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Musculoskeletal > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

This is a quantitative defect of bone characterised by reduction in bone mineral density and increased porosity, leading to increased risk of fracture

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2
Q

How is osteoporosis quantified?

A

Osteoporosis is described as having >2.5 standard deviations below the mean peak bone mass

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3
Q

How is osteopenia quantified?

A

Osteopenia is described as having 1-2.5 standard deviations below the mean peak bone mass

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4
Q

When does physiological loss of bone density begin to occur?

A

30 years

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5
Q

Why is peak bone mass found in young adults?

A

Higher physical activity
Increased muscle strength
Better diet
Hormonal status

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6
Q

What are some causes of primary osteoporosis?

A

Idiopathic
Post-menopausal
Senile

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7
Q

What are some risk factors for developing osteoporosis?

A

Smoking
Alcohol abuse
Lack of exercise
Poor diet

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8
Q

What complications can occur in post-menopausal osteoporosis?

A

Colles fractures
Vertebral insufficiency fractures

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9
Q

What complications can occur in senile osteoporosis?

A

Femoral neck fractures
Vertebral fractures

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10
Q

What are some endocrine disorders that can cause secondary osteoporosis?

A
  • Cushing’s syndrome
  • Hyperparathyroidism
  • Hyperthyroidism
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11
Q

What are some gastrointestinal disorders that can cause secondary osteoporosis?

A
  • Hepatic insufficiency
  • Malabsorption
  • Malnutrition
  • Vitamin C or D deficiency
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12
Q

What are some drugs that can cause secondary osteoporosis?

A

Alcohol
Corticosteroids

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13
Q

How do age related changes occur in osteoporosis?

A

Age related changes in osteoporosis are caused by the reduction in proliferative and biosynthetic capacity in osteoblasts and an attenuated response to growth factors

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14
Q

How can a reduction in physical activity lead to osteoporosis?

A

Reduction in physical activity such as immobilisation (or going to space) means that there is a lower load on the bone, so there is a physiological reduction in bone mass

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15
Q

How can genetic factors cause osteoporosis?

A

Genetic factors such as polymorphisms to genes regulating osteoclastic activity and vitamin D receptors can lead to decreased bone density

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16
Q

How can post-menopause cause osteoporosis?

A

In post-menopausal osteoporosis, low oestrogen levels causes high bone turnover, however osteoclastic activity exceeds osteoblastic activity, with monocytes also releasing inflammatory mediators

17
Q

In who are fracture risk assessments used in osteoporosis?

A
  • Anyone over 50 with risk factors
  • Anyone under 50 with very strong risk factors (e.g. early menopause, glucocorticoids)
18
Q

What are some investigations used in osteoporosis?

A

DEXA scanning (Mineral density)
Bloods

19
Q

What are some blood tests used in osteoporosis to find underlying causes?

A
  • U+Es
  • LFTs
  • FBC
  • Protein electrophoresis
  • Coeliac antibodies
  • PTH
20
Q

What is the aim of treatment in osteoporosis?

A

No treatments are available to increase bone mineral density

Treatments aim to slow any further deterioration and decrease risk of subsequent fracture

21
Q

What are soem lifestyle changes used in osteoporosis?

A
  • Increased calcium intake
  • High intensity strength training
  • Avoidance of excess alcohol
  • Smoking cessation
  • Fall prevention
22
Q

What are some pharmacological treatments used in osteoporosis?

A
  • Calcium and/or vitamin D supplements
  • Oral bisphosphonates
  • Zolendronic acid
  • Desunomab
  • Teriparatide
  • Romosozumab
23
Q

When should calcium supplements be given in relation to oral bisphosphonates?

A

Calcium supplements should not be taken within 2 hours of oral bisphosphonates

24
Q

What do oral bisphosphonates do in osteoporosis?

A

Reduce osteoclastic resorption

25
Q

When should oral bisphosphonates be indicated in osteoporosis?

A

Consider treatment with when T score ≤ -2.5
Or if on steroids (≥7.5mg) for over 3 months, consider if T score ≤ 1.5

26
Q

What is Zolendronic acid?

A

This is a once yearly IV bisphosphonate given second line in many patents who cannot tolerate oral bisphosphonates

27
Q

What is desunomab?

A

A monoclonal antibody which reduces osteoclast activity

28
Q

What is teriparatide?

A

A recombinant parathyroid hormone which stimulates bone growth rather than reducing bone loss

29
Q

Who is teriparatide treatment recommended in?

A

Women with severe post-menopausal osteoporosis with high risk of or with vertebral and non-vertebral fractures

30
Q

What is romosozumab?

A

A monoclonal antibody that binds to and inhibits sclerostin to increase bone formation and reduce bone resorption

31
Q

Who is romosozumab recommended in?

A

Recommended for postmenopausal women with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture (24 months)

32
Q
A

Musculoskeletal (123 decks)

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