Osteoporosis Flashcards
In which patients is osteoporosis most common?
In postmenopausal women and those taking long-term corticosteroid therapy.
What are some risk factors for the development of osteoporosis?
Low body weight, smoking, excess alcohol intake, lack of physical activity, family history, early menopause.
What should those at risk of osteoporosis do to minimise their risks?
Maintain adequate calcium and vitamin D intake. When using corticosteroids, use the lowest effective dose for the shortest duration.
Describe the physiological action of calcitonin.
Decreases blood calcium levels and is involved with parathyroid hormone in the regulation of bone turnover and the maintenance of calcium balance.
What is teriparatide and how is it used?
It is a recombinant form of PTH. Intermittent use activated osteoblasts, leading to an overall increase in bone.
What is the physiological action of cinacalcet?
Sensitises Ca2+ receptors of the parathyroid gland, reducing PTH levels.
What is denosumab and what is its physiological actions?
It is a human monoclonal antibody. It inhibits osteoclast formation, function, and survival, thereby decreasing bone reabsorption.
What do osteoblasts do?
Build up bones - Blasts Build.
What do osteoclasts do?
Break down bones - Clasts Consume.
Give some examples of bisphosphonates.
Alendronate (alendronic acid), risedronate, ibendronic acid.
What is the mechanism of action of the bisphosphonates?
They are absorbed onto growing bone crystals and slow down the rate of bone turnover.
What is one of the main risks associated with the use of bisphosphonates?
Osteonecrosis of the jaw (phossy jaw).
There is a greater risk of osteonecrosis of the jaw when bisphosphonates are administered by which route?
IV.
What monitoring and management should patients on bisphosphonates receive to minimise the risk/impact of osteonecrosis of the jaw?
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.
There is a rare risk of atypical femoral fractures in which patients on bisphosphonates?
Patients on long term treatment.
What potential symptoms of atypical femoral fracturs should patients on bisphosphonates be advised to report?
Thigh, hip, or groin pain.
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?
Ear pain, ear discharge, ear infection during treatment with bisphosphonates.
What is the mechanism of action of strontium ranelate?
Stimulates bone formation and reduces bone reabsorption.
What are the cautions for the use of strontium ranelate?
Increased risk of serious cardiovascular disease, including MI. Assess risk before treatment and regularly throughout.
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?
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.
What should be done if DRESS is suspected when using strontium ranelate?
Treatment should be discontinued and the GP should be contacted immediately.
When should strontium ranelate be taken?
Avoid food for 2 hours before and after taking granules, especially calcium-containing products such as milk and antacids containing aluminium and magnesium hydroxides.
