Osteoporosis Management

Question 1

what biochemistry investigations should be done in osteoporosis

Answer 1

U+Es, LFTs, Bone biochemistry, FBC, plasma volume, TSH

Question 2

what lifestyle management advice should be given to osteoporosis patients

Answer 2

high intensity strength training, low-impact weight bearing exercise, avoidance excess alcohol and smoking, fall prevention

Question 3

what dietary advice should be given to osteoporosis patients

Answer 3

700mg Ca2+(2-3 portions dairy food), 1000mg for post menopause women,

Question 4

what osteoporosis patients should intervention therapy be aimed at

Answer 4

those at high risk of low impact fracture

Question 5

what drug treatments are used for osteoporosis

Answer 5

Ca2+ and Vit D supplement, Bisphosphonates, Denosumab, Teriparatide, Romosozumab

Question 6

when would Ca2+ and Vit D supplements be considered in osteoporosis treatment

Answer 6

reduce risk of non-vertebral fractures in patients risk of deficiency due to insufficient dietary intake or limited sunlight exposure

Question 7

what type of drugs are bisphosphonates, and give 2 examples

Answer 7

anti-resorptive agents

examples = alendronate and risendronate

Question 8

what are the benefits of bisphosphonates in osteoporosis

Answer 8

prevent bone loss at all vulnerable sites, reduce risk of hip and spine fractures

Question 9

describe how bisphosphonates work to act against osteoporosis

Answer 9

ingested by osteoclasts leading to cell death thereby inhibiting bone resorption, filling of resorption sites by bone increases BMD(5-8%)

Question 10

how long should bisphosphonate treatment last

Answer 10

good data of benefit for 5 years, 10 years if vertebral fracture

Question 11

what are some long term consequences of bisphosphonates

Answer 11

osteonecrosis of the jaw, oesophageal Ca2+, atypical fractures

Question 12

describe the use of Zoledronic Acid for osteoporosis

Answer 12

once yearly IV infusion for 3 years, 70% reduction vertebral fractures 40% hip fractures

Question 13

what is the main side effect of Zoledronic Acid and how is it treated

Answer 13

1/3 have acute phase reaction to first infusion, treated with paracetamol

Question 14

describe the mechanism of action of Denosumab

Answer 14

fully human monoclonal antibody that targets and binds with high affinity RANKL, prevents activation of its receptor

Question 15

what is the effect of Denosumab in osteoporosis

Answer 15

inhibiting development of activity of osteoclasts, decreasing bone resorption and increasing bone density
(reduces risk of fractures)

Question 16

what is teriparatide and what effect does it have in osteoporosis

Answer 16

it is recombinant parathyroid hormone, stimulates bone growth rather than reducing bone loss(anabolic agent)

Question 17

what is the mechanism of action of Romosozumab

Answer 17

monoclonal antibody that binds to and inhibits sclerostin (which is secreted by mature osteocytes and inhibits bone formation)

Question 18

what effect does Romosozumab have on osteoporosis

Answer 18

increases bone formation and reduces bone resorption

Question 19

when is teriparatide recommended for osteoporosis

Answer 19

in postmenopausal women with severe osteoporosis

Question 20

when is Romosozumab recommended for osteoporosis

Answer 20

postmenopausal women with severe osteoporosis who have had fragility fracture and imminent risk of another

Question 21

what are the direct effects of corticosteroids on bone

Answer 21

reduction osteoblast activity, suppression of replication of osteoblast production, reduction Ca absorption

Question 22

what are the indirect effects of corticosteroids on bone

Answer 22

inhibition of gonadal and adrenal steroid production