⭐ LECTURE 4: OSTEOPOROSIS Flashcards

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1
Q

Mother cells

A

OSTEOPROGENITOR CELLS

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2
Q

immature bone cells and are found on the outer surface of the bone and in the bone cavities

A

OSTEOBLASTS

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3
Q

Mature bone cells

A

OSTEOCYTES

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4
Q

Large, phagocytic, multinucleated derivatives of monocytes or monocyte-like cells formed in the bone marrow

A

OSTEOCLASTS

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5
Q

What are the 2 types of growth in BONE REMODELING?

A

Linear Growth
Appositional Growth

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6
Q

initiates remote signal by activating the macrophages

A

ACTIVATION PHASE

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7
Q

will begin once osteoclasts are activated by RANKL and M CSF to release calcium and phosphorus

A

RESORPTION PHASE

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8
Q

osteoclasts will disappear and will undergo apoptosis

A

REVERSAL PHASE

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9
Q

bone calcification will begin once collagen molecules are secreted

A

FORMATION PHASE

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10
Q

Imbalance that occurs in bone resorption and bone formation due to:
-Decrease in bone resorption
-Increase in bone resorption
-Combination of both

A

OSTEOPOROSIS

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11
Q

What are the signs and symptoms of OSTEOPOROSIS

A

For menopausal women: lose 25-30% of spongy bone and 10-15% of cortical bone

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12
Q

What are the PRIMARY HORMONES?

A

PTH, Vitamin D, Fibroblast Growth Factor 23 (FGF23)

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13
Q

What are the SECONDARY HORMONES?

A

Calcitonin, Glucocorticoids, Estrogen, Prolactin, GH, Insulin, Thyroid Hormone

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14
Q

Albumin is at low level = decrease level in calcium

A

HYPOALBUMINEMIA

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15
Q

exhibition of Low level of ionization
and in favor of ionization

A

Acidosis

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16
Q

Disfavors ionization

A

Disfavors ionization

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17
Q

This primary hormone Promotes bone formation and resorption by stimulating osteoblasts and osteoclasts

A

PTH

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18
Q

This primary hormone Stimulates intestinal absorption of Ca and phosphate and Promotes bone formation and resorption by stimulating the osteoblasts and osteoclasts

A

Vitamin D

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19
Q

This primary hormone Stimulates P excretion in the kidney = hypophosphatemia and low levels of 1,25(OH)2D3

A

Fibroblast growth factor

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20
Q

This secondary hormone Lowers Ca and P and Inhibits osteoclastic bone resorption

A

Calcitonin

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21
Q

excess PTH promotes?

A

an increase in bone resorption

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22
Q

low PTH promotes?

A

an increase in bone formation

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23
Q

What are the common sites for osteoporosis related fracture?

A

Vertebrae
Hip
Distal radius

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24
Q

WHAT ARE THE AGENTS USED TO INCREASE BONE MINERAL DENSITY

A

Calcium
Vitamin D
Bisphosphonates
Calcitonin
Estrogen therapy
PTH
Monoclonal antibody

25
Q

2500 mg/day

A

MAXIMUM TOLERATED LIMIT

26
Q

1000 mg/day

A

CEILING EFFECT

27
Q

Daily requirement of calcium supplements

A

800-1500 mg per day

28
Q

what are the Risks in Calcium Supplements

A

arterial calcification and cardiovascular disease and hypercalcemia

29
Q

How many mg of calcium supplements are excreted daily in urine and feces?

A

300 mg

30
Q

mimics effects of endogenous calcium

A

Calcimimetic

31
Q

Helps prevent bone breakdown and increase in plasma calcium levels associated with excessive PTH release

A

CINACALCET (SENSIPAR)

32
Q

Enhance bone formation by increasing the absorption and retention of calcium and phosphate in the body

A

VITAMIN D AND VITAMIN D ANALOGS

33
Q

recommended intake of men and women from 51 to 70 yrs old of VITAMIN D AND VITAMIN D ANALOGS

A

600 IU/day

34
Q

recommended intake of men and women from > 70 yrs old of VITAMIN D AND VITAMIN D ANALOGS

A

800 IU/day

35
Q

Daily adult allowance of VITAMIN D AND VITAMIN D ANALOGS

A

2000 to 10000 units/day

36
Q

CALCITRIOL

A

Calcijex, Rocaltrol

37
Q

CHOLECALCIFEROL

A

Replesta, Vitamin D3

38
Q

ERGOCALCIFEROL

A

Calciferol, Drisdol

39
Q

PARICALCITOL

A

Zeemplar

40
Q

Absorbed into calcium crystal and blocks excessive bone resorption and formation by inhibiting osteoclast activity

A

BISPHOSPHONATES

41
Q

AR/SE of BISPHOSPHONATES

A

Osteonecrosis of the jaw
Atypical hip fractures
GI disturbances

42
Q

1st Generation
Oral Bisphosphonates

A

Etidronate (most common), Medronate, Clodronate, Tiludronate
→ Minimally modified side chain contain a chlorophenyl group
→ Metabolized into a non-hydrolyzable ATP analog that accumulate within osteoclasts and includes apoptosis which account for its antiresorptive effect
→ Least potent

43
Q

2nd Generation
Oral Bisphosphonates

A

→ Alendronate (most common), Pamidronate, Ibandronate
→ Contains nitrogen group in the side chain
→ Inhibits bone resorption
→ Antiresorptive activity involves inhibition of multiple steps in the pathway from mevalonate to cholesterol and isoprenoid lipids that are required for the prenylation of proteins that are important for osteoclast function
→ 10-100 times more potent than 1st Gen BP

44
Q

3rd Generation
IV Bisphosphonates

A

→ Risedronate and Zoledronate
→ Contain nitrogen atom within heterocyclic ring
→ 10 000 times more potent than 1st Gen BPs

45
Q

Taken up by the osteoclast
and can Cause cell apoptosis through activation of caspase pathway

A

NON-NITROGEN CONTAINING BPs

46
Q

Not metabolized
and Affects protein prenylation of osteoclast by inhibiting farnesyl diphosphate (FPP) synthase (key enzyme of the mevalonate pathway)

A

NITROGEN CONTAINING BPs

47
Q

Lower plasma calcium levels in hypercalcemic emergencies

A

Calcitonin

48
Q

Promote bone mineralization in women who lack endogenous estrogen production

A

Estrogen

49
Q

Able to preferentially activate estrogen receptors

A

SERM (Selective Estrogen Receptor Modulators)

50
Q

Activates receptors in bone and blocks receptors in breast and uterine tissues

A

RALOXIFENE (Evista 60 mg PO)

51
Q

Monoclonal antibody (MAB)
and Binds to specific receptors (RANK) on osteoclasts → inhibits ability of endogenous chemical to stimulate osteoclast activity → inhibition of osteoclast-induced bone resorption

A

DENOSUMAB (PROLIA)

52
Q

Stimulates new bone formation on trabecular and cortical bone surfaces by preferential stimulation of osteoblastic activity over osteoclastic activity

A

rPARATHYROID HORMONE [rPTH(1-34), TERIPARATIDE]

53
Q

Synthetic form of human PTH – recombinant human PTH (1-34) analog

A

TERIPARATIDE (FORTEO)

54
Q

“Dual action bone agents” (DABA)

A

STRONTIUM RANELATE

55
Q

Testosterone replacement therapy increases BMD in hypogonadal men

A

ANDROGENS

56
Q

Protease expressed in osteoclasts
Degrades type 1 collagen in organic bone
Inhibit matrix dissolution, decrease bone resorption, and improve BMD in postmenopausal women

A

CATHEPSIN K INHIBITORS

57
Q

Increase osteoblast number and promotion of osteoblastic differentiation, leading onto increased bone formation by simvastatin

A

STATINS

58
Q

potential new drug for osteoporosis

A

Echistatin

59
Q

Calcium-sensing receptor antagonists are new drug class of orally administered agents that stimulate endogenous PTH release and have bone forming action

A

CALCILYTICS