Osteoperosis Flashcards
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?
2.5
What is osteopenia?
Intermediate stage where bone mineral density is 1-2.5 standard deviations lower than the mean
When does bone mineral density loss normally start?
Around the age of 30
Why is bone mineral density normally lost?
Slowing down of osteoblastic activity.
Why do females lose more bone density after menopause?
Increase in osteoclast bone resorption due to loss of protective effects of oestrogen.
What two types of primary osteoporosis have been identified?
1 - post menopausal osteoporosis
2 - osteoporosis of old age
What types of fractures tend to occur in type 1 primary osteoporosis?
Colles and vertebral insufficiency fractures.
What is a Coles fracture?
A radial fracture
What are some risk factors for type 1 osteoporosis?
Smoking, alcohol abuse, lack of exercise and poor diet. Early menopause.
What characterises osteoporosis of old age?
Greater decline in bone mineral density than expected.
What risk factors in addition to factors for type 1 osteoporosis are there for type 2?
Chronic disease, inactivity and reduced sunlight exposure.
What types of fractures predominate in type 2 osteoporosis?
Femoral neck and vertebral.
What types of conditions can cause secondary osteoporosis?
Cortical steroid use, alcohol abuse, malnutrition, chronic disease e.g. RA or malignancy and endocrine disorders e.g. Crushings and thyroid disease.
What scan do we use to diagnose osteoporosis?
DEXA scan
What serum components are normal in osteoporosis?
Calcium and phosphate
What are the treatment aims of osteoporosis?
To slow progression of the disease and avoid fracture.
What can be done to reduce the risk of osteoporosis?
Building up bone density through exercise, good diet and sunlight exposure before natural loss begins.
What pharmacological treatments are given for osteoporosis?
Calcium, vitamin D, bisphosponates, desunomab and strontium.
What do bisphosponates do?
Reduce osteoclastic resorption.
What is desunomab and what does it do?
A monoclonal antibody that reduces osteoclast activity
What does strontium do?
Increases osteoblast replication and reduces resorption.
What is the name of a once yearly IV bisphosponate?
Zoledronic acid
What experimental intranasal drug has been tried and what have been the results?
Calcitonin has shown no benefits over other treatments and a small increased risk of cancer.
What are the recommendations for HRT?
No recommended as a first line agent post menopause, but can be used if their are side effects with other mess.
What are the risks of HRT?
Increased risk of breast and endometrial cancer as well as DVT.
What is Raloxifene and what are the risks?
Oestrogen receptor modulator that also has a risk of DVT.
Which is the best medication for osteoporosis and why?
Bisphosponates as they have the best efficacy, lowest costs and lowest side effects currently.
What are some of the different things that bisphosponates do?
Reduce regulatory T cells Increased anti tumour effect Disturb mitosis Decrease angiogenesis Decrease tumour cell proliferation
What is osteoporosis characterised by?
Reduced bone mineral density and increased porosity although the remaining bone is of normal quality.
