Osteoporosis symposium Flashcards by Olivia Tolson

What is a radiographic fracture?

Silent fracture that is only found on X-ray

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What are the reasons for broken bones?

Bone strength is reduced
- suboptimal peak bone mass
- reduced bone quality
They fall

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How can bone quality be reduced?

Reduced bone mineral (calcium)
Deteriorating architecture
Change in crystal size and composition
Abnormal collagen

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How can fractures be prevented?

Optimise peak bone mass in children, adolescents and young adults
Prevent deterioration of bone quality in adults
Prevent falls in adults
Identify elderly at high risk

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How can we identify fracture risk in the elderly?

History and examination
Increasing age
Previous fracture
Light weight (BMI 18)
Family history of osteoporosis 
Smoking
Alcohol
Many medical disorders

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What disorders can increase fracture risk?

Cushing's syndrome
Chronic inflammatory conditions 
Prostate cancer
Endocrine disorders:
- thyrotoxicosis
- hyperparathyroidism
- pituitary disease

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What types of nutritional deficiency can increase fracture risk?

Malabsorption conditions
Eating disorders
Alcoholism

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Why can prostate cancer increase fracture risk?

Prostate cancer is often treated with long-acting GnRH analogues which lower testosterone leading to loss of bone density

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What technology can be used to predict risk?

DEXA scan
Peripheral measurements to predict fracture
Heel ultrasound scanning device
WHO FRAX Risk calculator

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What are the objectives for drug treatment?

Prevent bone breakdown - inhibit osteoclasts
Stimulate bone build up
- stimulate osteoblasts
- modify osteocyte activity

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What do bisphosphonates do?

Inhibit osteoclast activity by inhibiting important enzyme

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What bisphosphonates can be given to prevent hip and spine fractures?

Alendronate

Risedronate

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What bisphosphonates will only prevent spine fractures?

Ibandronate

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How should bisphosphonates be taken?

In the morning with full glass of water and standing up
No food for 30min as this inhibits absorption
Can cause contact stomatitis or oesophageal ulcer if taken incorrectly

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What are the rare side effects of bisphosphonates?

Jaw osteonecrosis

Atypical femoral shaft fracture

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What is denosumab?

Fully human monoclonal antibody - IgG2 isotope
Binds to RANK ligand
- decoy receptor
- high affinity
- high specificity 
- no complement activation

How is denosumab cleared?

By the reticuloendoethlial system

No renal excretion

What is the anabolic treatment of osteoporosis?

S/C PTH 1-34 (teriparaide)
Abaloparatide - PTH / PtHRP analogue
Rososumab - antisclerostin antibody, increases Wnt signalling in bone

What is raloxifene?

Selective oestrogen receptor modulator

How can hypogonadism in men be treated?

Tostran

Nebido

What dietary components are needed to maximise bone health?

Dairy products
- cow's milk
- soya milk
Magnesium &amp; calcium
Protein intake
Vitamin D
PUFA
Gluten intolerance
Phytate
Oxalate

Why is protein intake important for bone health?

Excess protein leads to a reduction of calcium

Improve bone healing in diets with high protein intake

Describe the absorption of vitamin D

1st hydroxylation occurs in liver
- vit D –> 25-hydroxyvitamin D (calcidiol)
2nd hydroxylation occurs in kidney
- 25-hydroxyvitamin D –> 1,25-dihydroxyvitamin D

Why is PUFA important in maximising bone health?

Ratio of N6-N3 is important
N6 is pro-inflammatory & can impact bone health
N3 can increase PGE3 concentration and metabolic acidosis

What are the objectives when managing osteoporosis?

Maximise bone mass Reduce bone loss Encourage new bone growth

How is osteoporosis managed?

``` Supplement with vitamin D Calcium Vitamin K Sodium Phyto-oestrogens Strontium EFA's ALA (omega 3) & LA (omega 6) ```

What effect does sodium intake have on bone health?

High sodium intake leads to increased calcium loss in urine

What effect does vitamin K have on bone health?

Effect on osteocalcin which is the protein involved in bone mineralisation. Enhances ability to bind calcium

What effect does omega 3 have on bone reabsorption?

Reduces reabsorption

What effect does omega 6 have on bone reabsorption?

Increases reabsorption

What is the overall dietary advice for managing osteoporosis?

``` Avoid fizzy drinks Reduce intake of grains and protein Increase intake of fruits and vegetables Increase intake of N3 EFA found in fish and veg Calcium ```

What is the objectives of physiotherapy in managing fractures?

Decrease pain Increase confidence Increase function Decrease risk of further fracture

What are the impacts of fractures?

``` Pain Social - isolation Family Depression Body image Sleep deprivation General health - bowel, urine, swallowing, breathing ```

What does physiotherapy provide?

``` Assurance Relaxation Education Empower patient, increase confidence Pain relief Hydrotherapy Walking aids Exercise classes Spinal supports Referrals ```

What are the goals when prescribing exercise?

Decrease pain Decrease falls Increase bone loading

What are some examples of weight bearing exercise?

``` Jogging Aerobics Racquet sports Tennis Dancing Stair climbing 30 min, 5X week ```

What are some examples of strength training exercise?

``` Weights Therabands Resistance exercises Back reconditioning classes Pilates ```

How can exercise prevent falls?

Posture Flexibility Co-ordination Balance