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Lecture Notes - Endocrinology > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is important in the prevention of fatigue damage and the maintenance of calcium homeostasis

A

bone remodelling and resorption

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2
Q

What are the three phases of bone remodelling

A

Resorption
Reversal
Formation

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3
Q

What happens during resorption

A

osteoclasts remove matrix and mineral on the trabecular surface or within the cortical bone

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4
Q

What happens during reversal

A

mononuclear cells, possibly of monocyte/ macrophage lineage, appear on the bone surface and may provide signals for osteoblast differentiation and migration.
A layer of glycoprotein-rich material is laid down on the resorbed surface to which the new osteoblasts can adhere

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5
Q

What happens during formation

A

Osteoblasts lay down bone to replace resorbed bone

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6
Q

What is the factor that osteoblasts express and what does it do

A

RANKL
it interacts with a receptor on osteoclast precursors called RANK resulting tin the activation and differentiation of osteoclasts

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7
Q

What is osteoporosis

A

Skeletal disease characterised by reduced bone mass and micro architectural deterioration, resulting in increased bone fragility and fracture risk

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8
Q

How many women are affected and how many men are affected worldwide

A

1 in 3 women

1 in 8 men

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9
Q

What i osteoporosis characterised by

A

increased bone turnover

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10
Q

When is the maximum bone mineral density (peak bone mass)

A

achieved by the age of 30-40

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11
Q

Where do osteoporosis-related fractures associated with minor trauma tend to occur

A

at sites comprising more than 50% trabecular bone

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12
Q

Where are the sites comprising more than 50% trabecular bone

A

vertebral bodies - backache that subsides after 3 months
Proximal femur - mortality is increased by 20% in the first year
Distal radius - Colles’ fracture

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13
Q

How is bone mineral density measured

A

using dual-energy X Ray absorptiometry (DEXA)

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14
Q

What does the T score mean

A

it compares the patient\s BMD with that of a young reference population
A T score of -2.5 or less is osteoporosis in healthy postmenopausal women and men aged 50+

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15
Q

What T score is used for a diagnosis of osteoporosis

A

the lowest of the lumbar spine, proximal femur or distal radius

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16
Q

What is osteopenia

A

When a patent has a T score of -2.5 - -1.0

17
Q

What does the Z score do

A

it compared the patients BMD to that of an age-matched reference population
Z scores should be used for premenopausal women and men under 50

18
Q

What are the main aims of treatment

A

alleviation of symptoms (analgesics)
Reduction of the risk of further fractures
Treatment of the underlying cause (leads to a partial recovery of bone mass)

19
Q

What should all patients with a low BMD receive

A

adequate calcium and vitamin D supplementation

Advice regarding lifestyle modifications

20
Q

What are some lifestyle modifications that are useful for patients with a low BMD

A

weight bearing exercise
smoking cessation
avoidance of excess alcohol
fall prevention counselling

21
Q

What can be used to calculate the 10 year probability of hip fracture and major osteoporotic fracture

A

FRAX calculator

22
Q

What is an alternative therapy for those that can’t tolerate bisphosphonates

A

strontium ranelate or raloxifene

23
Q

Name 2 bisphosphonates often used as first line therapy

A

Alendronate or risedronate

24
Q

How should bisphospohonated be taken

A

once weekly
with a full glass of water half an hour before breakfast to help absorption
do not lie down for 30 minutes after taking

25
Q

What do bisphosphonates do

A

prevent fracture of the hip, spine and forearm

26
Q

What is the treatment for men with osteoporosis and hypogonadism

A

testosterone replacement therapy

27
Q

What is the aim of preventing osteoporosis

A

maximise peak bone mass and reduce the rate of bone loss

28
Q

What are some preventative measures of osteoporosis

A

Adequate calcium and vitamin D intake
regular weight bearing exercise
avoidance of smoking and alcohol

29
Q

What might be useful in predicting the rate of future bone loss

A

markers of bone turnover

30
Q

How often should a patient with osteoporosis be followed up

A

most guidelines recommend a follow-up DEXA scan 1 year after stating treatment
Then a DEXA scan after 2 -3 years

31
Q

What might a decrease of less than 40 % be due to

A

Non-compliance or poor absorption

32
Q

If a patient is receiving PTH treatment, what should be measured during the course of treatment

A

Srum calcium
renal function
uric acid prior to initiation of therapy

33
Q

What drug should be considered in patients with a T score less than -2.5 and at least one fragility fracture who do not tolerate bisphosphonates

A

Teriparatide

Lecture Notes - Endocrinology (40 decks)

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