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Module 204 MSK & Immune system > Osteoporosis symposium > Flashcards

Osteoporosis symposium Flashcards

1
Q

What is a radiographic fracture?

A

Silent fracture that is only found on X-ray

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2
Q

What are the reasons for broken bones?

A

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

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3
Q

How can bone quality be reduced?

A

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

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4
Q

How can fractures be prevented?

A

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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5
Q

How can we identify fracture risk in the elderly?

A 
History and examination
Increasing age
Previous fracture
Light weight (BMI 18)
Family history of osteoporosis 
Smoking
Alcohol
Many medical disorders
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6
Q

What disorders can increase fracture risk?

A 
Cushing's syndrome
Chronic inflammatory conditions 
Prostate cancer
Endocrine disorders:
- thyrotoxicosis
- hyperparathyroidism
- pituitary disease
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7
Q

What types of nutritional deficiency can increase fracture risk?

A

Malabsorption conditions
Eating disorders
Alcoholism

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8
Q

Why can prostate cancer increase fracture risk?

A

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

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9
Q

What technology can be used to predict risk?

A

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

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10
Q

What are the objectives for drug treatment?

A

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

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11
Q

What do bisphosphonates do?

A

Inhibit osteoclast activity by inhibiting important enzyme

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12
Q

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

A

Alendronate

Risedronate

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13
Q

What bisphosphonates will only prevent spine fractures?

A

Ibandronate

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14
Q

How should bisphosphonates be taken?

A

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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15
Q

What are the rare side effects of bisphosphonates?

A

Jaw osteonecrosis

Atypical femoral shaft fracture

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16
Q

What is denosumab?

A 
Fully human monoclonal antibody - IgG2 isotope
Binds to RANK ligand
- decoy receptor
- high affinity
- high specificity 
- no complement activation
17
Q

How is denosumab cleared?

A

By the reticuloendoethlial system

No renal excretion

18
Q

What is the anabolic treatment of osteoporosis?

A

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

19
Q

What is raloxifene?

A

Selective oestrogen receptor modulator

20
Q

How can hypogonadism in men be treated?

A

Tostran

Nebido

21
Q

What dietary components are needed to maximise bone health?

A 
Dairy products
- cow's milk
- soya milk
Magnesium & calcium
Protein intake
Vitamin D
PUFA
Gluten intolerance
Phytate
Oxalate
22
Q

Why is protein intake important for bone health?

A

Excess protein leads to a reduction of calcium

Improve bone healing in diets with high protein intake

23
Q

Describe the absorption of vitamin D

A

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

24
Q

Why is PUFA important in maximising bone health?

A

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

25
Q

What are the objectives when managing osteoporosis?

A

Maximise bone mass
Reduce bone loss
Encourage new bone growth

26
Q

How is osteoporosis managed?

A 
Supplement with vitamin D
Calcium
Vitamin K
Sodium
Phyto-oestrogens
Strontium
EFA's ALA (omega 3) & LA (omega 6)
27
Q

What effect does sodium intake have on bone health?

A

High sodium intake leads to increased calcium loss in urine

28
Q

What effect does vitamin K have on bone health?

A

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

29
Q

What effect does omega 3 have on bone reabsorption?

A

Reduces reabsorption

30
Q

What effect does omega 6 have on bone reabsorption?

A

Increases reabsorption

31
Q

What is the overall dietary advice for managing osteoporosis?

A 
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
32
Q

What is the objectives of physiotherapy in managing fractures?

A

Decrease pain
Increase confidence
Increase function
Decrease risk of further fracture

33
Q

What are the impacts of fractures?

A 
Pain
Social - isolation 
Family
Depression
Body image
Sleep deprivation
General health - bowel, urine, swallowing, breathing
34
Q

What does physiotherapy provide?

A 
Assurance
Relaxation
Education
Empower patient, increase confidence
Pain relief 
Hydrotherapy
Walking aids
Exercise classes
Spinal supports
Referrals
35
Q

What are the goals when prescribing exercise?

A

Decrease pain
Decrease falls
Increase bone loading

36
Q

What are some examples of weight bearing exercise?

A 
Jogging
Aerobics
Racquet sports
Tennis
Dancing
Stair climbing
30 min, 5X week
37
Q

What are some examples of strength training exercise?

A 
Weights 
Therabands
Resistance exercises
Back reconditioning classes
Pilates
38
Q

How can exercise prevent falls?

A

Posture
Flexibility
Co-ordination
Balance

Module 204 MSK & Immune system (44 decks)

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