Osteoprosis Flashcards
What is osteoporosis
Skeletal disorder, loss of bone mass and deterioration of the bone tissue
Increase in bone fragility and porous bones
What are the symptoms of OP
Increase risk of fractures
Loss of height
Won’t have pain ( if so it’s something else)
What are the risk factors of OP
Woman
Age
Repeated steroid use
Underweight
Early menopause
Lifestyle (alcohol, smoking, immobility)
Inflammatory conditions
Eating disorders
What drugs increase the risk of OP
Corticosteroids
PPI
Anti epileptics
Anti depressants SSRI
Cancer drugs aromatase inhibitor
What are the most common areas of OP fractures
Hip
Wrist
Spine
What is the patho of osteoporosis menopause
Decreased serum estrogen
Increased IL1, IL6, TNF levels
Increased expression of RANK, RANKL
Increased osteoclast activity
What is the patho of osteoporosis aging
Decreased replicative activity of osteoprogenitor cells
Decreased synthetic activity of osteoblasts
Decreased biological activity of matrix bound growth factors
Reduces physical activity
What are osteoblast cells in the bone and what do they do
Active bone - forming cells that produce collagenase bone matrix
Secrete enzyme alkaline phosphates
Promotes deposition of calcium phosphate salts in the matrix to calcify the bone
What are osteocytes cells in the bone and what do they do
Osteoblasts become incorporated within the bone and transform into mature bone cells called osteocytes
What are osteoclasts in the bone and what do they do
Bone reabsorption
Remove bone matrix by phagocytosis, dissolve the bone salts and release calcium and phosphate ions in circulation
RANKL activates osteoclasts
What is the diagnosis for OP
FRAX to calculate fracture risk
Z & T scores
T score -1 and -2.5 osteopenia
Less that -2.5 osteoporosis
DEXA scan
Bone mineral density test (BMD)
Every 5 years
What are the treatments for OP
1st line alendronic acid/ risedronate (if alendronic not tolerated)
Teriparatide
Denosumab
Zoledronic
What is the lifestyle advice for OP
Stop smoking
Drink within limits
Healthy weight (frail =weight gain)
Reasonable exercise
Calcium and vitamin D RX
What is the interaction between calcium sups and oral BPs
Reduced clinical effect of alendronic acid and risedrone
Why are drug holidays needed?
Bisphophates long term increase risks of atypical fracture and ONJ (use for up to 5 years)
When would you prescribe calcium and vitamin D?
Consider all patients on medication (NOT teriparatide)
Particularly Rx if calcium intake is poor / housebound
