Symposia: Osteoporosis, Nutrition and Fragility Fracture Flashcards
1
Q
What causes people to break their bone?
- specific biological factors
A
- Bone strength is reduced
- Suboptimal peak bone mass
- Reduced bone quality
- Reduced bone Mineral ( Calcium )
- Deteriorating architecture
- Change in crystal size & composition
- Abnormal collagen
- Falls
2
Q
What factors can increase peak bone mass?
A
- Excercise
- Diet
- Sex hormones
- oestrogen deficiency –> osteoporosis
3
Q
What is Osteogenesis Imperfecta?
A
- a genetic defect where collagen (the protein that is responsible for bone structure) is missing, reduced or of low quality, so is not enough to support the minerals in the bone.
4
Q
What factors need to be considered in the history/ examination when considering fracture risks in older people?
A
- Age
- Previous Fracture
- Lightweight ( BMI < 18 )
- Family History
- Smoking
- Alcohol
- Medical Disorders
5
Q
What Medical disorders increase fracture risks?
A
- Osteogenesis imperfecta
- underproduction of collagen
- Cushing’s Syndrome
- treatment with Glucocorticoids/ steroids
- those with Inflammatory conditions
- Rheumatoid nodules
- Rheumatoid arthritis
- Prostate cancer - treatment with Androgen Deprivation Therapy
- low levels of testosterone reduces bone density similar to women going through menopause
- Chronic respiratory disease - treatment with steriods and reduced physical activity
6
Q
What nutritional factors impact bone health?
A
- Cows milk—source of calcium, magnesium, Vitamin D, protein and fat - good ‘bone’ food.
- Soya milk—bioavailability of calcium requires a higher level of fortification than that naturally seen in cows milk. Bioavailability may be compromised in some products.
- Balance of magnesium and calcium important—excess calcium depletes magnesium.
- Protein - diets high in protein can lead to a reduction of calcium but studies
- fractures neck of the Femur indicates improved bone healing in diets with high protein intake. Meta-analysis suggests no benefits from plant sources
- Vitamin D
- PUFA
- Gluten intolerance- gliadin and phytate are linked to reduced calcium absorption
- Phytate creates insoluble complexes with calcium
- Oxalate also inhibits bioavailability
7
Q
How can bone health be managed in osteoporosis?
A
-
Calcium—benefit seen in children in the short term.
- Postmenopausal women no effect on bone density but an effect on bone loss.
- Should be supplemented with Vit D +ve result
-
Vitamin K effect on osteocalcin, protein involved in bone mineralisation, enhances ability to bind calcium
- having a good microbiome in the colon benefits the activity
- Sodium—reduces intake in diey. causes increased calcium urinary loss seen when sodium intake high
- Phyto oestrogens - under investigation, some benefit seen where habitual intakes are high (regularly take soy products
- Strontium—stable strontium in low doses has been shown to increase bone formation and decreases done resorption
- EFA’s ALA [Omega 3] and LA [Omega 6] provide substrates for eicosanoids—prostaglandins, leukotrienes and thromboxanes. Dietary ratio affects bone formation and resorption. Omega 3 (alpha linolenic acid) reduces bone resorpion. Omega 6 (Linoleic acid ) increases bone resorption
8
Q
What is a clear physical sign of vertebral fractures?
A
- having a curved spine
- not often diagnosed presents as chronic back pain
9
Q
What is the traditional diagnosis of Osteoporosis?
A
- when the DXA scan T-score is -2.5 SD below the Bone Mineral Density (BMD) normal adult
10
Q
What are the Bone Health Assessment Tools in the UK?
A
- FRAX score
- calculates 10yr probability of a major osteoporotic fracture or of hip fracture
- Q Fracture Risk Calculator
- Estimates the 1-10 year cumulative incidence of hip or major osteoporotic fracture
11
Q
What significance does the site of a fracture have?
A
- All fragility fractures increase future fracture risk independent of BMD - but some more than others.
- Fractures of the hip and spine carry a higher risk for recurrent fracture than fractures of the distal radius.
- vertebral fractures have a 5-fold increased risk of fracture in the year following
12
Q
What algorithm is used to assess absolute risk using a FRAX
(flow chart pathway)
A
13
Q
What advice on Calcium is given to patients with osteoporosis?
- what are the guidelines for adults and adolescents?
A
- Advised a daily Calcium intake 700mg/d to1200mg/d for prevention and treatment
- If on Bone medicines and cannot obtain dietary >700mgs then supplement (NOGG 2017)
- RNI: 700 mg/d per adult
- 800mg/d(F) to 1000mg/d(M) Adolescents
14
Q
What is the exercise strategy for reducing secondary fractures?
A
- STRONG, STRAIGHT STEADY
- STRONG
- exercise and physical activity that will strengthen bones safely
- STRAIGHT
- moving, lifting and living safely with osteoporosis
- help with pain and posture after spinal fractures
- STEADY
- balance and muscle strength to stop you falling
15
Q
What are treatments for osteoporosis?
- side effects?
A
-
Bisphosphonates
- oral Alendronate, oral Risedronate, oral Ibandronate
- IV Zoledronate
- can be taken annually possibly up to 2 years
- Jaw Osteonecrosis happens in 1/10000 after long term use
- Denosumab - human monoclonal antibody
- Anabolic Treatment- PTH
- Romososumab - human anti-sclerostin recombinant antibody
- Nebido - testosterone injection
