Osteoporosis Flashcards by David Houghton

Osteoporosis refers to weak and porous bones due to low bone mineral density. This is the most common metabolic bone disease. The fractures that are due to osteoporosis can be divided into which of the 2 categories below?

1 - trauma and pathological (diseased bone)
2 - trauma and accidental
3 - pathological and physiological
4 - pathological and accidental

1 - trauma and pathological (diseased bone)

patients with osteoporosis commonly have fragility fractures

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Patients with osteoporosis are said to have fragility fractures, which are fractures sustained through low energy trauma, such as a fall from standing height of less. What are the 4 most common sites for fractures in osteoporosis

1 - PIP, DIP, proximal humerus and spine
2 - proximal humerus, hip/neck of the femur, spine, forearm
3 - proximal humerus, hip/neck of the femur, femur, forearm
4 - ankle, hip/neck of the femur, spine, forearm

1 - proximal humerus
2 - hip/neck of the femur
3 - spine
4 - forearm

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How can we diagnose osteoporosis?

1 - DEXA
2 - X-ray
3 - MRI
4 - ultrasound

1 - DEXA

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Bone mineral density is the amount of bone contained with a unique area, which can only be quantified using a DEXA scanner. The DEXA scanner can generate a T score, what is a T score?

1 - score for patients BMD compared to peak of a 30 y/o female
2 - score for patients BMD compared against same gender and age
3 - score for patients BMD compared to peak of a 30 y/o male
4 - score for patients BMD compared against same age

1 - score for patients BMD compared to peak of a 30 y/o female

patients BMD is converted to a T score to standardise BMD scores
t score is then compared to the peak of a 30 y/ol female as SD either side of peak female T score

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What is osteopenia?

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Osteopenia is less severe form of osteoporosis. Using the DEXA what is the diagnosis of osteopenia?

a normal DEXA T score is > -1

1 - -1 to -2.5
2 - < -2.5
3 - < -2.5 with at least one fracture
4 - >-1

1 = -1 to -2.5

< -2.5 = osteoporosis
< -2.5 with at least one fracture = severe osteoporosis

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What proportion of >65 will fall in a year, and thus increase the risk of fractures?

1 - 33%
2 - 50%
3 - 70%
4 - 100%

1 - 33%

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What is the single most important risk fracture for a fragility fractures?

1 - exercise
2 - diet
3 - gender
4 - age

4 - age

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What % of adult women will have one or more fragility fracture in their lifetime?

1 - 15%
2 - 25%
3 - 50%
4 - 80%

3 - 50%
- 20% in men
- 549,000 new fragility each year in the UK

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What is the most common fragility fracture?

1 - vertebral
2 - hip
3 - femur
4 - radius

1 - vertebral
- 70% go undiagnosed as they as asymptomatic

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What is the most common fracture in young patients?

1 - vertebral
2 - hip
3 - femur
4 - radius

4 - radius
- forearm (distal radius) fracture from falling over

- older = hips (fall directly onto the hips)

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What is the most common fracture in older patients?

1 - vertebral
2 - hip
3 - femur
4 - radius

2 - hips
- fragility fractures account for 105,000 hip fractures/year in the UK

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What is an index fracture?

1 - risk of subsequent fractures following an initial fracture
2 - risk of 1st fractures
3 - risk of developing multipole fractures simultaneously

1 - risk of subsequent fractures following an initial fracture

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What % of patients will die within 12 months of a hip fracture?

1 - 10-15%
2 - 15-20%
3 - 25-30%
4 -30-40%

3 - 25-30%

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Which of the following patients does NOT need to be assessed for frailty fracture risk?

1 - women aged ?65 years and over, and
2 - men aged >75 years
3 - women aged 50–64 and men aged 50–74 with the risk factors
4 - women <50y/o with a fracture

4 - women <50y/o with a fracture

Risk factors used to identify those that need to be assessed for frailty fracture risk include:

previous osteoporotic fragility fracture
corticosteroids use
history of falls
low BMI(less than18.5kg/m2)
smoker
alcoholintake >14 units per week
secondary cause of osteoporosis

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Is the mortality higher in patients following a hip or vertebral fracture?

vertebral
number of vertebral fractures increases mortality
thoracolumbar part of spine is most common

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What are some common signs of a vertebral fracture?

1 - pain, height loss and hearing changes
2 - pain, height loss and change in posture
3 - height loss and change in posture
4 - height loss and change in posture

2 - pain, height loss and change in posture

pain is from compressed nerves
posture and height loss are due to damaged vertebrae creating a wedged vertebrae

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We all have a degree of lordosis (outward curvature of the spine) and kyphosis (inward curvature of the spine) in a normal and healthy spine. Which segments of the vertebral spine are lordosis and kyphosis in normal spine?

1 - cervical and lumber = lordosis and thoracic = kyphosis
2- cervical and lumber = kyphosis and thoracic = lordosis
3 - cervical and thoracic = lordosis and lumbar = kyphosis
4 - thoracic and lumber = lordosis and cervical = kyphosis

1 - cervical and lumber = lordosis and thoracic = kyphosis

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At what age does bone mass peak in our lifetime?

1 - 10-15 y/o
2 - 15-20 y/o
3 - 20-25 y/o
4 - 28-30 y/o

4 - 28-30 y/o

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Is bone mineral mass affected by genetics?

yes
polygenic up to aprox 50-70%

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What is key in terms of lifetime bone mass that we can modify?

1 - medications
2 - employment
3 - lifestyle through diet and exercise
4 - low alcohol and drug use

3 - lifestyle through diet and exercise

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What are the key 2 key micronutrients that are essential for bone health?

1 - Ca2+ and Vitamin A
2 - Ca2+ and Vitamin K
3 - Folic Acid and Vitamin D
4 - Ca2+ and Vitamin D

4 - Ca2+ and Vitamin D
Protein
Micronutrients: Vitamin A, B Vitamins, Vitamin K, Magnesium and Zinc

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99% of the bodies Ca2+is maintained within bones. But 1% is found within serum, Why is serum Ca2+ a bad marker for assessing overall Ca2+ absorption and consumption?

1 - slow to respond to pathology
2 - will be normal even if patient has osteoporosis
3 - assays have poor sensitivity
4 - assays have poor specificity

2 - will be normal even if patient has osteoporosis

even if patient has osteoporosis, PTH will ensure serum Ca2+ is maintained from bones stores
need to measure Ca2+ and hormone levels as PTH could be high in osteoporosis

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What is the recommended intake of Ca2+?

1 - 100mg
2 - 1500mg
3 - >1000mg
4 - >3000mg

3 - >1000mg

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In addition to dairy, which of the following is NOT a good sources of Ca2+? 1 - nuts (almonds) 2 - bread 3 - broccoli 4 - spinach 5 - dairy substitutes

2 - bread

What is the most commonly prescribed for patients with low bone mineral density? 1 - magnesium and Ca2+ 2 - zinc and vitamin D3 3 - Ca2+ with vitamin D3 4 - Ca2+ and zinc

3 - Ca2+ with vitamin D3 - D3 important for bone health

What % of vitamin D is absorbed through sunlight? 1 - 10% 2 - 30% 3 - 55% 4 - 95%

4 - 95%

Order the process of how vitamin D is process to make active vitamin D using the labels below: - converted to 1, 25 hydroxyvitamin D (active vitamin D) - converted into calcifediol (25-hydroxycholecalciferol) in the liver - vitamin D3 or D2 absorbed through skin or diet, respectively

1st - vitamin D3 or D2 absorbed through skin or diet, respectively 2nd - converted into calcifediol (25-hydroxycholecalciferol) in the liver 3rd - converted to 1, 25 hydroxyvitamin D (active vitamin D)

What effect does vitamin D have on GIT and bone? 1 - increases vitamin D absorption in GIT 2 - increases bile secretion to ensure absorption 3 - increases Ca2+ absorption from enterocytes in GIT 4 - all of the above

3 - increases Ca2+ absorption from enterocytes in GIT - mobilises Ca2+ stores by acting like PTH

What affect can chronic liver disease affect vitamin D? 1 - increaeses PTH levels in the blood 2 - decreases conversion of vitamin D3 and D2 into 25 hydroxyvitamin 3 - increases conversion of vitamin D3 and D2 into 25 hydroxyvitamin 4 - reduces PTH levels in the blood

2 - decreases conversion of vitamin D3 and D2 into 25 hydroxyvitamin - so active vitamin D is not created

What affect can obesity affect vitamin D? 1 - increaeses PTH levels in the blood 2 - increases vitamin D absorption as larger surface area exposes to sun 3 - impairs skins ability to absorb vitamin D 4 - reduces PTH levels in the blood

3 - impairs skins ability to absorb vitamin D

Can medications such as long term use of anti-epileptics or retrovirals affect vitamin D levels?

- yes - impairs vitamin D synthesis

What affect can chronic kidney disease affect vitamin D? 1 - D1 - cannot reabsorb Ca2+ or convert 25 hydroxyvitamin D into 1,25 hydroxyvitamin D, the active form of vitamin 2 - increases vitamin D absorption as larger surface area exposes to sun 3 - impairs skins ability to absorb vitamin D 4 - rincreases Ca2+ re-absorption causing hypercalcaemia

1 - D1 - cannot reabsorb Ca2+ or convert 25 hydroxyvitamin D into 1,25 hydroxyvitamin D, the active form of vitamin

Protein is important for bone health, why is this? 1 - amino acids are essential for bone matrix 2 - amino acids stimulate muscle growth and bone development 3 - amino acids are raised in puberty 4 - amino acids are released stimulating RANK-L release in bone

1 - amino acids are essential for bone matrix

What affect does vitamin K have on bone health? 1 - crucial for making osteocalcin which is secreted by osteoclasts 2 - crucial for making osteocalcin which is secreted by osteoblasts 3 - crucial for making osteocalcin which is important in the conversion of active Vitamin D 4 - all of the above

1 - crucial for making osteocalcin which is secreted by osteoclasts

What effect does magnesium have on bone health? 1 - inhibits osteoblasts proliferation 2 - stimulates osteoclasts proliferation 3 - stimulates osteocyte proliferation 4 - stimulates osteoblasts proliferation

4 - stimulates osteoblasts proliferation - osteoblasts build new bone

What effect does zinc have on bone health? 1 - involved in bone deposition 2 - involved in osteoblasts development 3 - involved in osteoclasts development 4 - involved in bone mineralisation

4 - involved in bone mineralisation

How does a low BMI (<19) affect bone health in a woman? 1 - low vitamin D intake 2 - amenorrhea so no progesterone 3 - amenorrhea so no estrogen 4 - low Ca2+ intake

3 - amenorrhea so no estrogen - oestrogen inhibits osteoclasts, if low estrogen then there will be high breakdown of bone that is not matched by osteoblast activity - also poor diet and reduced weight so reduced mechanical stress

How does alcohol affect bone density? 1 - reduces hormones (testosterone and estrogen) 2 - impairs vitamin D metabolism 3 - impairs Ca2+ absorption 4 - inhibits osteoblasts

1 - reduces hormones (testosterone and estrogen) - suppresses osteoblasts differentiation - estorgen inhibits osteoclasts, so will get high bone turnover - increases falls and fracture risk

The cumulative risk of bone fracture is dependent on what in smoking? 1 - amount smoked 2 - duration of smoking 3 - what is smoked 4 - amount and duration of smoking

4 - amount and duration of smoking

How much exercise should be done weekly and daily in an attempt to maintain bone mass? 1 - 10 minutes a day/70 minutes/week 2 - 30 minutes a day/120 minutes/week 3 - 60 minutes a day/150 minutes/week 4 - 90 minutes a day/360 minutes/week

3 - 60 minutes a day/150 minutes/week

How does inflammatory disease, which has increased levels of TNF-a, IL-6 and IL-1 affect the risk of osteoporosis? 1 - inhibits osteoblasts 2 - increases osteoblast activity 3 - decreases Ca2+ absorption 4 - decreases conversion of active vitamin D

1 - inhibits osteoblasts - increase RANK-L and activate osteoclasts activity - results in increased bone breakdown that is not matched by osteoblast activity

What is the FRAX tool?

- algorithm for the risk of fracture over 10 years

Before a fracture occurs, what are the common signs of osteoporosis? 1 - sore bones 2 - weak muscles 3 - no symptoms 4 - history of fractures

3 - no symptoms

Once an osteoporotic woman has had a 1st vertebral fracture, what % of the these women are likely to have another vertebral fracture within the next 12 months? 1 - 5% 2 - 10% 3 - 19% 4 - 33%

3 - 19%

Fragility vertebral fractures can cause kyphosis, which is an abnormal rounding of the spine. What happens to the patients centre of gravity and what can this lead to? 1 - centre of gravity moves horizontally (backwards) increasing the risk of falls 2 - centre of gravity moves horizontally (backwards) increasing the risk of fractures 3 - centre of gravity moves horizontally (forwards) increasing the risk of falls 4 - centre of gravity moves horizontally (forwards) increasing the risk of fractures

2 - centre of gravity moves horizontally (backwards) increasing the risk of fractures

How many units of alcohol p/w doubles the risk of bone fracture? 1 - 1 unit 2 - 1-2 units 3 - 3-4 units 4 - >4 units

3 - 3-4 units

Glucocorticoids have been linked with osteoporosis, which of the following is NOT linked with Glucocorticoids? 1 - Increased PTH secretion 2 - Reduced Ca2+ reabsorption in kidneys 3 - Reduced oestrogen 4 - Impaired Vit D absorption 5 - Acute suppression of osteoblasts 6 - Stimulation of osteoclastogenesis

2 - Reduced Ca2+ reabsorption in kidneys

A 50 year old lady was referred to the RA clinic. She had the following on a medical history: - Family history maternal hip fracture - Coeliac Disease – strict gluten-free adherence - Lactose Intolerance - Family history breast cancer - Last menstrual period 49 yrs - Well, regular weight-bearing exercise - No history of falls - Never fractured - Never smoked - Alcohol 6U/wk - BMI 17.31 - paracetamol - no history of corticosteroids or PPIs Which of the above factors are risk factors for osteoporosis?

- Family history maternal hip fracture = high genetic association - Coeliac Disease – strict gluten-free adherence (poor Ca2+ absorption) - Lactose Intolerance (low Ca2+ intake) - Low BMI (high risk amenorrhea and low mechanical loading)

A 50 year old lady was referred to the RA clinic. She had the following on a medical history: - Family history maternal hip fracture - Coeliac Disease – strict gluten-free adherence - Lactose Intolerance - Family history breast cancer - Last menstrual period 49 yrs - Well, regular weight-bearing exercise - No history of falls - Never fractured - Never smoked - Alcohol 6U/wk - BMI 17.31 - paracetamol - no history of corticosteroids or PPIs This patient then has a DEXA, which gives a T score of -2.1. What does this score mean?

- patient is osteopenic -1 to -2.5 = osteopenic < -2.5 osteoporosis < -2.5 with at least one fracture severe osteoporosis

What is the goal of any treatment for osteoporosis?

- fragility fracture prevention

When we look at modifying patients lifestyle we need to reduce or stop known risk factors for RA. What are the 3 lifestyle factors, excluding diet that need modifying? 1 - smoking, alcohol, exercise 2 - medication, alcohol, exercise 3 - smoking, sleep, exercise 4 - sleep, alcohol, exercise

1 - smoking, alcohol, exercise - smoking = stop smoking - alcohol = reduce alcohol <4u/wk exercise = encourage weight bearing exercise

When we look at modifying patients lifestyle we need to reduce or stop known risk factors for osteoporosis. What are the 2 most important dietary changes that should be addressed? 1 - vitamin D and A supplements 2 - vitamin D and B12 supplements 3 - vitamin B12 and Ca2+ supplements 4 - vitamin D and Ca2+ supplements

4 - vitamin D and Ca2+ supplements - vitamin D supplementation (1000-2000 IU colecalciferol/day) - Ca2+ if levels are low: 700-1200mg

Which cell within bones is responsible for mechanotransduction in bones, which is the mechanism by which cells convert mechanical stimuli into cellular responses to a variety of mechanical loads? 1 - osteons 2 - osteoclasts 3 - osteoblasts 4 - osteocytes

4 - osteocytes

When deciding on which patients to treat who may have osteoporosis, which scoring tool is used? 1 - National Osteoporosis Guideline Group (NOGG) guidelines 2 - royal college of geriatricians guidelines 3 - GP guidelines 4 - all of the above

1 - National Osteoporosis Guideline Group (NOGG) guidelines

There are only 2 ways that any osteotherapy drugs are able to target bones, what are they? 1 - inhibit osteoblasts and stimulate osteoclasts 2 - inhibit osteoblasts and osteoclasts 3 - stimulate osteoblasts and inhibit osteoclasts 4 - stimulate osteoblasts and osteoclasts

3 - stimulate osteoblasts and inhibit osteoclasts

When we talk about osteotherapy drugs we talk about antiresorptive and anabolic. What does antiresorptive mean? 1 - inhibit reabsorption of bone 2 - inhibit forming of new bone 3 - inhibit reabsorption of Ca2+ 3 - increase reabsorption of Ca2+

1 - inhibit reabsorption of bone - essentially targets osteoclasts

When we talk about osteotherapy drugs we talk about antiresorptive and anabolic. What does anabolic mean? 1 - inhibit reabsorption of bone 2 - accentuate forming of new bone 3 - inhibit reabsorption of Ca2+ 3 - increase reabsorption of Ca2+

2 - accentuate forming of new bone - anabolic = building, in this instance its bone rebuilding

If a clinician is considering prescribing hormone replacement therapy, specifically oestrogen for a female patient with osteoporosis, what must they ensure prior to prescribing them oestrogen? 1 - cervical cancer 2 - breast cancer 3 - osteosarcoma 4 - hepatocarcinoma

2 - breast cancer - oestrogen receptor positive breast cancer can increase the risk of breast cancer, so we wouldn't want to give this patient oestrogen

What are selective oestrogen receptor modulator medication that can be given to patients with osteoporosis? 1 - drugs that regulate non-estrogen receptors 2 - drugs that regulate all estrogen receptors 3 - drugs that regulate estrogen receptors on breast tissue only 4 - drugs that regulate estrogen receptors on bones only

2 - drugs that regulate all estrogen receptors - inhibits/down regulates osteoclast activity

Selective oestrogen receptor modulator medication can be given to patients with osteoporosis, which are drugs that act on estrogen receptors. For example in bone they inhibits/down regulates osteoclast activity. Which of the following is the drug commonly used in the UK? 1 - Methotrexate 2 - Tamoxifen 3 - Raloxifene 4 - Prednisolone

3 - Raloxifene

Selective oestrogen receptor modulator medication can be given to patients with osteoporosis, which are drugs that act on estrogen receptors. For example in bone they inhibits/down regulates osteoclast activity, with Raloxifene being the key drug used in the UK. Although effective at reducing the risk of vertebral fracture, what are the most common adverse events that can occur with this drug? 1 - heart attack and strokes 2 - stroke and deep vein thrombosis 3 - stroke and breast cancer 4 - breast cancer and deep vein thrombosis

2 - stroke and deep vein thrombosis

If you have a patient that has previously had a fracture, is hormone therapy (HRT or Selective Oestrogen Receptor Modulators) going to be potent enough for treatment?

- no

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. What is the 1st line treatment for patients who have previously had a fracture? 1 - antibiotics 2 - steroids 3 - bisphosphonates 4 - RANK-L medication

3 - bisphosphonates

4 - Amiodarone - class III anti-arrhythmic medication through K+ channel inhibition

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are: 1 - Alendronic acid 2 - Disodium pamidronate 3 - Zolendronic acid What is the basic mechanism of action of this group of drugs? 1 - induce osteoblast proliferation 2 - induce osteocyte proliferation 3 - induce osteoblast apoptosis 4 - induce osteoclasts apoptosis

4 - induce osteoclasts apoptosis - bisphosphonates have a similar structure to inorganic pyrophosphate - bisphosphonates are incorporated into bone matrix - bisphosphonates accumulates in osteoclasts and inhibits inhibit Farnesyl Pyrophosphate Synthase (FPS) - FPS inhibition induces apoptosis of osteoclasts

What is paget's disease?

- disease of bone - interferes with bones normal recycling process - bones become fragile and misshapen

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are: 1 - Alendronic acid 2 - Disodium pamidronate 3 - Zolendronic acid These drugs essentially cause apoptosis of osteoclasts. Which of the following diseases have these medications NOT been licensed for? 1 - hypercalcaemia of malignancy 2 - metastatic bone cancer 3 - active pagets disease 4 - acute kidney injury 5 - osteoporosis

4 - acute kidney injury

- taken once a week in the morning - on a empty stomach with a full glass of water standing up - must not eat for 30 minutes

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates, with the 3 core drugs being Alendronic acid, Disodium pamidronate and Zolendronic acid. What is the most common side effect of these drugs? 1 - rickets disease 2 - oesophagitis/gastritis (oral agents) 3 - osteonecrosis of the jaw (rare) 4 - atypical femoral fractures (rare)

2 - oesophagitis/gastritis (oral agents)

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are: 1 - Alendronic acid 2 - Disodium pamidronate 3 - Zolendronic acid Which of the following is NOT a key contraindications for these drugs? 1 - renal impairment as excreted by kidneys 2 - hypocalcaemia 3 - Hypothyroidism 4 - upper gastrointestinal pathology eg peptic ulcer disease 5 - dental disease

3 - Hypothyroidism

RANK-L is a protein that is a member of the protein family TNF-a, a cytokine. Which cells secrete RANK-L? 1 - osteoclasts 2 - neutrophils 3 - osteoblasts 4 - macrophages

3 - osteoblasts - RANK-L binds to RANK-L recepotors on precursor monocytes - precursor monocytes fuse together and form osteoclasts - RANK-L also helps osteoclast mature

Osteoprotegerin is a inhibitory factor released by osteoblasts. What is the function of osteoprotegerin? 1 - binds osteoblasts and inhibits RANK-L production 2 - binds with osteocytes and inhibits bone remodelling 3 - binds with RANK-L and inhibits RANK-Ls ability to bind with osteoclasts 4 - all of the above

3 - binds with RANK-L and inhibits RANK-Ls ability to bind with osteoclasts

Osteoprotegerin is a inhibitory factor released by osteoblasts. Osteoprotegerin binds RANK-L and inhibits its ability to bind with osteoclasts. There are synthetic forms of osteoprotegerin that can have the same effect. Denosumab is the core drug that we need to know that comes under this category. How often and how is this drug administered? 1 - weekly 2 - monthly 3 - 6 monthly 4 - annually

3 - 6 monthly - given via - subcutaneous injection

Osteoprotegerin is a inhibitory factor released by osteoblasts. Osteoprotegerin binds RANK-L and inhibits osteoclasts maturation. There are synthetic forms of osteoprotegerin that can have the same effect, which are classed as RANK-L inhibitors. What is the core drug that we need to know that comes under this category? 1 - bisphosphonate 2 - denosumab 3 - estrogen 4 - triparitide

2 - denosumab - very expensive

What core drug do we need to know that is an anabolic (means to build things) drug that increases bone formation? 1 - bisphosphonate 2 - denosumab 3 - estrogen 4 - triparitide

4 - triparitide

Triparitide is a hormone regulator and is the core drug that we need to know that is an anabolic drug that increases bone formation. What is the mechanism of action of this drug? 1 - inhibits PTH 2 - induces constant secretion of PTH 3 - inhibits calcitonin and vitamin D 3 - induces a pulsatile secretion of PTH PTH = parathyroid hormone

- triparitide is a recombinant analogue of parathyroid hormone (essentially a copy of PTH) - forms pulses of PTH stimulating both osteoblasts and osteoclasts - BUT stimulates osteoblast more and increases bone formation

Triparitide is a hormone regulator and is the core drug that we need to know that is an anabolic drug that increases bone formation. It is a recombinant analogue of parathyroid hormone (essentially a copy of PTH) that stimulates osteoblasts preferentially over osteoclasts, thus increasing bone formation over bone re-absorption. How often and how is this drug administered?

- administered daily via subcutaneous injection

1 - patients with a cancer diagnosis

Bone mineral density is the amount of bone contained with a unique area, which can only be quantified using a DEXA scanner. What is the Z score? 1 - score for patients BMD compared to peak of a 30 y/o female 2 - score for patients BMD compared against same gender and age 3 - score for patients BMD compared to peak of a 30 y/o male 4 - score for patients BMD compared against same age

2 - score for patients BMD compared against same gender and age - z score = patients BMD as a number of SD above or below people of the same gender and age

The normal T score generated from a DEXA scan is <1. What is the diagnosis of severe osteoporosis? 1 = -1 to -2.5 2 = < -2.5 3 = < -2.5 with at least one fracture

3 = < -2.5 with at least one fracture

The normal T score generated from a DEXA scan is <1. What is the diagnosis of osteoporosis? 1 = -1 to -2.5 2 = < -2.5 3 = < -2.5 with at least one fracture

2 = < -2.5

We all have a degree of lordosis (outward curvature of the spine) and kyphosis (inward curvature of the spine) in a normal and healthy spine. Patients with osteoporosis can present with excessive kyphosis. What happens here?

- excessive kyphosis is present in the thoracic region - results in patients looking like they are bowing of bending over

When does the majority of bone mass accumulate? 1 - when baby is a foetus 2 - early childhood 3 - puberty 4 - adulthood

3 - puberty

The amino acids contained within protein are important for the matrix of bone. What else is protein important for in bone development? 1 - amino acids are essential for bone matrix 2 - stimulate the release of IGF-1 which stimulates osteoclasts 3 - stimulate the release of IGF-1 which stimulates osteoblasts 4 - stimulate the release of IGF-1 which stimulates osteocytes IGF-1 = insulin like growth factor

3 - stimulate the release of IGF-1 which stimulates osteoblasts

What % of adult women will have a fragility fracture in their lifetime? 1 - 15% 2 - 25% 3 - 50% 4 - 80%

3 - 50% - 20% in men