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3818 > osteoporosis > Flashcards

osteoporosis Flashcards

1
Q

What 3 cells maintain bone homeostasis?

A

Osteoclasts, osteoblasts, osteocytes

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2
Q

What is the role of osteoclasts?

A

Breaks down bones and releases Ca from bone into blood

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3
Q

What is the role of osteoblasts?

A

Builds bones

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4
Q

What is the role of osteocytes

A

Keeps the remodeling of bones in balance so the microstructure is preserved. Keeps bones in equilibrium so you don’t have 1 cell working faster than the other

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5
Q

Apart from the osteo cells, what else regulates bones?

A

Sex hormones and parathyroid hormone-activated vit D

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6
Q

What do you check to diagnose osteoporosis, and how do you check that?

A

Check bone mineral density using dual-energy x-ray absorptiometry

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7
Q

What part of the body is bone mineral density measured? (3)

A

Lumbar area (spine), femoral neck (upper leg/thigh bone) and total hip (hip bone)

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8
Q

Define T-score

A

It is the standard deviation of a healthy bone mineral density vs an unhealthy patient of the same gender/ethnicity

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9
Q

What is the relationship between good health and T-score?

A

Inversely proportional, the higher the T-score, the lower the health

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10
Q

What does it mean when you have a T-score of -1 to -2.5?

A

Means you have osteopenia, which is a warning sign that you will hit osteoporosis, but it isn’t the diagnosis yet

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11
Q

Which of these is NOT a risk factor for osteoporosis?
A. Aging
B. Family history
C. Low BMI, low physical acitvity
D. Smoking/alcohol
E. Fractures

A

E - that is a consequence of osteoporosis, not a risk factor

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12
Q

Which of these is NOT a risk factor for osteoporosis?
A. Low vit D and low Ca intake
B. Weaker bones
C. Drugs

A

B - that is a consequence of osteoporosis, not a risk factor

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13
Q

Which of these is NOT a drug that induces osteoporosis?
A. PPI
B. SSRI
C. SGLT2 inhibitors
D. Gonadotropin-releasing hormone (GnRH)
E. Antiepileptic drugs

A

C

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14
Q

Anastrozole, letrozole, exemestane are drugs that induces osteoporosis. What drug class do they belong to?

A

Aromatase inhibitors

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15
Q

Goserelin and nafarelin are drugs that induce osteoporosis. What drug class do they belong to?

A

GnRH agonists

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16
Q

MOA of aromatase inhibitors

A

Prevents conversion of androgen to E, leading to lower E levels, leading to higher bone loss

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17
Q

How do GnRH agonists induce osteoporosis?

A

Long-term use suppresses ovaries/testes from making sex hormones, leading to weaker bones and bone mineral density

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18
Q

How do glucocorticoids directly affect the bone?

A

Reduces osteoblast and increases osteoclast activity

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19
Q

Which of these if NOT an indirect impact of glucocorticoids on the bone?
A. Reduce Ca absorption from blood
B. Suppress growth hormone
C. CHange sex hormone levels
D. Change vit D activation
E. Suppresses osteoblast activity

A

E - that is a DIRECT impact, not indirect

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20
Q

MOA of how PPI impacts bone density

A

Ca is absorbed by being dissolved. Ca is best dissolved in lower pH. PPI decreases acid secretion, thereby increasing pH, and inhibiting Ca from being dissolved. Hence, there is less absorption of pH

21
Q

Thyroxine, tetracycline, quinolone, bisphosphonates.
What impact do these drugs have on Ca?

A

They reduce Ca absorption from the gut

22
Q

If thyroxine, tetracycline, quinolone and bisphosphonates reduce Ca, can pxs take them with Ca supplements if they contradict each other?

A

Pxs can take both but needs to be 2 hours apart

23
Q

Why is it important to maintain vit D to maintain bone help?

A

Because Vit D, after being converted into its metabolites by kidney, it promotes Ca absorption and assists with mineralisation of bones by interacting with the parathyroid hormone

24
Q

How long do you need to wait to take vit D supplements after testing 25-hydroxyvitamin D levels? Why?

A

3 months. Because it takes that long for vit D to reach steady state

25
Q

What is the target level for vit D in osteoporosis?

A

75nmol/L or higher

26
Q

What is the difference between cholecalciferol and calcitriol?

A

Cholecalciferol - D3 - increases bone mineral density and is inactive
Calcitriol - D - reduced rate of bone mineral loss and is the active form

27
Q

When is the best time to take Ca? Why?

A

In the evening because there is more bone loss at night

28
Q

When is the best time to take D?

A

Any time

29
Q

Which of these drugs is NOT used for osteoporosis?
A. Bisphosphonates
B. PPI
C. Denosumab
D. Teriparatide
E. Hormone replacement therapy (HRT)

A

B - PPIs actually make osteoporosis worse

30
Q

Which drug is the first line drug for postmenopausal osteoporosis?

A

Bisphosphonates

31
Q

MOA of bisphosphonates

A

Inhibit osteoclasts

32
Q

What drug class do these belong to?
Alendronate, risendronate

A

Bisphosphonates

33
Q

What drug class does zoledronic acid IV infusion belong to?

A

Bisphosphonates

34
Q

When would denosumab be considered for tx?

A

When px isn’t responding to bisphosphonates

35
Q

What does the suffix -mab refer to?

A

Monoclonal antibodies

36
Q

What is RANKL and RANK?

A

RANKL is a ligand that is secreted by osteoblasts when there is enough regeneration of bones. RANKL then binds to RANK that is already bound to osteoclasts in order to stimulate it and keep balance

37
Q

MOA of denosumab

A

Inhibits RANKL to stop them from binding to RANK, hence inhibiting the stimulation of osteoclasts

38
Q

How often is denosumab injected?

A

Every 6 months

39
Q

Why should pxs on denosumab and bisphosphonates have any dental procedures before initiating therapy?

A

To avoid osteonecrosis of the jaw. A side effect of the drugs is the exposure of the jaw bone which leads to the death of blood vessels

40
Q

MOA of raloxifene

A

E agonist on bone mass and lipids, however it is an E antagonist on other E-receptive tissues like breast and endometrium

41
Q

Which condition is raloxifene suited for?

A

Post-menopausal osteoporosis, especially younger post-menopausal women with spine osteoporosis. Also good for women with a higher risk of breast cancer

42
Q

Relationship between raloxifene and VTE/blockage of veins in legs

A

Raloxifene increases risk of VTE

42
Q

Relationship between raloxifene and breast cancer

A

Raloxifene reduces risk of breast cancer

43
Q

What is teriparatide

A

Synthetic form of human parathyroid hormone

44
Q

MOA of teriparatide

A

Promote bone formation and increase bone mineral density

45
Q

Difference between teriparatide and other osteoporosis drugs

A

Other drugs inhibit bone resorption, teriparatide is the only one that promotes bone formation

46
Q

True or false?
Teriparatide is the first-line treatment for postmenopausal women and men

A

False
Teriparatide is the second line tx when pxs can’t tolerated bisphosphonates and denosumab

47
Q

Why can pxs only use teriparatide for a maximum of 18 months?

A

To avoid the potential risk of osteosarcoma (type of bone cancer)

3818 (8 decks)

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