Osteoporosis symposium Flashcards
What is a radiographic fracture?
Silent fracture that is only found on X-ray
What are the reasons for broken bones?
Bone strength is reduced
- suboptimal peak bone mass
- reduced bone quality
They fall
How can bone quality be reduced?
Reduced bone mineral (calcium)
Deteriorating architecture
Change in crystal size and composition
Abnormal collagen
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
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
What disorders can increase fracture risk?
Cushing's syndrome Chronic inflammatory conditions Prostate cancer Endocrine disorders: - thyrotoxicosis - hyperparathyroidism - pituitary disease
What types of nutritional deficiency can increase fracture risk?
Malabsorption conditions
Eating disorders
Alcoholism
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
What technology can be used to predict risk?
DEXA scan
Peripheral measurements to predict fracture
Heel ultrasound scanning device
WHO FRAX Risk calculator
What are the objectives for drug treatment?
Prevent bone breakdown - inhibit osteoclasts
Stimulate bone build up
- stimulate osteoblasts
- modify osteocyte activity
What do bisphosphonates do?
Inhibit osteoclast activity by inhibiting important enzyme
What bisphosphonates can be given to prevent hip and spine fractures?
Alendronate
Risedronate
What bisphosphonates will only prevent spine fractures?
Ibandronate
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
What are the rare side effects of bisphosphonates?
Jaw osteonecrosis
Atypical femoral shaft fracture
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 & 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
