Osteoporosis Management Flashcards
what biochemistry investigations should be done in osteoporosis
U+Es, LFTs, Bone biochemistry, FBC, plasma volume, TSH
what lifestyle management advice should be given to osteoporosis patients
high intensity strength training, low-impact weight bearing exercise, avoidance excess alcohol and smoking, fall prevention
what dietary advice should be given to osteoporosis patients
700mg Ca2+(2-3 portions dairy food), 1000mg for post menopause women,
what osteoporosis patients should intervention therapy be aimed at
those at high risk of low impact fracture
what drug treatments are used for osteoporosis
Ca2+ and Vit D supplement, Bisphosphonates, Denosumab, Teriparatide, Romosozumab
when would Ca2+ and Vit D supplements be considered in osteoporosis treatment
reduce risk of non-vertebral fractures in patients risk of deficiency due to insufficient dietary intake or limited sunlight exposure
what type of drugs are bisphosphonates, and give 2 examples
anti-resorptive agents
examples = alendronate and risendronate
what are the benefits of bisphosphonates in osteoporosis
prevent bone loss at all vulnerable sites, reduce risk of hip and spine fractures
describe how bisphosphonates work to act against osteoporosis
ingested by osteoclasts leading to cell death thereby inhibiting bone resorption, filling of resorption sites by bone increases BMD(5-8%)
how long should bisphosphonate treatment last
good data of benefit for 5 years, 10 years if vertebral fracture
what are some long term consequences of bisphosphonates
osteonecrosis of the jaw, oesophageal Ca2+, atypical fractures
describe the use of Zoledronic Acid for osteoporosis
once yearly IV infusion for 3 years, 70% reduction vertebral fractures 40% hip fractures
what is the main side effect of Zoledronic Acid and how is it treated
1/3 have acute phase reaction to first infusion, treated with paracetamol
describe the mechanism of action of Denosumab
fully human monoclonal antibody that targets and binds with high affinity RANKL, prevents activation of its receptor
what is the effect of Denosumab in osteoporosis
inhibiting development of activity of osteoclasts, decreasing bone resorption and increasing bone density
(reduces risk of fractures)
what is teriparatide and what effect does it have in osteoporosis
it is recombinant parathyroid hormone, stimulates bone growth rather than reducing bone loss(anabolic agent)
what is the mechanism of action of Romosozumab
monoclonal antibody that binds to and inhibits sclerostin (which is secreted by mature osteocytes and inhibits bone formation)
what effect does Romosozumab have on osteoporosis
increases bone formation and reduces bone resorption
when is teriparatide recommended for osteoporosis
in postmenopausal women with severe osteoporosis
when is Romosozumab recommended for osteoporosis
postmenopausal women with severe osteoporosis who have had fragility fracture and imminent risk of another
what are the direct effects of corticosteroids on bone
reduction osteoblast activity, suppression of replication of osteoblast production, reduction Ca absorption
what are the indirect effects of corticosteroids on bone
inhibition of gonadal and adrenal steroid production
