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Locomotor > Drugs used to treat disorders of bone > Flashcards

Drugs used to treat disorders of bone Flashcards

1
Q

Which cells are present in bone?

A

Osteoblasts

Osteoclasts

Osteocytes

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2
Q

What makes up the matrix of bone?

A

Osteoid (e.g. collagen)

Minerals (calcium, phosphate)

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3
Q

Briefly describe how new bone is formed?

A

Osteoblasts secrete new bone matrix (osteoid)

Osteoid is mineralised (hydroxyapatite)

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4
Q

How much bone is remodelled per year in adults?

A

25% trabecular bone

3% cortical bone

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5
Q

Which bones have the highest desnity of trabecular bone?

What is the consequence of this?

A

Femoral neck and vertebral bodies

Most affected by processes that alter bone remodelling (e.g. osteoporosis)

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6
Q

Describe the factors which affect bone remodelling?

A

Ageing

Physical factors (e.g. exercise, loading)

Hormones (oestrogen)

Drugs (crorticosteroids)

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7
Q

Describe how osteoblasts regulate osteoclast activity?

A

Calcitriol and PTH stimulate osteoblasts to express RANKL > RANKL interacts with RANK on osteoclasts > osteoclast maturation

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8
Q

How does PTH affect bone remodelling?

A

Increased osteoblast and osteoclast activity

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9
Q

How does oestrogen affect bone remodelling?

A

Decreased osteoclast activity

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10
Q

How do glucocortcoids affect bone remodelling?

A

Increased osteoclast activity

Decreased osteoblast activity (apoptosis induced)

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11
Q

How do embedded cytokines affect bone remodelling?

A

Increase osteoblast activity

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12
Q

How does calcitonin affect bone remodelling?

A

Decreased osteoclast activity

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13
Q

Which two factors regulate bone mineralisation?

A

1) Vitamin D
2) PTH and calcitonin

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14
Q

Define osteoporosis?

A

Reduction in bone mass more than 2.5 SD below mean for healthy 30 yo woman

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15
Q

Define osteopaenia?

A

Reduction in bone mass 1-2.5 SD below norm for healthy 30 yo woman

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16
Q

Describe how bone density changes over the life span?

A

Increases until peak at 30

Declines afetr menopause

17
Q

Describe the changes that occur in bone in osteoporosis?

A

Loss of cells and matrix

Loss of trabeculae and thinning

Los of trabecular connectivity

18
Q

Describe the pathophysiology of osteoporosis?

A
19
Q

What are the two categories of drugs used in bone disorders?

A

Antiresorptive agents

Bone anabolic agents

20
Q

List three types of antiresorptive agents?

A

Bisphosphonates

Selective oestrogen receptor modulators

RANKL inhibitors

21
Q

List four types of bone anabolic agents?

A

PTH

Oral calcium

Oral Vitamin D analogues

Calcitonin

22
Q

What are bisphosphonates?

A

Antiresorptive agents

Analogues of pyrophosphate

23
Q

Describe the action of bisphosphonates?

A

Incorporated into bone matrix > ingested by osteoclasts > toxic

Inhibit recrutimnet of osteoclasts

Promote apoptosis of osteoclasts

24
Q

Describe the administration of bisphosphonates?

A

Administered weekly (due to accumulation)

Don;t lie down for for hours after administration (due to reflux)

25
Q

Describe the risks and benefits of bisphosphonates?

A

BENEFITS

Reduced fracture risk

RISKS

Oesophageal cancer?

Atypical fractures?

Osteonecrosis of jaw?

26
Q

What is Raloxifene?

A

Selective oestrogen receptor modulator

27
Q

Describe the actions of Raloxifene?

A

Agonist at oestrogen receptors in bone and cardiovascualr tissue

Antagonist at oestrogen receptors in mammary tissue and uterus

28
Q

What is Denosumab?

A

RANKL inhibitor

Human monoclonal antibody

29
Q

Describe the actions of Denosumab?

A

Binds RANKL > inhibits RANKL activity > reduces osteoclast activity

30
Q

Why is Denosumab not commonly used?

A

New and expensive

31
Q

Describe the paradoxical behaviour of PTH?

A

Acutely promotes osteoblast development and activity

Continuous or high exposure promotes osteoclast activity

32
Q

Describe the use of oral calcium in bone disorders?

A

Used as an adjunctive therapy in osteoporosis

33
Q

Describe the side effects of oral calcium?

A

GI disturbances

34
Q

What is strontium?

A

Oral calcium

35
Q

Describe the use of Vitamin D in treatment of bone disorders?

A

Used in deficiency states (e.g. Rickets and osteomalacia)

Used in endocrine dysfunction (e.g. hypoparathyroidism)

Used in chronic renal disease

36
Q

Describe the effects of calcitonin?

A

Decsreases mobilisation of calcium from bone

37
Q

Describe the types of calcitonin available for use?

A

Natural: porcine

Synthetic: Salcatonin

38
Q

Describe the suggested treatment options for women with osteoporosis?

A

Locomotor (28 decks)

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