Disorders Of Bone Metabolism Flashcards

1
Q

What are the risk factors for osteoporosis?

A
Low body weight
Elderly
Smoker
Lack of exercise
Family history
Menopause
Long term oral corticosteroids
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2
Q

What do patients at risk of osteoporosis need to do?

A

Calcium me vitamin D intake high or supplements

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3
Q

What is the treatment and prophylaxis of corticosteroid induced osteoporosis?

A

Bisphosphonates

Calcitriol
HRT
Testosterone

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4
Q

What puts a patient at risk of developing corticosteroid induced osteoporosis?

A

Oral corticosteroid for > 3 months

Low trauma fracture

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5
Q

What is the prophylaxis for post menopausal osteoporosis?

A

Bisphosphonates (alendronic/risedronate)

Strontium

HRT

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6
Q

What is the treatment for post menopausal osteoporosis?

A

Bisphosphonates (alendronic/risedronate)

Strontium/raloxifene

Teriparatide

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7
Q

What is the mechanism of action of bisphosphonates?

A

Slows the rate of bone growth and dissolution by adsorbing onto the hydroxyapatite crystals in the bone

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8
Q

What are the bisphosphonates?

A

Alendronic acid
Risedronate

Ibandronic acid
Sodium coordinate

Pamidronate (IV)
Zoledronic acid (IV, most potent)
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9
Q

Which bisphosphonate has the highest risk of osteonecrosis of the jaw?

A

Zoledronic acid

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10
Q

Which bisphosphonates are used for bone metastases in breast cancer/severe hypercalcaemia of malignancy?

A

Pamidronate

Zoledronic acid

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11
Q

What are the counselling points for alendronic acid?

A

70mg/week or 10mg/day

Swallow whole with plenty of water
While sitting or standing upright
On an empty stomach
Remain upright 30 minutes after

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12
Q

What are the counselling points for risedronate?

A

35mg weekly or 5 mg daily

Leave 2 hour gap between risedronate and food, drink, antacids, calcium containing products

Stand or sit upright for 30 minutes

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13
Q

What are the side effects of bisphosphonates?

A

Oesophageal reactions

Atypical femoral fractures

Osteonecrosis of jaw

Osteonecrosis of external auditory canal

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14
Q

What are the side effect counselling points for bisphosphonates?

A

Stop and report dysphagia, new or worsening heartburn or retrosternal pain

Report hip, thigh or groin pain

Report any oral symptoms

Report ear pain, discharge or infection

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15
Q

What needs to be checked before starting bisphosphonates?

A

Dental check up

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16
Q

What is the mechanism of action of strontium?

A

Bone formation stimulant and reduces bone resorption

17
Q

What are the side effects of strontium?

A

Serious CVD

Severe allergic reaction - DRESS
If skin rash occurs stop and report