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Y3R5: Medicine I 🩺 > L17: Osteoporosis & MBD > Flashcards

L17: Osteoporosis & MBD Flashcards

1
Q

Def of Osteoporosis

A
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2
Q

Pathogenesis of Osteoporosis

A

Osteoporosis results from imbalance between bone formation and resorption due to:

  • Increased bone breakdown by osteoclasts
  • Decreased bone formation by osteoblasts.
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3
Q

Types of Osteoporosis

A

primary & secondary

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4
Q

Types of 1ry Osteoporosis

A
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5
Q

Type I (Postmenopausal osteoporosis)

A
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6
Q

Type II (Senile osteoporosis)

A
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7
Q

Secondary osteoporosis

A

Affects males and females at any age as a result of disease process or medications.

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8
Q

General Risk factors of Osteoporosis

A
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9
Q

General Risk factors of Osteoporosis

  • Age
A

Affects 30% of over 50 years

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10
Q

General Risk factors of Osteoporosis

  • Sex
A

Female ( Women four times more affected than men)

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11
Q

General Risk factors of Osteoporosis

  • Race
A

Caucasian and Asian

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12
Q

Diseases predisposing to Secondary Osteoporosis

A
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13
Q

Diseases predisposing to Secondary Osteoporosis

  • Endocrine
A

Cushing – Hyperparathyroidism – Thyrotoxicosis –
Hypogonadism - Diabetes mellitus.

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14
Q

Diseases predisposing to Secondary Osteoporosis

  • Rheumatologic
A

RA arthritis - ankylosing spondylitis.

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15
Q

Diseases predisposing to Secondary Osteoporosis

  • Deblitating Diseases
A

Chronic kidney disease (Renal Osteodystrophy) - Chronic liver disease - Chronic obstructive pulmonary disease.

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16
Q

Diseases predisposing to Secondary Osteoporosis

  • Hematologic
A

myeloma - lymphoma and leukemia – hemophilia - sickle-cell disease and thalassemia.

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17
Q

Diseases predisposing to Secondary Osteoporosis

  • Inherited
A

Osteogenesis imperfecta - Marfan syndrome

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18
Q

Medications predisposing to Secondary Osteoporosis

A
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19
Q

Medications predisposing to Secondary Osteoporosis

  • Hormonal
A

Steroid-induced, L-Thyroxine, progesterone, Thiazolidinedione, Anti- androgens.

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20
Q

Medications predisposing to Secondary Osteoporosis

  • CNS
A

Barbiturates, phenytoin, antiepileptics, lithium.

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21
Q

Medications predisposing to Secondary Osteoporosis

  • Antimetabolite drugs
A

Methotrexate

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22
Q

Medications predisposing to Secondary Osteoporosis

  • Anticoagulant drugs
A

heparin and warfarin.

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23
Q

Medications predisposing to Secondary Osteoporosis

  • Antacids
A

Proton pump inhibitors and chronic oral antacids

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24
Q

CP of Osteoporosis

A
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25
Q

INVx for Osteoporosis

A
  • Rads
  • Labs
26
Q

Rad INVx of Osteoporosis

A
  • Conventional X-ray
  • Dual energy X-ray absorptiometry (DEXA)
27
Q

x-Ray in Osteoporosis

A

Shows vertebral compression fracture, cortical thinning, decrease in the number of trabeculae and increased radiolucency.

27
Q

DEXA in Osteoporosis

A
  • Is the gold standard in osteoporosis diagnosis usually of the lumbar spine and proximal femur
  • It is precise, accurate, uses low dose of radiation.
28
Q

T-Score in DEXA for Osteoporosis

A
29
Q

Z-Score for DEXA in Osteoporosis

A

Matches BMD to age matched control

30
Q

Labs in Osteoporosis

A
31
Q

TTT of Osteoporosis

A
  • Non-Drug Therapy & Drug Therapy
32
Q

Non-Drug Therapy of Osteoporosis

A
33
Q

Drug Therapy of Osteoporosis

A
  • Anti-Resorptive Therapy
  • Anabolic Therapy
34
Q

Types of Anti-Resorpative Theray

A
  • Bisphosphonates
  • Hormone replacement therapy (HRT)
  • Selective estrogen receptor modulator (SERMs)
  • Androgen
  • Calcitonin
  • Supplementation with calcium and vitamin D
35
Q

MOA of Bisphosphonates

A

are potent inhibitors of osteoclast activity.

36
Q

Examples of Bisphosphonates

A
37
Q

SE of Bisphosphonates

A
38
Q
  • …… has been associated with renal toxicity
  • Bisphosphonates are not recommended for patients with impaired renal function.
A

Zoledronate

39
Q

In which type of osteoporosis is Hormone replacement therapy (HRT) Used?

A

type I osteoporosis

40
Q

MOA of Hormone replacement therapy (HRT)

A

Estrogen suppresses bone resorption by inhibiting osteoclasts.

41
Q

SE of Hormone replacement therapy (HRT)

A
42
Q

Because of adverse effects, HRT is a second-line option for osteoporosis except ……

A

in early postmenopausal women at high fracture risk who also have perimenopausal symptoms.

43
Q

Example of Selective estrogen receptor modulator (SERMs)

A

Raloxifene

44
Q

Indications of Selective estrogen receptor modulator (SERMs)

A

(Type I osteoporosis)

45
Q

MOA of Selective estrogen receptor modulator (SERMs)

A
  • It is not a hormone, it activates estrogen receptors in bone but has no stimulatory effect on the endometrium.
  • So it inhibits the effect of PTH on osteoclast without trophic effect on breast or uterus
46
Q

SE of Selective estrogen receptor modulator (SERMs)

A

May cause or worsen hot flushes and also increase the risk of thromboembolic disease

47
Q

Indications of Androgen in osteoporosis

A

In men with osteoporosis who have clinical and biochemical evidence of hypogonadism, testosterone replacement is used.

48
Q

Calcitonin in TTT of Osteoporosis

A
  • Nasal or subcutaneous: it Slows bone loss
  • Occasional nausea, vomiting, flushing may occur.
49
Q

Supplementation with calcium and vitamin D in TTT of Osteoporosis

A
  • In those with low dietary calcium intake and at risk from vitamin D insufficiency, calcium and vitamin D supplements should be advised,
  • The recommended dose is 800 IU of vitamin D and 1–1.2 g calcium daily
50
Q

Examples of Anabolic Therapy in TTT of Osteoporosis

A

Recombinant human parathyroid hormone peptide

  • Teriparatide
51
Q

MOA of Anabolic Therapy in TTT of Osteoporosis

A

Anabolic agents that stimulate bone formation.

52
Q

Indications of Anabolic Therapy in TTT of Osteoporosis

A

Indicated in severe cases of vertebral osteoporosis or in women who fail to respond to other therapies.

53
Q

Examples of Metabolic Bone Disease

A

1) Osteoporosis
2) Osteomalacia (see rheumatology)
3) Paget disease of the bone (Osteitis deformans)

54
Q

Another name of Paget’s Disease

A

Osteitis deformans

55
Q

Def of Paget’s Disease

A
  • Is a disorder of increased bone resorption with compensatory increased bone formation (structurally abnormal)
56
Q

Epidemeology of Paget’s Disease

A
  • It affects men and women (2 : 3) over the age of 40 years.
  • The prevalence of Paget disease increases with age ( Affects up to 10% of persons older than 80 years )
57
Q

Etiology & Pathogenesis of Paget’s Disease

A
58
Q

CP of Paget’s Disease

A
59
Q

Complications of Paget’s Disease

A
60
Q

INVx in Paget’s Disease

A
61
Q

TTT of Paget’s Disease

A

Y3R5: Medicine I 🩺 (47 decks)

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