Osteoporosis Flashcards

1
Q

In which patients is osteoporosis most common?

A

In postmenopausal women and those taking long-term corticosteroid therapy.

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2
Q

What are some risk factors for the development of osteoporosis?

A

Low body weight, smoking, excess alcohol intake, lack of physical activity, family history, early menopause.

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3
Q

What should those at risk of osteoporosis do to minimise their risks?

A

Maintain adequate calcium and vitamin D intake. When using corticosteroids, use the lowest effective dose for the shortest duration.

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4
Q

Describe the physiological action of calcitonin.

A

Decreases blood calcium levels and is involved with parathyroid hormone in the regulation of bone turnover and the maintenance of calcium balance.

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5
Q

What is teriparatide and how is it used?

A

It is a recombinant form of PTH. Intermittent use activated osteoblasts, leading to an overall increase in bone.

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6
Q

What is the physiological action of cinacalcet?

A

Sensitises Ca2+ receptors of the parathyroid gland, reducing PTH levels.

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7
Q

What is denosumab and what is its physiological actions?

A

It is a human monoclonal antibody. It inhibits osteoclast formation, function, and survival, thereby decreasing bone reabsorption.

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8
Q

What do osteoblasts do?

A

Build up bones - Blasts Build.

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9
Q

What do osteoclasts do?

A

Break down bones - Clasts Consume.

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10
Q

Give some examples of bisphosphonates.

A

Alendronate (alendronic acid), risedronate, ibendronic acid.

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11
Q

What is the mechanism of action of the bisphosphonates?

A

They are absorbed onto growing bone crystals and slow down the rate of bone turnover.

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12
Q

What is one of the main risks associated with the use of bisphosphonates?

A

Osteonecrosis of the jaw (phossy jaw).

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13
Q

There is a greater risk of osteonecrosis of the jaw when bisphosphonates are administered by which route?

A

IV.

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14
Q

What monitoring and management should patients on bisphosphonates receive to minimise the risk/impact of osteonecrosis of the jaw?

A

Dental checks before treatment, routine dental check-ups, maintain good oral hygiene, report any oral symptoms such as pain, swelling, dental mobility, non-healing sores, discharge. Report to doctor or dentist.

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15
Q

There is a rare risk of atypical femoral fractures in which patients on bisphosphonates?

A

Patients on long term treatment.

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16
Q

What potential symptoms of atypical femoral fracturs should patients on bisphosphonates be advised to report?

A

Thigh, hip, or groin pain.

17
Q

There is a very rare risk of benign idiopathic osteonecrosis of the external auditory canal when using bisphosphonates. What signs of this should patients be advised to report?

A

Ear pain, ear discharge, ear infection during treatment with bisphosphonates.

18
Q

What is the mechanism of action of strontium ranelate?

A

Stimulates bone formation and reduces bone reabsorption.

19
Q

What are the cautions for the use of strontium ranelate?

A

Increased risk of serious cardiovascular disease, including MI. Assess risk before treatment and regularly throughout.

20
Q

Severe allergic reactions including drug rash with eosinophilia and systemic symptoms (DRESS) have been reported with the use of strontium ranelate. What are the symptoms of DRESS?

A

DRESS starts with fever, rash, swollen glands and increased white cell count. It can also affect the liver, kidneys and lungs. DRESS can be fatal.

21
Q

What should be done if DRESS is suspected when using strontium ranelate?

A

Treatment should be discontinued and the GP should be contacted immediately.

22
Q

When should strontium ranelate be taken?

A

Avoid food for 2 hours before and after taking granules, especially calcium-containing products such as milk and antacids containing aluminium and magnesium hydroxides.