Osteoporosis

Question 1

Role of osteoblasts

Answer 1

Fill in bone cavity
Release cytokines to attract osteoclasts
Build Bone

Question 2

Role of osteoclasts

Answer 2

Releases proteases which dissolves bone
Clears damaged bone
Release chemicals that attract osteoblasts

Question 3

What does T-score show? E.G: a value more that 2.5 and a value of 1?

Answer 3

No. of standard deviations away from mean peak Bone Mass Density
2.5 = osteoporosis
1= normal

Question 4

Primary Osteoporosis

Answer 4

Diagnosed when patient has no other osteoporosis causing disorders
E.g: Postmenopausal women

Question 5

Secondary Osteoporosis

Answer 5

IBD
Endocrine illnesses
Drug therapies
Rheumatoid Arthritis

Question 6

Most common cause of secondary Osteoporosis?

Answer 6

Corticosteroids
Decrease osteoblast activity and life span
Decrease calcium absorption
Suppresses sex hormone production

Question 7

What is a fragility fracture?

Answer 7

Fracture from a force that wouldn’t usually cause a fracture: falling from standing etc.

Question 8

what is kyphosis?

Answer 8

Deformed spine- forward curvature

Question 9

Groups of people who need prophylaxis of osteoporosis

Answer 9

Anyone with fragility fracture
women over 70yrs
Post menopausal women
men over 50 years if on high dose steroids

Question 10

What is FRAX score

Answer 10

To predict 10 yr risk of osteoporotic fracture

Question 11

Treatment for Low Risk Osteoporosis

Answer 11

Lifestyle and calcium/ vitamin D

Question 12

Treatment for Medium Risk Osteoporosis

Answer 12

Assess BMD with DEXA scan

Question 13

Treatment for High Risk Osteoporosis

Answer 13

Start treatment without BMD assessment

Question 14

Lifestyle changes for osteoporosis

Answer 14

Low impact exercise
Muscle training for hip, spine or wrist
Avoid smoking/ drinking
Eat calcium rich foods
Exposure to sun

Question 15

Dosage of calcium and vit. D

Answer 15

1000mg calcium
800 units vit. D

Question 16

What medications increase risk of falls

Answer 16

Anti-hypertensives
Sedatives
Diuretics
Vision problems

Question 17

Drug treatments for osteoporosis

Answer 17

1st line: Bisphosphonates
2nd line: Denosumab, raloxifene, HRT / also with Calcium and Vitamin D

Question 18

Example of bisphosphonates

Answer 18

Alendronate
Risedronate

Question 19

Counselling points for bisposphonates

Answer 19

Empty stomach
30mins before food
With water
Remain upright for 30mins
Report any oesophageal irritation

Question 20

Vitamin D deficiency (~25nmol/L)

Answer 20

Loading dose ~300k units over 6-10 weeks
Maintenance dose: 800-2000 units daily

Question 21

Bisphosphonates Pharmacology

Answer 21

Alendronic acid- binds to calcium in bone
Released as bone is reabsorbed
Main action is osteoclasts

Question 22

Raloxifene Pharmacology

Answer 22

Selective oestrogen receptor modulator
Stimulates osteoblast activity

Question 23

Denosumab Pharmacology

Answer 23

Monoclonal antibody to RANKL
Inhibits binding of RANKL to RANK

Question 24

Calcitonin Pharmacology

Answer 24

Antagonistic to PTH
increases conc. of calcium in urine
Decreases conc. of calcium

Question 25

Teriparatide Pharmacology

Answer 25

Active fragment of PTH
Acts at PTH receptors
Opposite effects to PTH

Question 26

Strontium Pharmacology

Answer 26

Increases sensitivity of calcium sensing receptor in parathyroid cells
Decreases PTH secretion