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PY6020 > Management of Osteoporosis > Flashcards

Management of Osteoporosis Flashcards

1
Q

What is the difference between osteoblasts & osteoclasts?

A

Osteoblasts: cells responsible for bone formation
Osteoclasts: cells responsible for bone shedding

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2
Q

What happens to the balance of osteoblasts & osteoclasts in osteoporosis?

A

Osteoclast activity > osteoblast activity.

More bone is shedded then formed.

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3
Q

Which specific class of drug can cause osteoporosis?

A

Corticosteroids, because they increase osteoclast activity.

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4
Q

Why are patients with osteoporosis more prone to fractures?

A

Because the thinning of their bone results in less bone density = more prone to fractures

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5
Q

Why are menopausal women more prone to osteoporosis?

A

Because in menopause you lose oestrogen, which normally helps in maintaining bone function.

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6
Q

What are the risk factors of osteporosis?

A
  1. Increasing age
  2. Females
  3. Early menopause
  4. Smoking/alcohol
  5. White & Asian people
  6. Drugs that increase metabolism of vit. D (phenytoin, PPIs)
  7. Fragile, low weight individuals
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7
Q

What are the symptoms of osteoporosis?

A

Symptoms are the result of fractures from osteoporosis. They can occur at 3 sights in the spine.

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8
Q

What is a Colles Fracture?

A

Wrist fracture.

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9
Q

What is kyphosis?

A

Curvature of the spine, making you lose height.

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10
Q

What 3 investigations are performed to diagnose osteoporosis?

A
  1. DXA scan (dual energy x-ray) - measures real bone density. It is a negative number.
  2. T score - is the measurement of the DXA scan
  3. X-ray
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11
Q

What is the T score of someone with osteoporosis?

A

Less than -2.5 = osteoporosis

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12
Q

What is Bindex in osteoporosis?

A

It is a portable ultrasound device used to investigate the density of the bone using sound waves.

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13
Q

At what age should someone be assessed for a fracture risk?

A

Women >65yrs + presence of risk factors

Men >75 yrs + presence of risk factors

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14
Q

What main factors should you focus on when assessing a person for osteoporosis?

A
  1. Their gender (females more prone)
  2. Age
  3. Weight - are they frail?
  4. Any medications they are taking
  5. Menopause
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15
Q

When should you assess a patient <40years old for osteoporosis?

A
  1. If they have premature menopause
  2. Taking corticosteroids
  3. History of falls/fractures
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16
Q

What is FRAX (or Qfracture) in osteoporosis?

A

It is a tool/questionnaire to assess the risk of a fracture of a person within the next 10 years

  • Remember FRAX only screens for osteoporosis, nothing else
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17
Q

What risk factors are considered when using FRAX?

A
  1. Age/sex
  2. BMI
  3. Previous fractures
  4. Current glucocorticoid treatment
  5. Smoking/alcohol
  6. Any secondary causes
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18
Q

What is the advantage of having IV bisphosphonate?

A

It is only given once a year (if the risk of a fracture is >10%)

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19
Q

What are some non-drug therapies for osteoporosis?

A
  1. Regular exercise
  2. Vitamin D & Ca2+ intake
  3. Stop smoking/alcohol
  4. Maintain BMI
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20
Q

Even if someone has a 1% risk of a fracture, are they still treated?

A

Yes to prevent future fractures.

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21
Q

Which supplement excess can cause osteoporosis?

A

Ca2+

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22
Q

What is the main class of drug given as treatment for osteoporosis?

A

Bisphosphonates

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23
Q

What is the mode of action of bisphosphonates?

A
  1. They bind to the crystal structure of the bone & decrease osteoclast activity
  2. This prevents shedding of Ca2+ from the bone
  3. Osteoclasts undergo apoptosis
24
Q

Which 2 bisphosphonate drugs are in an IV infusion?

A
  1. Ibandronic acid

2. Zoledronic acid

25
Q

Why cant bisphosphonates (e.g. alendronic acid, or risedronate sodium) be taken with Ca2+ supplements/food/drink?

A

Because they would bind to the Ca2+ from the tablet/food/drink & not on the bone = no efficacy

26
Q

Why should alendronic acid be taken with a full glass of water, standing up?

A

Because it can cause oesophageal reactions if the tablet does not go down fully.

27
Q

What is the dose of alendronic acid, and risedronate sodium?

A

Alendronic acid:
70mg weekly , or 10mg daily

Risedronate sodium:
5mg daily, or 35mg weekly

28
Q

What condition are patients taking IV bisphosphonates more prone to?

A

Osteonecrosis of the jaw.

Good dental/oral hygiene is therefore needed.

29
Q

How many years should a patients bisphosphonate use be reviewed?

A

Should be reviewed every 5 years.

Zoledronic acid reviewed every 3 years

30
Q

How long is the holiday treatment period for alendronic acid, risedronate sodium, and zolendronic acid?

A

Alendronic acid: 2 years
Risedronate sodium: 1 year
Zolendronic acid: 3 years

  • Remember it like 1R, 2A, 3Z (RAZ)
31
Q

What ear condition can occur due to long-term usage of bisphosphonate?

A

Osteonecrosis of the external auditory canal.

32
Q

What type of drug is denosumab, & what is its mode of action?

A

It is a monoclonal antibody.

It prevents RANKL from binding to RANK receptors on osteoclasts, so osteoclasts are not activated = no shedding occurs

33
Q

What is the dose for denosumab in osteoporosis?

A

60mg every 6 months via subcutaneous injection (Prolia)

34
Q

How does estrogen & teriparatide work?

A

They bind to osteoblasts to increasing bone formation

35
Q

When is denusomab given?

A

If the patient cannot take any other bisphosphonate, AND have a high risk of fracture.

36
Q

What 4 major things do you have to consider before choosing the right treatment for a patient with osteoporosis?

A
  1. History of hip fractures
  2. Alcohol intake
  3. Rheumatoid arthritis
  4. Age
  5. (other risk factors if applicable)
37
Q

What 2 risks can occur while taking denosumab 60mg?

A
  1. Osteonecrosis of the jaw - more common in cancer treatment
  2. Hypocalcaemia
38
Q

What risk factors can increase a patients chance of having osteonecrosis of the jaw?

A
  1. Smoking
  2. Advanced cancer
  3. Poor oral hygiene
  4. Previous treatment with bisphosphonates
  5. Old age
39
Q

What should always be measured before each administration of denosumab?

A

Ca2+ levels.

40
Q

What are the symptoms of hypocalcaemia?

A
  1. Muscle spams
  2. Tingling in fingers/toes/around mouth
  3. Numbness
  4. Cramps
41
Q

What is an example of a SERM, and what is its mode of action?

A

Raloxifene. It activates estrogen receptors on osteoblasts to induce bone formation.

42
Q

What is the mechanism of action of strontium ranelate?

A

It stimulates bone formation & reduces bone shedding.

43
Q

When is strontium ranelate used?

A

Only if previous treatments have not worked, & only in specialist care.

44
Q

What is the dosing of strontium ranelate?

A

2g OD in 30mL water, at bedtime.

  • Avoid Ca2+ containing products too
45
Q

When should the use of strontium ranelate be stopped immediately?

A

If a rash/severe allergic reaction occurs.

Assess the CV risk of the patient since it can increase CV risk too.

46
Q

When is HRT used as treatment for osteoporosis?

A

When all other treatments have failed.

It is also only used for premature menopausal women, & stopped at the natural age of menopause (50 years old)

47
Q

What risks increase while taking HRT?

A

CVD (clotting), stroke, and breast cancer

48
Q

What can HRT also be used for besides treatment?

A

Prophylaxis of postmenopausal osteoporosis (those with high risk)

49
Q

When is teriparatide given?

A

As a secondary prevention in fragile women who have osteoporosis to reduce their risk of a fracture.

  • Used in those very high risk
  • Use it limited due to costs
50
Q

What is the dosing of teriparatide?

A

20mcg daily via subcutaneous injection (for 2 years)

51
Q

What makes up teriparatide?

A

It is a fragment of the parathyroid hormone (inducing growth factors to make new bone)

52
Q

How does romosozumab work?

A

It is a monoclonal antibody which binds to sclerostin in osteocytes.
Sclerostin inhibits bone formation, so blocking this = bone remains

53
Q

What is the dosing of romosozumab?

A

210mg once a month for 1 year +

vit C/D also taken as 105mg injections

54
Q

Besides osteoporosis, which patients should be considered for bone protective therapy?

A

Patients >70years old taking high levels of corticosteroids (>7.5mg/day prednisolone)

55
Q

What are the 2 first line treatment options for osteoporosis in men?

A

Alendronic acid & risedronate

56
Q

What are the alternative treatment options for osteoporosis in men?

A

Zoledronic acid, or denosumab (can also consider strontium ranelate or teriparatide)

PY6020 (22 decks)

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