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E4 - Integrated Care (M) > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Is osteoporosis common?

A

Yes

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2
Q

What proportion of women over 50 will sustain an osteoporotic fracture in their lifetime?

A

1/3

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3
Q

What % of people with a hip fracture die within a year?

A

33%

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4
Q

What % of people will require help to walk 1 year after a hip fracture?

A

35%

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5
Q

How much do hip fracture cost the NHS per year?

A

£2 billion

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6
Q

How many hip fractures are there per year?

A

75,000

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7
Q

What is osteoporosis defined as?

A

Progressive loss of bone mass associated with changes in bone micro-architecture

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8
Q

What pathological process is osteoporosis linked with?

A

Reduced cross-linking within the trabecular bone, resulting in cortical thinning

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9
Q

What is remodelling?

A

The normal process continually taking place within bone

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10
Q

Why is bone remodelling an essential process?

A

Because it allows bone to adapt to stressors and repair microdamage

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11
Q

What is bone remodelling the net product of?

A

Bone formation and resorption

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12
Q

What is involved in bone remodelling?

A
  • Activation of osteoclasts from circulating precursor-cells
  • Aggregation and adherence of osteoclasts to regions of active bone reabsorption on the trabecular plate
  • Osteoclastic breakdown of bone matrix
  • Simultaneous osteoblastic deposition of osteoid with subsequent mineralisation
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13
Q

What mediates the activation of osteoclasts from circulating precursor cells in bone remodelling?

A

Receptor binding of NF-kappaB (RANK) ligand

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14
Q

What does the osteclastic breakdown of the bone matrix release in bone remodelling?

A
  • Calcium
  • Minerals
  • Active growth factors
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15
Q

What causes mineralisation of newly deposited osteoid in remodelling?

A

Calcium and phosphate deposition

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16
Q

What happens to the remodelling process in post-menopausal women?

A

There is a shift towards bone resorption, leading to net bone loss

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17
Q

What happen to the function of osteoclasts in postmenopausal women?

A

They function in a less regulated manner

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18
Q

What is the result of the osteoclasts functioning in a less regulated manner in postmenopausal women?

A

They perforate through the trabecular plate

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19
Q

What is the result of osteoclasts perforating through the trabecular plate in post-menopausal women?

A

There is no framework for osteoblast activity and structural integrity is lost

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20
Q

What are the risk factors for primary osteoporosis?

A
  • Female gender
  • Previous fragility fracture
  • Maternal history of hip fracture
  • Current smoker
  • Alcohol intake >3 units/day
  • Glucocorticoids >3 months at more than 5mg/day
  • Low calcium and vitamin D deficiency
  • Low BMI
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21
Q

What are the causes of secondary arthritis?

A
  • Rheumatoid arthritis
  • Hyperthyroidism/hyperparathyroidism
  • Premature menopause
  • Chronic malabsorption or malnutrition, e.g. coeliac
  • Chronic liver disease
22
Q

What is the FRAX tool?

A

A free online resource developed WHO to calculate the 10-year fracture risk

23
Q

Why can calculating the 10-year fracture risk be helpful?

A

It can help inform decisions about treatment alongside investigations

24
Q

What investigations are done in osteoporosis?

A
  • Blood tests

- Imaging

25
Q

What blood tests should be done in osteoporosis?

A
  • FBC
  • U&Es
  • LFTs
  • TFT
  • Ca
  • PO4
  • Vitamin D
  • PTH
  • Coeliac serology
  • Myeloma screen
26
Q

What imaging may be done in osteoporosis?

A
  • DEXA scanning

- Whole-spine x-ray

27
Q

What is the gold standard diagnosis to establish a formal diagnosis of osteoporosis?

A

Dual energy X-ray absorptiometry (DEXA) scanning

28
Q

How does DEXA scanning help establish a diagnosis of osteoporosis?

A

By measuring bone mineral density (BMD)

29
Q

What is DEXA scanning reported as?

A
  • T score

- Z score

30
Q

What does the T score correspond to in DEXA scanning for osteoporosis?

A

The number of standard deviations above or below the bone mineral density for an average 25-year

31
Q

What T-score represents osteoporosis?

A

2.5SDs below normal

32
Q

What does the Z-score correspond to in osteoporosis?

A

The number of SDs above or below the bone mineral density in age-matched controls

33
Q

What kind of fractures can DEXA be used to identify?

A

Moderate to severe wedge or compression fractures

34
Q

How can DEXA scanning identify moderate to severe wedge or compression fractures?

A

It can provide morphometric measurements of the individual vertebrae

35
Q

Why might a whole spine x-ray be useful in osteoporosis?

A

Can help identify the presence of asymptomatic fractures

36
Q

What proportion of vertebral fractures in osteoporosis are asymptomatic?

A

1/3

37
Q

What investigation into osteoporosis can be used in specialist clinics?

A

Bone turnover markers such as serum C-terminal telopeptide (CTX) levels

38
Q

What can bone turnover markers be useful for in osteoporosis?

A

To establish compliance and effectiveness of treatment

39
Q

What management should be commenced in all patients with osteoporotic fractures, or at risk of sustaining them?

A

Vitamin D supplementation

40
Q

Is calcium co-administered with vitamin D supplementation in people at risk of osteoporotic fractures?

A

Depends on baseline serum calcium levels and dietary intake

41
Q

What is the mainstay of treatment in osteoporosis?

A

Bisphosphonates

42
Q

What do bisphosphonates do?

A

They inhibit osteoclastic bone reabsorption

43
Q

How does the inhibition of osteoclastic bone reabsorption help in osteoporosis?

A

Because the processes are linked, impaired bone reabsorption results in reduced bone formation and turnover as a whole is reduced

44
Q

How long do patients usually receive bisphosphonates?

A

3-5 years

45
Q

What is the risk of keeping a patient on bisphosphonates for more than 3-5 years?

A

Risk of atypical subtrochanteric fracture and osteonecrosis of the jaw

46
Q

What is required if you want to keep a patient on bisphosphonates for more than 3 years?

A

Reassessment of fracture risk and up to date BMD measurements

47
Q

What BMD measurements would support the continuation of treatment?

A

T score or -2.5, or -2.0 if in conjunction with established vertebral fractures - indicates continued risk of fractures

48
Q

What other drugs may be used for osteoporosis?

A
  • Zolendronic acid
  • Denosumab
  • Raloxifene
  • Teriparatide
49
Q

Give an example of an oral bisphosphate?

A

Alendronate

50
Q

What are the indications for alendronate?

A
  • Fragility fracture >75 years of age

- Post-menopausal women

51
Q

What sites benefit from alendronate?

A
  • Hip
  • Verteral
  • Non-vertebral

E4 - Integrated Care (M) (17 decks)

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