osteoporosis

Question 1

—— is metabolic bone disease, characterised by low bone mineral density and increased risk of fracture

Answer 1

osteoprosis

Question 2

—–is a systemic skeletal disorder characterised by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk

Answer 2

osteoporosis

Question 3

osteoprosis is seen when the bone mineral density os —-

Answer 3

Lowet than -2.5

Question 4

—- is the pre-condition to osteoporosis

Answer 4

osteopenia

Question 5

why is it important:
1- —– are a major cause of morbidity, mortality and reduction in quality of life.
2- associated w — hospital stay and loss of —–
3- predominantly affects —-

Answer 5

• hip and vertebral insufficnecy fracture
• prolonged
• functional indépendance
• post menopausal women
  1-1in 2 women aged > 50 will have an osteoporotic fracture in their lifetime.
  2-1 in 5 men aged > 50 will have an osteoporotic fracture in their lifetime.

Question 6

we need to categorise the risk factors as modifiable and non modifiable ( u cant change them)
1- modifable includes:
2- non modifiable :

Answer 6

1-
1-Low vitamin D intake / production.
2-Low dietary calcium / phosphorous intake.
3-Sedentary lifestyle, immobility.
4-Excessive alcohol & smoking.
5-Oestrogen deficiency (post-menopausal).
6-Testosterone deficiency in men.
5-Low body mass index (BMI).
6-Proton pump inhibitors (commonly prescribed -omeprazole / pantoprazole etc.).
7-Corticosteroid use.
2- non modifiable includes :
-Genetics (~ 30genes associated with osteoporosis).
-Advancing age.
-Female sex.
-Prior fracture (hip / vertebral).
-Maternal hip fracture.

Question 7

conditions associated w osteoporosis :
1- —– : Cushing’s disease, hyperparathyroidism, hyperthyroidism, prolactinoma, hypogonadism
2- any cause of —- example:coeliac disease
3- —- deficieny
4- ——
5- —– : osteogenesis imperfecta, Ehlers-Danlos syndrome
6- —- : rheumatoid arthritis, Crohn’s disease, ulcerative colitis
7- —–
8- —– as: multiple myeloma
7- —- used to treat other conditions as asthma

Answer 7

• endocrine disorders
• malabsorption
• vitamin d
  -chronic liver or chronic renal disease
• genetic disorders
• systemic inflammatory disease
• anorexia nervosa
• malignancies
• corticosteroids

Question 8

bones are constantly being — which is coupled process of bone formation by — and bone resporbtion by —
- this process is normally — to keep the skeletal integrity
- After menopause, due to lack of oestrogen, osteoblast under fill areas of—- resulting in — of the bone

Answer 8

• remodelled
• osteoblst
• osteoclast
• equal
• resorption
• thinning
  ( check slide 15 for the cycle importantttttt)

Question 9

Generally —- until a fracture occurs.
these fractures can be:

Answer 9

• asymptomatic
  1-Hip (Neck of femur).
  2-Wrist (Fall onto an out-stretched hand – FOOSH – radial fracture).
  3-vertebral (Loss of vertebral height) - wedge-shaped vertebrae.

Question 10

—– Shortening and external rotation of the fractured hip.

Answer 10

hip fractures ( most common at neck of femur)

Question 11

osetoprosis complications include:
- abornmal – and loss of —

Answer 11

• posture and loss of height :
  Kyphosis and vertebral shortening due to vertebral fractures.
  Can lead to increased falls risk

Question 12

assessment of osteoporosis :

Answer 12

1- symptoms:
-Ask about symptoms of back pain.
-Any history of fragility fractures (A fracture resulting from a fall from standing height or less).
2- signs:
- loss of height
- Kyphosis (Dowager’s hump) - Stooped posture/ hump on the back
3- back pain on palpation

Question 13

-osteoporosis are diagnosed by 2 methods:
-bone mineral density is measured by —- which measures how much — you have
- — measures the bone density at hip and lumbar spin

Answer 13

2 methods:
- By bone mineral density measurement.
-By history offragility fracture regardless of bone mineral density
- DEXA (dual-energy x-ray absorptiometry )
- bone tissue
- DEXA

Question 14

citeria for osteorpsois in post menopausal ppl over 65:
—- > -1.0 SD
—- -1.01 to -2.49 SD
—- < or equal to -2.5
—- < or equal to -2.5 SD w fragility fractures

Answer 14

• normal
• osteopenia
• osteoprosis
• severe osteoporosis
  ( SD= Standard Deviation is a measurement of the spread of data around the mean)

Question 15

investigation - looking for other causes:

Answer 15

Bloods:
-Full blood count (Anaemia).
-Bone profile (Calcium and alkaline phosphate).
-Vitamin D levels.
-Other causes:
1-Parathyroid hormone levels (Importantfor bone turnover).
2-Thyroid function tests (Hyperthyroidism can cause osteoporosis).
3-Cortisol (Low cortisol might be a sign of exogenous steroids).

-Plain film x-rays of lumbar spine:
1-Assessment for thoracic and lumbar vertebral fractures.

Question 16

fracture prediction tools:
- Treatment initiation can be guided by the —- of a fracture , this is calculated using —–
- this took gives the % chance of —- and % chance —-
- treatment becomes cost effective when 10 year fracture risk is over —

Answer 16

• 10 year probability
• FRAX ( fracture risk assessment tool)
• Gives the % chance of a major osteoporotic fracture and the % chance of a hip fracture within the next 10 years
• approx. 4%

Question 17

the 2 key concepts of management :
1- based on mannaging the —
2- changing the balance between

Answer 17

• modifable risk
• osteoblast and osteoclast
  1-Low vitamin D:
  Vitamin D replacement (sunlight or tablets).
  2-Low calcium intake:
  Dietary calcium education (cheese / yoghurt etc.).
  Calcium tablets.
  3-Low BMI:
  Dietary advice.
  Increasing calorie intake.
  4-Sedentary lifestyle:
  Weight bearing exercise.
  Low oestrogen
  Oestrogen replacement therapy.
  5:Low testosterone
  Testosterone replacement therapy.
  6:Excessive alcohol
  Behaviour modification
  7:Smoking
  Behaviour modification
  Nicotine replacement therapy.
  8:Fall risk
  Use of mobility aids (walking frame) to reduced fall risk.

Question 18

management by medication
1- anti-resprtion action - reducing bone reasbprtion as:

Answer 18

biohphonate , denusumab , oestrogen replacement , selective psterogen receptor modulator SERMs
1- biophosphonate:
-Bisphosphonates are first line anti-resorptive agents
-Reduce osteoclast activity causing osteoclast apoptosis
-SE – can cause osteonecrosis of Jaw.
2- denosumab:
Monoclonal antibody that binds to RANK ligand andprevents it activating osteoclasts which inhibits theirfunction
3-ostroegn replacemnt:
-Forpeople who enter early menopause -importantly, there is an increased risk of breast cancer
-Promotes osteoblast
4 SERM:
-acts on oestrogen receptors in bone much like oestrogen but works as an anti-oestrogen in breast tissue [no increased breast cancer risk]
-An example of a SERM is raloxifene.
* Used in Post menopausal women only*

Question 19

management medication :
2- anabolic agents:- anabolic agents promote new bone formation by activation of osteoblasts and bone remodelling as:

Answer 19

1- tetraparaditde; Parathyroid hormone analogue which increases osteoblast activity (and bone formation)

2- strontium : Chemicallysimilar to calcium and replaces calcium in bones – activates osteoblasts and inhibits osteoclasts

3- romosozumab : Newer monoclonal antibody that inhibitssclerostin which is released by osteocytes. This promotes bone formation

Question 20

summary : —— supplementation are the first medications used.—- are next, followed by—- generally.

Answer 20

• vitamin d and calcium
• biophosphonate
• denosumab