Osteoperosis

Question 1

How many standard deviations lower than the mean peak value of young adults of the same race and sex does WHO describe as being osteoporotic?

Answer 1

2.5

Question 2

What is osteopenia?

Answer 2

Intermediate stage where bone mineral density is 1-2.5 standard deviations lower than the mean

Question 3

When does bone mineral density loss normally start?

Answer 3

Around the age of 30

Question 4

Why is bone mineral density normally lost?

Answer 4

Slowing down of osteoblastic activity.

Question 5

Why do females lose more bone density after menopause?

Answer 5

Increase in osteoclast bone resorption due to loss of protective effects of oestrogen.

Question 6

What two types of primary osteoporosis have been identified?

Answer 6

1 - post menopausal osteoporosis

2 - osteoporosis of old age

Question 7

What types of fractures tend to occur in type 1 primary osteoporosis?

Answer 7

Colles and vertebral insufficiency fractures.

Question 8

What is a Coles fracture?

Answer 8

A radial fracture

Question 9

What are some risk factors for type 1 osteoporosis?

Answer 9

Smoking, alcohol abuse, lack of exercise and poor diet. Early menopause.

Question 10

What characterises osteoporosis of old age?

Answer 10

Greater decline in bone mineral density than expected.

Question 11

What risk factors in addition to factors for type 1 osteoporosis are there for type 2?

Answer 11

Chronic disease, inactivity and reduced sunlight exposure.

Question 12

What types of fractures predominate in type 2 osteoporosis?

Answer 12

Femoral neck and vertebral.

Question 13

What types of conditions can cause secondary osteoporosis?

Answer 13

Cortical steroid use, alcohol abuse, malnutrition, chronic disease e.g. RA or malignancy and endocrine disorders e.g. Crushings and thyroid disease.

Question 14

What scan do we use to diagnose osteoporosis?

Answer 14

DEXA scan

Question 15

What serum components are normal in osteoporosis?

Answer 15

Calcium and phosphate

Question 16

What are the treatment aims of osteoporosis?

Answer 16

To slow progression of the disease and avoid fracture.

Question 17

What can be done to reduce the risk of osteoporosis?

Answer 17

Building up bone density through exercise, good diet and sunlight exposure before natural loss begins.

Question 18

What pharmacological treatments are given for osteoporosis?

Answer 18

Calcium, vitamin D, bisphosponates, desunomab and strontium.

Question 19

What do bisphosponates do?

Answer 19

Reduce osteoclastic resorption.

Question 20

What is desunomab and what does it do?

Answer 20

A monoclonal antibody that reduces osteoclast activity

Question 21

What does strontium do?

Answer 21

Increases osteoblast replication and reduces resorption.

Question 22

What is the name of a once yearly IV bisphosponate?

Answer 22

Zoledronic acid

Question 23

What experimental intranasal drug has been tried and what have been the results?

Answer 23

Calcitonin has shown no benefits over other treatments and a small increased risk of cancer.

Question 24

What are the recommendations for HRT?

Answer 24

No recommended as a first line agent post menopause, but can be used if their are side effects with other mess.

Question 25

What are the risks of HRT?

Answer 25

Increased risk of breast and endometrial cancer as well as DVT.

Question 26

What is Raloxifene and what are the risks?

Answer 26

Oestrogen receptor modulator that also has a risk of DVT.

Question 27

Which is the best medication for osteoporosis and why?

Answer 27

Bisphosponates as they have the best efficacy, lowest costs and lowest side effects currently.

Question 28

What are some of the different things that bisphosponates do?

Answer 28

Reduce regulatory T cells
Increased anti tumour effect
Disturb mitosis
Decrease angiogenesis
Decrease tumour cell proliferation

Question 29

What is osteoporosis characterised by?

Answer 29

Reduced bone mineral density and increased porosity although the remaining bone is of normal quality.