Osteoporosis, nutrition and fragility fractures

Question 1

What is a Fragility ( Low Energy ) Fracture?

Answer 1

A Fracture which occurs without excessive trauma

or follows a fall from standing height or less

Question 2

What is the problem of an ageing population?

Answer 2

More frequent fractures

Question 3

Name some long term consequences of hips fractures

Answer 3

Death
Permanat disability
Unable walk independently
Unable to continue activities of daily living

Question 4

How much do fractures cost per year?

Answer 4

£2billion

Question 5

Why do people break bones?

Answer 5

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

Question 6

Describe fracture prevention in children and adults

Answer 6

Children / Adolescents / Young Adults
Optimize Peak bone Mass
Adults 
Prevent deterioration of bone quality
Prevent falls

Question 7

How do you optimize bone mass

Answer 7

Diet
Exercise
Sex Hormones

Question 8

How do you identify people with a high fracture risk

Answer 8

Increasing Age
Previous Fracture 
Light weight ( BMI < 18 )
Family History of osteoporosis
Smoking
Alcohol
Many medical Disorders

Question 9

How do you predict a frailty fracture?

Answer 9

Steroids > 3 months
65 years
Use Preventative Treatment

Question 10

What are rheumatoid nodules associated with?

Answer 10

Chronic inflammatory conditions

Question 11

List some medical disorders predisposing to osteoporosis

Answer 11

Endocrine disorders
Thyrotoxicosis
Hyperparathyroidism
Pituitary disease
Conditions causing Nutritional Deficiency
Malabsorption conditions
Eating disorders
Alcoholism
Inflammatory conditions
Many chronic general medical conditions

Question 12

What does 1 standard deviation below the BMD for young adults do?

Answer 12

Doubles the risk of fracture

Question 13

What are the objectives of drugs for osteoporosis?

Answer 13

Prevent bone breakdown - Inhibit Osteoclasts

Stimulate Bone Build up - Stimulate Osteoblasts and Modify Osteocyte activity

Prevent all types of fracture

Question 14

Name a class of drug used to treat osteoporosis in both men and women

Answer 14

Bisphosphonates

Question 15

What is the function of bisphosphonates

Answer 15

Inhibit Osteoclast action

by inhibiting an important enzyme

Question 16

Name some Oral Nitrogen Containing Bisphosphonates

Answer 16

Prevent Hip & Spine fracture 
-  Generic Alendronate  ( weekly )
 - Generic Risedronate   ( weekly )
Prevention of spine fracture only
 Ibandronate  ( monthly )

Question 17

How to Take Alendronate, Risedronate & oral Ibandronate

Answer 17

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

Question 18

What can alendronate cause?

Answer 18

Contact stomatitis

Oesophageal ulcer

Question 19

What is denosumab?

Answer 19

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

Question 20

Describe anabolic treatment for osteoporosis

Answer 20

Daily s/c Injection
Pulse of PTH
Anabolic to bone
Reduces  Fractures
Vertebral
Non-vertebral

Question 21

Describe fracture prevention

Answer 21

EXERCISE – bone build 
FALLS PREVENTION
Identify risk of…
Education
Posture & balance classes

Question 22

What can happen if fractures are ignored?

Answer 22

Can get progressively worse

Question 23

What causes 95% of hip fractures?

Answer 23

falls

Question 24

What is the personal impact of fractures

Answer 24

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

Question 25

What do physiotherapy do?

Answer 25

Improve gait and balance