disorders of bone metabolism

Question 1

what are the risk factors for osteoporosis ?

Answer 1

low body weight
elderly 65 plus
cigarette smoking
lack of movement
excess  alcohol
family history
menopause, especially if early
long-term oral corticosteroids

Question 2

how does bisphosphonates work ?

Answer 2

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

Question 3

which electrolyte imbalance does bisphosphonates cause ?

Answer 3

hypocalcaemia

Question 4

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

Answer 4

zolendronic acid

Question 5

what are counselling points for alendronic acid ?

Answer 5

• swallow with plenty of water
• while sitting or standing upright
• on an empty stomach 30 min before breakfast or another oral medicine
• remain upright for 30 min

Question 6

what are the side effects of bisphosphonates ?

Answer 6

-oesophagitis, strictures, ulcers and erosions:
patients should report dysphagia, new or worsening heartburn or retrosternal pain
-atypical femoral fractures: report hip, thigh or groin pain
-osteonecoris of jaw
-osteonecrosis of external auditory Canal : main if taking it for more than 2 years : report ear infection, ear pain , ear discharge

Question 7

what are the side effects of strontium ranelate ?

Answer 7

serious cardiovascular disease: including myocardial infarction and VTE
severe allergic reactions: DRESS ( drug rash with eosinophilia and systemic symptoms) starts with a rash, swelling glands, high WBC count, can affect kidneys, liver, lungs and be fatal