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Endocrine > disorders of bone health including osteopersosis > Flashcards

disorders of bone health including osteopersosis Flashcards

1
Q

what is osteoporosis?

A

-progressive systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

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2
Q

where does the bone remodelling cycle occur?

A

-at distinct sites called bone remodelling units

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3
Q

what process contributes to calcium homeostasis and skeletal repair?

A

the continual bone remodelling cycle

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4
Q

what are the 3 main types of bone cells?

A
  • osteoclasts
  • osteoblasts
  • osteocytes
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5
Q

what are osteoclasts?

A

-multinucleated cells responsible for bone reabsorption, derived from haematopoietic progenitors

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6
Q

what are osteoblasts?

A

-mononucleated cells derived from mesenchymal cells in the bone marrow stroma, responsible for bone formation

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7
Q

what are osteocytes?

A

-primary cell of mature bone and most common type of bone cell, derived from the osteoblasts which become buried in bone matrix

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8
Q

what are the three phases of bone remodelling in a bone remodelling unit?

A
  • resting phase
  • active bone resorption
  • bone formation
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9
Q

what bone cell is responsible for active bone resorption?

A

osteoclasts

C=cut

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10
Q

what is bone resorption?

A

-destruction of bone tissue, promoting bone loss

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11
Q

what bone cell is responsible for bone formation?

A

-osteoblasts

B=build

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12
Q

describe the bone microarchitecture at a healthy 20 year old

A
  • good strong trabecular

- healthy bone

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13
Q

describe the bone microarchitecture of a 50 year old

A

-decrease in trabecular thickness which is more pronounced for non load-bearing horizontal trabeculae

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13
Q

describe the bone microarchitecture of a 50 year old

A

-decrease in

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14
Q

describe bone microarchitecture in 80 years?

A

-decrease in number of connections between vertical trabeculae which causes a decrease in trabeculae strength

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15
Q

what are bone trabeculae?

A

-highly porous forms of bone tissue that are organised into a network of interconnected rods and plates

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16
Q

what occurs to the tubercular in osteoporotic bone?

A

-they’re a lot weaker and there’s breaks between them

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17
Q

what factors can lead to bone loss?

A
  • sex hormone deficiency
  • changes in body weight
  • genetics
  • diet
  • immobility
  • disease
  • drugs especially glucocorticoids and aromatase inhibitors
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18
Q

what are some non-modifiable risks of a fragility fracture?

A
  • age
  • gender
  • ethnicity
  • previous fracture
  • family history
  • menopause <45
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19
Q

what are some modifiable risks of a fragility fracture?

A
  • BMD
  • alcohol
  • weight
  • smoking
  • physical inactivity
  • drugs
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20
Q

what is used to determine fracture risk?

A

QFracture score

21
Q

who would you do a risk factor assessment on?

A

> 50 with risk factors

<50 with very stron clinical factors:

  • early menopause
  • glucocorticoids
22
Q

when to refer for DXA (dual energy Xray)?

A

-patients >50 years with low trauma fracture

  • patients at increased risk of fracture based on risk factures (calculated using risk essessment tool e.g. FRAX or Q fracture)
  • this would have to be >10% risk of fracture over 10 years
23
Q

what is the most widely used method of measuring bone mass density?

A

DEXA scans

24
Q

what is the T score?

A

way of measuring risk of osteoperosis

-compare the patients BMD with an estimate of what their BMD would’ve been when they were a young adult (at peak bone density)

25
Q

what is a normal BMD?

A

within 1 SD (standard deviation) of the young adult reference mean

26
Q

what would be classed as osteopenia (low bone mass)?

A

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

27
Q

what would be classed as osteoporosis?

A

BMD> or equal to 2.5 SD below the young adult mean

28
Q

what would be classed as severe osteoporosis?

A

BMD equal to or over 2.5 SD below the young adult mean fragility with fragility fracture

29
Q

what is used to class BMD if a patient is <20?

A

Z score report

30
Q

what is the Z score?

A

the average bone density of an aged match group of patients

used in patients <20

31
Q

what is the relationship between T score and risk of fracture?

A
  • for every additional SD below normal there is a doubling of fracture risk
  • As the T score increases the fracture risk increases
32
Q

what are some endocrine secondary causes of osteoporosis?

A
  • hyperthyroidism
  • hyperparathyroidism
  • cushings disease
33
Q

what are some GI secondary causes of osteoperosis?

A
  • coeliac
  • IBD
  • chronic liver disease
  • chronic pancreatitic
34
Q

what are some resp secondary causes of osteoperosis?

A
  • CF

- COPD

35
Q

what are some renal secondary causes of osteoperosis?

A

-chronic kidney disease

36
Q

what investigations are done for a patient with suspected osteoperosis?

A
  • U + Es
  • LFTs
  • FBC
  • PV
  • TSH levels
  • bone biochemistry
37
Q

what is some lifestyle advice for patients diagnosed with osteoporosis?

A
  • High intensity strenght training
  • low impact weight bearing excercise (standing, one foot always on floor)
  • avoid of excess alcohol
  • smoking cessation
  • fall prevention
38
Q

what is some diet advice for patients with osteoporosis?

A
  • 700mg of calcium (2-3 portions from milk and dairy food groups)
  • post menopausal women aim dietary intake 1000mg calcium per (3-4 portion calcium rich foods)
  • bread and cereal
  • fish with bones
  • nuts
  • green vegetables
  • beans
39
Q

what is the drug treatment for osteoperosis?

A
  • calcium and vitamin D
  • biphsophonates= 1st line
  • denosumab
  • teriparatide
  • romosozumab
  • HRT
  • SERMs (selective estrogen receptor modulators)
  • testosterone
40
Q

when is osteoporosis treated?

A

-majority of patients, consider treatment with antiresorptive therapy when T score /=7.5mg prednisolone for 3 months or more if there is a prevalent vertebral fracture, consider treatment with T score

41
Q

what drug is used if patients are intolerant to biphosphonates or are high risk?

A
  • Zoledronic Acid (given IV infusion for 3 years)

- Denosumab

42
Q

what are the side effects of donsumab?

A
  • hypocalcaemia
  • eczema
  • cellulitis
43
Q

when is donsumab contraindicated?

A

severe renal impairement

44
Q

when is Teriparatide recommended?

A

-patients with most severe osteoperosis especially patients with non trauma vertebral fractures in postmenapausal women

45
Q

when is romosozumab recommended?

A

recommended for postmenopausal women with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture (24 months)

46
Q

what are the direct effects that corticosteroids have on bone?

A
  • reduction of osteoblast activity and lifespan
  • suppression of replication of osteoblasts precursors
  • reduction in calcium absorptions
47
Q

what is an indirect effect of corticosteroids and bone?

A

-inhibition of gonadal and adrenal steroid production

48
Q

what is Paget’s disease?

A
  • abnormal osteoclastic activity followed by increase osteoblastic activity
  • abnormal bone structure with reduced strength and increased fracture risk
49
Q

what bones does Paget’s usually affect?

A
  • long bones
  • pelvis
  • lumbar spine
  • skull

Endocrine (53 decks)

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