OP Flashcards
What is OP
Skeletal disorder, loss of bone mass and deterioration of bone tissue, increase in bone fragility and porous bones
Most common OP fractures
Hip, wrist and spine
OP symptoms
Increases risk of fractures
Won’t have pain (if so it’s something else)
OP risk factors
Woman
Age
Repeated steroid use
Underweight
Early menopause
Lifestyle ( alcohol, smoking , immobility)
Inflammatory conditions
Eating disorders
Diagnosis of OP
FRAX to calculate fracture risk
Z and T scores
T score -1 to -2.5 osteopenia
T score less than -2.5 osteoporosis
DEXA scan
bone mineral density test (BMD) every 5 years
Treatment of OP
1st line alendronic acid /risedronate
Zoledronic (parental BP)
Denosumab (SB injection)
Teriparatide
Drugs that increase risk of osteoporosis
Corticosteroids
PPI
Anti epileptics
Anti depressants (SSRI)
Cancer drugs (aromatase inhibitors)
Lifestyle advice for OP
Stop smoking
Alcohol (14 units weekly)
Healthy weight
Exersize
Calcium and vitamin D
What is the interaction between calcium sups and oral BP
Reduce clinical effects of alendronic acid / risedroanate
Denosumab MOA
Mab that binds to RANKL, decreasing osteoclast formation
Teriparatide MOA
Synthetic PTH with a biphasic effect and when given it activates osteoblasts
Raloxifene MOA
In the bone environment it acts as an ER agnosist
What directly activates osteoclasts
RANKL
What modification prevents GI hydrolysis
Central oxygen is replaced with a carbon
What is kyphosis
Visible postural change with an exaggerated posterior curve or rounding of the spine and lower back
What is paget disease
Progressive skeletal disorder, excessive bone destruction and repair increasing structural changes of the long bones, spine, pelvis and cranium
What are osteoblast cells in the bone
Active bone forming cells that produce collagenase bone matrix
Secretes enzyme alkaline phosphates
Promotes deposition of calcium phosphate salts in the matrix to calcify bones
What are osteocytes cells in the bone
Osteoblasts become incorporated within the bone and transform into mature bone cells called osteocytes
What are osteoclasts cells in the bone
Bone reabsorption
Remove bone matrix by phagocytosis, dissolve the bone salts and release calcium and phosphate ions in circulation
RANKL activates osteoclasts
Which is only OP drug causes HYPERglacemia
Teriparatide
What are alendronic/risedronate, Zoledronic and Denosumab monitoring
Oral BP - review 5 years continue or drug holiday for 1-2 years (long term risks ATF ONJ)
Zoledronic - review 3 years drug holiday, renal function, correct calcium and vitamin D before infusion
Denosumab - NO drug holiday (not retained in bone) renal and correct calcium and vit D before Injections
What are the SERIOUS SE
REPORT any thigh/hip/groin pain - atypical fracture
Maintain good oral hygiene (ONJ)
What are CI and cautions for alendronic and risedronate
Alendronic - AVOID eGFR below 35ml/min
Risedronate - AVOID eGFR below 30ml/min
Known hypoglycaemia
Swallowing difficulty / dysphasia
Recent GI bleed
Calcium ( take 2-4 hrs after )
What to do if 1st line if c/I
If renal impairment (eGFR) use Denosumab as not renally cleared BUT higher hypoglycaemia risk
