Osteoporosis

Question 1

What are some reasons for bones breaking?

Answer 1

• Suboptimal peak bone mass
• Reduced bone quality: reduced bone mineral (Ca2+), deteriorating architecture, change in crystal size and composition, abnormal collagen

Question 2

What are some ways of optimising bone mass?

Answer 2

1. Exercise
2. Diet
3. Regulating sex hormones
4. Genetics

Question 3

What does blue sclera of the eyeballs indicate?

Answer 3

Caused by the sclera being thin

It’s a common sign of osteogenesis imperfecta

Question 4

What is a rheumatoid nodule?

Answer 4

It’s a subcutaneous mass filled with inflammatory tissue

It’s common in people with rheumatoid arthritis

Question 5

What are some medical disorders that predispose people of osteoporosis?

Answer 5

Endocrine disorders:

• Thyrotoxicosis
• Hyperparathyroidism
• Pituitary disease

Nutritional deficiencies:

• Malabsorption conditions
• Eating disorders
• Alcoholism

Inflammatory conditions
Chronic respiratory disease

Question 6

What is the FRAX risk calculator for?

Answer 6

It estimates the risk of having a hip or other major fracture in the next 10 years

Question 7

What is a DEXA scan?

Answer 7

A bone density scan

Question 8

How do Bisphosphonates work?

Answer 8

They inhibit osteoclast action by inhibiting an important enzyme

Question 9

What do osteoclasts do?

Answer 9

Degrade bone for remodelling

Question 10

What do osteoblasts do?

Answer 10

They build bone by synthesising the bone matrix

Question 11

How must bisphosphonates be taken and why?

Answer 11

They need to be taken once a week in the morning before breakfast with a full glass of water standing up because they are very acidic and can cause severe damage Eg. contact stomatitis, oesophageal ulcers, osteonecrosis of the jaw (ONJ)

Question 12

What is the function of Rank ligand?

Answer 12

It stimulates the osteoclasts

Question 13

Name some drugs used to prevent fractures in osteoporosis

Answer 13

-Alendronate (weekly)
Can be buffered (less acidic) or standard
-Risendronate (weekly)
-Zolendronate (IV annually)
-Denosumab (subcutaneous 6 monthly)
-Gonadal hormone replacement therapy
-Calcium and vitamin D in the elderly

Question 14

Name some drugs that encourage bone growth in osteoporosis

Answer 14

-Teriparatide (subcutaneous daily for 2 years)

-Romosozumab (intramuscular monthly for 1 year)
It increases bone growthy by increasing signalling

Question 15

How is calcium absorbed by the body?

Answer 15

It must be first released into a soluble and ionised form for absorption via transcellular and paracellular transport. Vitamin D is needed for transcellular transport of calcium

The bioavailability of calcium varies between foods

Question 16

Which nutrients increase the absorption of calcium?

Answer 16

Lactose and oligosaccharides

Question 17

What are the effects of vitamin D deficiency?

Answer 17

Rickets in children
Osteoporosis in adults
Secondary hyperparathyroidism

Question 18

What is vitamin K important for in bones?

Answer 18

It activates osteocalcin which builds and heals bone

Question 19

What is Zinc important for in bones?

Answer 19

Important for bone metabolism

Question 20

Name a indicator for a hip fracture in the blood

Answer 20

Under-gamma-carboxylated osteocalcin which is a marker for vitamin K statues and indicates hip fracture

Question 21

What are the impacts of bad posture?

Answer 21

• Pressure on the vertebrae
• Increased risk of fall
• Causes muscle weakening
• Increases social problems like body image

Question 22

Which type of fracture can be fatal and why?

Answer 22

Hip fractures are very dangerous because they result in many breaks at once which damages lots of the sacral blood vessels and nerves

95% are caused by falls