Case of Crumbling Spine

Question 1

fragility fracture?

Answer 1

fracture caused by a fall rom a standing height or less or a spontaneous fracture

Question 2

Why do people have fragility fractures?

Answer 2

reduced bone mineral density, altered bone architecture

Question 3

why does bone quality change?

Answer 3

mutations in type 1 collagen, altered hydroxyapatite crystal structure, advanced glycation end products in diabetes

Question 4

what would drive bone breakkdown?

Answer 4

osteoblast have rank ligand which binds to rank receptor on osteoclast precursor causing mature osteoclast

osteoprotgerin can bind to rank ligand and reduce its activity

Question 5

what happened after they found out osteoprotogerin function?

Answer 5

denosumab 60mg s/c, igG2 isotype which bind to rank ligand so prevents osteoclast activity

Question 6

denosumab is cleared through?

Answer 6

reticuloendothelial system

Question 7

sclereosteosis?

Answer 7

SOST gene mutation- thick bones

Question 8

sclerosteosis work by?

Answer 8

sost gene is osteocytes causes sclerostin which inhibits WnT signalling and so reduces osteoblast activity

Question 9

what does romosozumab do?

Answer 9

binds to sclerostin and so WnT signalling system remains active and so increased osteoblast activity

Question 10

how to reduce skeletal aging?

Answer 10

senescent immune cells accumulate in bone marrow and secrete grancalcin, which represses osteogenesis and promotes adipogenesis via plexin b2 in BMSCs

grancalcin neutralising antibody

Question 11

systematic review

Answer 11

maximally informed and minimally biased clinical decision making

Question 12

protocol should be developed?

Answer 12

before, detailing rationale, hypothesis and planned methods

Question 13

review question

Answer 13

PICO- quantitative/ intervention
SPIDER- qualitative

Question 14

TYPE 1/2 Osteoporosis?

Answer 14

type 1- post menopausal
type 2 senile

Question 15

secondary osteoporosis due to?

Answer 15

rheumatois, anorexia, steroids, aromatase inhibitors, PPi, thyroxine, anti-epileptics

Question 16

Bone mass relies on?

Answer 16

oestogren levels, calcium and vitamin d, PTH

Question 17

clinically relevant skeletal sites?

Answer 17

spine l1-l4
left hip
right forearm

Question 18

what is t score?

Answer 18

difference measured BMD and that of a young healthy adult

Question 19

what is z score?

Answer 19

difference in measured BMD and healthy adult of same age

Question 20

osteoporosis WHO defintion?

Answer 20

BMD of 2.5. SD or more below the mean peak bone mass average for healthy young adults as measured by DEXA

Question 21

for postmenopausal women and men over 50 use t score?

Answer 21

normal= equal or greater than -1
osteopenia= -1 and -2.5
osteporosis equal or below -2.5

Question 22

what does FRAX calculate?

Answer 22

10 year probability of hip fracture or major osteoporotic fracture

Question 23

cross over vs parallel?

Answer 23

parallel- test drug/ placebo
cross over- swap assigned treatments

Question 24

interventional?

Answer 24

investigation drug or not for indication

Question 25

double dummy?

Answer 25

fake tablet/ fake inhaler

Question 26

relative risk?

Answer 26

risk of an event in active group/ risk of an event in the control group