Disorders Of Bone Metabolism Flashcards
What are the risk factors for osteoporosis?
Low body weight Elderly Smoker Lack of exercise Family history Menopause Long term oral corticosteroids
What do patients at risk of osteoporosis need to do?
Calcium me vitamin D intake high or supplements
What is the treatment and prophylaxis of corticosteroid induced osteoporosis?
Bisphosphonates
Calcitriol
HRT
Testosterone
What puts a patient at risk of developing corticosteroid induced osteoporosis?
Oral corticosteroid for > 3 months
Low trauma fracture
What is the prophylaxis for post menopausal osteoporosis?
Bisphosphonates (alendronic/risedronate)
Strontium
HRT
What is the treatment for post menopausal osteoporosis?
Bisphosphonates (alendronic/risedronate)
Strontium/raloxifene
Teriparatide
What is the mechanism of action of bisphosphonates?
Slows the rate of bone growth and dissolution by adsorbing onto the hydroxyapatite crystals in the bone
What are the bisphosphonates?
Alendronic acid
Risedronate
Ibandronic acid
Sodium coordinate
Pamidronate (IV) Zoledronic acid (IV, most potent)
Which bisphosphonate has the highest risk of osteonecrosis of the jaw?
Zoledronic acid
Which bisphosphonates are used for bone metastases in breast cancer/severe hypercalcaemia of malignancy?
Pamidronate
Zoledronic acid
What are the counselling points for alendronic acid?
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
What are the counselling points for risedronate?
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
What are the side effects of bisphosphonates?
Oesophageal reactions
Atypical femoral fractures
Osteonecrosis of jaw
Osteonecrosis of external auditory canal
What are the side effect counselling points for bisphosphonates?
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
What needs to be checked before starting bisphosphonates?
Dental check up