Osteoporosis, nutrition and fragility fractures Flashcards
What is a Fragility ( Low Energy ) Fracture?
A Fracture which occurs without excessive trauma
or follows a fall from standing height or less
What is the problem of an ageing population?
More frequent fractures
Name some long term consequences of hips fractures
Death
Permanat disability
Unable walk independently
Unable to continue activities of daily living
How much do fractures cost per year?
£2billion
Why do people break bones?
Bone strength is reduced - Sub optimal peak bone mass, Reduced bone quality, Reduced bone Mineral ( Calcium ), Deteriorating architecture, Change in crystal size & composition, Abnormal collagen
Describe fracture prevention in children and adults
Children / Adolescents / Young Adults Optimize Peak bone Mass Adults Prevent deterioration of bone quality Prevent falls
How do you optimize bone mass
Diet
Exercise
Sex Hormones
How do you identify people with a high fracture risk
Increasing Age Previous Fracture Light weight ( BMI < 18 ) Family History of osteoporosis Smoking Alcohol Many medical Disorders
How do you predict a frailty fracture?
Steroids > 3 months
65 years
Use Preventative Treatment
What are rheumatoid nodules associated with?
Chronic inflammatory conditions
List some medical disorders predisposing to osteoporosis
Endocrine disorders Thyrotoxicosis Hyperparathyroidism Pituitary disease Conditions causing Nutritional Deficiency Malabsorption conditions Eating disorders Alcoholism Inflammatory conditions Many chronic general medical conditions
What does 1 standard deviation below the BMD for young adults do?
Doubles the risk of fracture
What are the objectives of drugs for osteoporosis?
Prevent bone breakdown - Inhibit Osteoclasts
Stimulate Bone Build up - Stimulate Osteoblasts and Modify Osteocyte activity
Prevent all types of fracture
Name a class of drug used to treat osteoporosis in both men and women
Bisphosphonates
What is the function of bisphosphonates
Inhibit Osteoclast action
by inhibiting an important enzyme
Name some Oral Nitrogen Containing Bisphosphonates
Prevent Hip & Spine fracture - Generic Alendronate ( weekly ) - Generic Risedronate ( weekly ) Prevention of spine fracture only Ibandronate ( monthly )
How to Take Alendronate, Risedronate & oral Ibandronate
Take In the morning With a full glass of water Standing up Do not lie down after No food for 30 minutes Food inhibits absorption
What can alendronate cause?
Contact stomatitis
Oesophageal ulcer
What is denosumab?
Fully human monoclonal antibody
IgG2 isotype Binds to RANK Ligand Decoy Receptor High affinity High specificity No complement activation
Rapidly absorbed Long half-life 26 days ( 34 days with max dose ) 6 monthly injection Cleared by Reticuloendothelial system No renal excretion Reduces spine & Hip Fractures
Describe anabolic treatment for osteoporosis
Daily s/c Injection Pulse of PTH Anabolic to bone Reduces Fractures Vertebral Non-vertebral
Describe fracture prevention
EXERCISE – bone build FALLS PREVENTION Identify risk of… Education Posture & balance classes
What can happen if fractures are ignored?
Can get progressively worse
What causes 95% of hip fractures?
falls
What is the personal impact of fractures
Role in society / family
Unable to drive
Carer
Decrease confidence
Isolation = depression = decrease activity levels = poor physical recovery
Effect of long hospital stay
Can age someone very quickly
What do physiotherapy do?
Improve gait and balance
