Case 8 - Ageing

Question 1

what is the menopause and what age does it begin

Answer 1

no periods for 12 consecutive months
can’t get pregnant naturally
45-55, ave 51

Question 2

what is primary hypogonadism and give 2 examples

Answer 2

problem w ovaries
POI - menopause before age 40
natural menopause

Question 3

what are the patterns of results for primary hypogonadism

Answer 3

low estradiol

high fsh/lh

Question 4

what is secondary HGadism and examples

Answer 4

problem with PT and HT
eg hypothalamic disease bc anorexic
pituitary tumours = non functioning hormones

Question 5

pattern of results for secondary HGadism

Answer 5

low estradiol

low fsh and lh

Question 6

5 symptoms of menopause?

Answer 6

joint pain
mood swings
vasomotor symptoms
insomnia
vaginal and urogenital dysfunction

Question 7

what happens w bone loss in menopause and why?

Answer 7

lose 20% of BD

estrogen inhibits resorption of bone so low estrogen = resorption of bone

Question 8

how can you improve bone loss in menopause

Answer 8

limit alcohol and smoking
healthy diet w adequate calcium and d3
weight bearing exercise

Question 9

4 treatments for menopause

Answer 9

prescription
HRT
natural = phytoestrogens and acupuncture
lifestyle

Question 10

how long for and when do you take HRT

Answer 10

in perimenopause you can start

5 years max

Question 11

3 negatives of HRT

Answer 11

increased risk of breast and womb cancer, VTE and stroke

Question 12

what HRT do u take with a uterus and why

Answer 12

combined

bc oestrogen causes proliferation of endometrium, progesterone has anti-prolif effects

Question 13

what HRT do you take if you have had a hysterectomy

Answer 13

oestrogen only

Question 14

best method of estrogen? what are the other ways of delivering it?

Answer 14

best = transdermal bc no cancer or VTE risk

patch, gel, orally

Question 15

what is micronized progesterone and why is it good

Answer 15

natural, body identical progesterone

no androgenic or gcc effects like synthetic

Question 16

what does HRT reduce

Answer 16

all symptoms of menopause basically

Question 17

what are prescription remedies for HRT

Answer 17

anti-depressants
clonidine - anti hypertensive
developing: neurokinin 3 receptor antagonist, reduces hot flushes and insomnia

Question 18

when do you give androgen therapy to women

Answer 18

if loss of libido and sexual drive

Question 19

what is osteomalacia

Answer 19

loss of bone mineral
associated w lack of vitamin d3
can still produce collagen

Question 20

osteomyelitis?

Answer 20

infection of bone bc of bacterial origin

Question 21

osteoarthritis?

Answer 21

mechanical in origin, disease of joints

Question 22

osteoporosis?

Answer 22

loss of entire bone substance including extra-cellular matrix and minerals
fractures of non-traumatic origin are sustained

Question 23

what is the WHO definition of OP and what are T and Z scores?

Answer 23

BMD 2.5 SD away from a normal healthy control
T score - BMD matched to control
Z - age matched BMD

Question 24

how is BMD measured

Answer 24

DEXA of lower spine and hips

2 streams - absorbed by total body and one by soft tissue, subtract to get bone

Question 25

OP in men and women figures

Answer 25

men - 1/12 | women 1/3

Question 26

what is the osteoid

Answer 26

unmineralized matrix, laid down by OB

Question 27

what is bone remodelling

Answer 27

resp for maintaing mechanical integrity of skeleton in adult life removes defective bone responds to mechanical signals

Question 28

what is the bone metabolic unit

Answer 28

``` osteoblasts on one side OC on other signalling going on between them osteoid laid down collagen type 1 formed in circles, lamella formed around outside ```

Question 29

what is bone modelling

Answer 29

resp for growth and shaping of bones through childhood and adolescence

Question 30

what does an 18 y old bone look like

Answer 30

epiphyseal plates open trabeculae thick corticies visible and thick

Question 31

bone at menopause?

Answer 31

thinner trabeculae and corticies | fused EP plates

Question 32

bone after 80?

Answer 32

no corticies, large gaps in trabeculae

Question 33

what effect does oestrogen reduction have on bone

Answer 33

increases OC too many for OB to keep up esp bc sudden reduction BMD deficit

Question 34

what does oestrogen do normally on OB

Answer 34

increases alkaline phosphate expression incr collagen and tf GF synthesis eg IGF causes reg cell division and proliferation of OB receptor for colecalciferol is a marker for OB differentiation is stim by oestrogen

Question 35

what does oestrogen do normally on OC

Answer 35

incr apoptosis suppresses proliferation acts on OC via OB bc of rank/l protein

Question 36

impact of peak bone mass on OP

Answer 36

higher PBM = stronger bones later in life

Question 37

impact of genetics on PBM

Answer 37

afro-caribean higher than asians and whites

Question 38

why do men have lower OP levels

Answer 38

bc higher PBM and oestrogen levels decreases slower bc no menopause

Question 39

what are the bone markers used for OB and OC

Answer 39

alkaline phosphatase and collagen breakdown products

Question 40

why can't we use biochem to test for OP

Answer 40

bc disease of bone remodelling, takes approx 9 months to see | DEXA and BMD done every year reflect entire section of skeleton

Question 41

OP in men risk and risk factors

Answer 41

25% lifetime risk of fractures | HGadism, smoking, alcohol, steroid therapy

Question 42

effect of oestrogen on bone mass in men

Answer 42

required | bc mutation in aromatase or oestrogen receptors on OB and OC = OP

Question 43

what is CCS therapy used for

Answer 43

asthma, RA, AID and inflammtory diseases like crohn's disease

Question 44

calcium regulation in terms of 1,25 D etc

Answer 44

o Calcium hormone decreases, PTH goes up o PTH acts in kidney to metabolise 25OH (vitamin D) to 1,25 D (cole-calciferol) o Vitamin D production in skin; o Transformed in liver to 25 OH D3 o Major target for active form of vitamin d3: calcium resorption in the gut o In the gut: many receptors for active form of vitamin D; enable calcium resorption to return calcium levels to normal

Question 45

how do CCS affect calcium levels

Answer 45

prevents reabsorption through gut, increased levels of PTH left

Question 46

how to classify fractures

Answer 46

by location - epi,di, metaphyseal | by type: open/closed, complete/incomplete

Question 47

what is a fracture

Answer 47

condition that changes bone contour

Question 48

stage 1 of wound healing?

Answer 48

haematoma formation BV rupture = bleeding clot forms, closes off injured vessels and leaves meshwork in damaged area

Question 49

stage 2?

Answer 49

FC callus formation external callus - organises w in medullary cavity, between broken ends of shaft external - forms bone at level of fracture centre: chondrocytes form hyaline cartilage edges: diff into OB and bridge broken ends together

Question 50

stage 3?

Answer 50

bony callus formation OB replace cartilage w spongy bone struts of sb join broken ends and hold in place

Question 51

stage 4?

Answer 51

remodelling,