoporosis

A

high intesity strength training

low impact weight bearing exercises

avoidance of alcohol and smoking

fall prevention

25
Q

dietary management of osteoporosis

A
  • RNI 700mg Calcium
  • Postmenopausal women aim for dietary intake of 1g Calcium per day to reduce fracture risk
  • Calcium is also in fortified bread and cereals, nuts, beans etc.
26
Q

calcium and vitamin D for osteoporosis treatment

A
  • Supplements may be considered due to reduce non-vertebral fracture risk in patients who are at risk of deficiency due to insufficient dietary intake/limited sun exposure
  • Calcium supplements should not be taken within 2 hours of oral Bisphosphonates
  • If dietary Calcium is adequate (>700mg daily), only vitamin D may be required as the osteoporosis treatment adjunct
27
Q

how to biphosphonates work

A

analogues of pyrophosphate that adsorb onto bone within the matrix and inhibit osteoclast acitivty by killing them (anti-resorptive)

prevent bone loss at all vulnerable sites and reduce the risk of hip and spine fractures

28
Q

1st line biphosphonate

A

alendronate

risedronate

29
Q

what are the long term consequences of biphosphonate use

A
  • fractures eg femoral shaft, subtrochanteric
  • there is evidence that they have a benefit for 5 years (10 in vertebral)
  • one may want to consider a bone holiday
30
Q

what are some other drug treatments available for osteoporosis

A

zoledronic acid

denosumab

teriparatide

31
Q

how is zoledronic acid adminstered

A

once yearly infusion for 3 years

1 in 3 have an acute phase reaction with 1st infusion - give paracetamol

32
Q

denosumab mechanism of action

A

inhibits development and activity of osteoclasts, decreasing bone resoprtion and increasing bone density

33
Q

what is teriparatide

A

recombinant PTH

34
Q

who is teriparatide used in

A

those who suffer further fractures despite treatment with other agents

stimulates a bone growth factor rather than reducing bone loss - anabolic agent

35
Q

at what T score should treatment be commenced

A

≤-2.5

(1-2.5 is osteopenia, offer lifestyle advice)

36
Q

when should one consider treatment with a T score of ≤-1.5

A

ongoing steroid treatmnet, preveleant vertebral fracture

37
Q

what can be used for prevention of osteoporosis in long term steroid use

A

bisposphonates

RB Y2 MSK Revision (3 decks)

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