disorders of bone health Flashcards

1
Q

what are osteoblasts?

A

bone forming cells

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2
Q

what are osteoclasts responsible for?

A

bone breakdown/reabsorption

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3
Q

what are osteocytes?

A

mature bone cells within the bone matrix, help to maintain bone and act as mechanosensors

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4
Q

which drugs can cause bone mass loss?

A

glucocorticoids

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5
Q

what are the common fracture sites?

A

Neck of femur
Vertebral body
Distal radius
Humeral neck

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6
Q

what are the non modifiable risk factors for fractures?

A

Age
Gender
Ethnicity
Previous fracture
Family history
Menopause ≤ 45 years
Co-existing diseases

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7
Q

what are the modifiable risk factors for fractures?

A

BMD (bone mineral density)
Alcohol
Weight
Smoking
Physical inactivity
Pharmacological risk factors

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8
Q

who gets referred for DEXA?

A

patients over 50with low trauma fracture
people who have a risk >10% over a 10 year period

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9
Q

what is the clinical range for osteopenia?

A

BMD>1 SD below young adult mean but <2.5 below this value

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10
Q

what is the clinical range for osteoperosis?

A

BMD ≥ 2.5 SD below the young adult mean

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11
Q

if the patient is younger than 20, which score is reported?

A

Only the Z score

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12
Q

what are the secondary causes of osteoperosis?

A

endocrine eg hyperthyroidism, cushings disesase

GI eg coeliac, IBD chronic liver disease

respiratory eg COPD

chronic kidney disease

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13
Q

what is the lifestyle advice for management of osteoperosis?

A

High intensity strength training
Low-impact weight-bearing exercise (standing, one foot always on the floor)
Avoidance of excess alcohol
Avoidance of smoking
Fall prevention

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14
Q

what are the drug treatments for osteoperosis?

A

Calcium & vitamin D supplementation
Bisphosphonates
Denosumab
Teriparatide
Romosozumab
HRT
Testosterone

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15
Q

how do biphosphonates work?

A

ingested by osteoclasts leading to cell death
thereby inhibiting bone resorption

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16
Q

what are some examples of biphosphonates?

A

alendronate
risedronate

both taken 1 per week

17
Q

what are the side affects of biphosphonate therapy?

A

osteonecrosis of jaw
oesophageal Ca

18
Q

what is an alternative to biphosphonates?

A

zoledronic acids (IV done if people cant tolerate biphosphonates)
denosumab (SC monoclonal antibody)

19
Q

what are the direct effects of corticosteroids on the bone?

A

Reduction of osteoblast activity and lifespan
Suppression of replication of osteoblast precursors
Reduction in calcium absorption

20
Q

what are the indirect effects of corticosteroids on the bone?

A

inhibition of gonadal and adrenal steroid production

21
Q

what % of BMD is lost in the first 6 months of use of corticosteroids?

22
Q

what bones does pagets disease primarily affect?

A

long bones
pelvis
lumbar spine
skull

23
Q

what causes pagets disease?

A

unknown aetiology

24
Q

how does pagets disease present

A

bone pain, deformity, deafness, compression neuropathies

25
what is a rare complication of pagets disease?
osteosarcoma
26
how is pagets treated?
with biphosphonates if pain not responding to analgesia?
27
what happens in pagets disease?
Abnormal osteoclastic activity followed by increased osteoblastic activity
28
what is osteogenesis imperfecta?
a rare group of genetic disorders mainly affecting bone
29
what mutations tend to cause osteogenesis imperfecta?
type 1 collagen mutations (COL1A1 and COL1A2)
30
what pattern of inheritance does osteogenesis imperfecta follow?
autosomal dominant
31
what can osteogenesis imperfecta be associated with?
blue sclerae and dentinogenesis imperfecta