ENDOCRINE - BONE DISORDERS Flashcards
What is osteoporosis?
Low bone mineral density + risk of fractures.
What are other risk factors for osteoporosis?
Elderly, hx of hip fractures
Low BMI, smoking , excess alcohol, diabetes, vit d + calcium deficiency, early menopause
What are 3 main risk factors for osteoporosis?
Menopause
50+ in men
Long term glucocorticoid
What is 1st line treatment for osteoporosis?
Oral bisphosphonates
e.g. alendronic acid + Risedronate
How to prevent osteoporosis?
Avoid Long term glucocorticoids
What dose of steroid is likely to give high risk of osteoporosis?
7.5mg or more daily prednisolone
What 3 situations should prophylactic bisphosphonate tx start for gluccocorticoid treatment in women?
If 70 or +
OR
Previous fracture
OR
Large dose steroid 7.5mg pred or more (>3 months)
What 3 situations should prophylactic bisphosphonate tx start for gluccocorticoid treatment in men?
70 and over AND either:
previous fracture
large doses steroid (>3 months)
What do menopause women go on to reduce risk. of osteoporosis?
HRT - if they are more than 60+ and have menopause symtpoms
What is calcitriol?
synthetic Vit d3
What are 3 examples of HRT which can reduce risk of osteopororis?
Oestrogens
Tibolone
Raloxifene
What is a risk of using strontium ranelate?
CV events, reports of severe allergy
MOA of bisphosphonates?
Slows bone resorption by adsorbing onto hydroxyapatite crystals.
How long is treatment with bisphosphonates?
5 years
What bisphosphonate has the highest risk of jaw osteonecrosis?
Zolendronic acid
What is the most potent bisphosphonate and what is route?
Zolendronic acid - iv
What is dosing regimen like for alendronic acid?
ONCE weekly
What are 4 patient counselling points for alendronic acid?
Swallow whole with water, sitting or standing
Take it on empty stomach for at least 30 min before breakfast and stand/ sit upright for 30 mins.
What is administration instruction for for Risedronate?
Leave 2 hr gap between between food + drink, calcium products, antacids, iron or minerals
Take least 30 min before breakfast
Sit or stand upright for 30 mins - avoid at bedtime.
What are 4 SEs of bisphosphonates?
Oesophageal reactions
Atypical femoral fractures
Osteonecrosis of jaw
osteonecrosis of auditory canal
What are 4 counselling points regarding bisphosphonate SEs?
Report symptoms of oesophageal irritation e.g. dysphagia, heartburn, pain swallowing
Report hip, thigh, groin pain.
report ear symptoms
routine dental checkups
What are 3 MHRA warnings about bisphosphonates?
osteonecrosis of the external auditory canal
osteonecrosis of the jaw
atypical femoral fractures
what 4 things to minimise risk of osteonecrosis of the jaw rom bisphosphonates?
high risk of IV bisphosphonate tx for cancer pts.
dental check-up, good oral hygiene
report any oral symptoms such as dental mobility, pain, or swelling, non-healing sores
wear fitting dentures
patient reminder card
What are some life style changes to reduce risk of fractures?
increase exercise
stop smoking
maintain good BMI
Reduce alcohol intake
increase vit D + Calcium
When to review treatment with zolendronic acid?
3 years
What is dose of alendronic acid for women?
10 mg once daily, OR 70 mg once weekly.
What is dose of alendronic acid for Men?
10 mg once daily.
What 4 bisphosphonates are used for post-menopausal women?
Ibandronic acid
denosumab
raloxifene
strontium
When is teriparatide used?
Severe osteoporosis in post- meno women
What 4 bisphosphonates are used for men?
Zolendronic acid
denosumab
teriparatide
strontium
What is 1st line for glucocorticoid induced osteoporosis? (2)
alendronic acid or risedronate sodium
What crcl to avoid alendronic acid?
less than 35 mL/minute
What crcl to avoid Risendronate?
less than 30 mL/minute
