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intro to biomedical sciences IBMS > Bisphosphonates and Bone > Flashcards

Bisphosphonates and Bone Flashcards

why and how does bone remodel? how do antiresorptives work? what are the problems? how is this relevant to dentistry?

1
Q

what is bone composed of

A

water-10%
collagen-20%
mineral-70%

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2
Q

what minerals are found in bone

A

hydroxyapatite/Ca5(PO4)3(OH)

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3
Q

what are cortical bones comprised of

A

a basic unit called an osteon which goes the entire length of the bone

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4
Q

what does the osteon contain

A

concentric rings of bone tissues

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5
Q

why is the bone tissue strong

A

because of the arrangement of the collagen fibre and minerals are in different directions which means it can resist stress in different directions

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6
Q

what is contained inside a osteon

A 
lacunae containing osteocytes 
blood vessels 
haversian canal 
lamellae 
canaliculi
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7
Q

which cells take away bone

A

osteoCLAST

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8
Q

which cells remake bone

A

osteoBLAST

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9
Q

how do the osteoblasts and osteoclasts communicate with one another

A

by negative and positive feedback reactions

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10
Q

which hormones are involved in balancing bone absorption and bone formation

A

parathyroid hormone

oestrogen

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11
Q

what happens if you have hyperparathyroidism

A

dissolves bones

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12
Q

what can people with parathyroid tumours have

A

weak bones and can have high blood calcium levels

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13
Q

what other chemicals are involved in bone homeostasis

A

cytokines- inflammation
tumour factors- influences bone homeostasis
RANK-L inhibitors are more commonly prescribed and more patients take them
OPG-

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14
Q

what does RANK-L stand for

A

Receptor activator for nuclear factor kappa B ligand

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15
Q

what is a common drug which is a RANK-L inhibitor

A

denosumab- for the treatment of osteoporosis treatment-induced bone loss, metastases to bone,and giant cell tumor of bone

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16
Q

what is OPG

A

OsteoProtegerin

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17
Q

what are the stages of bone homeostasis

A
  1. the osteoblasts secrete RANK-L AND OPG
  2. the osteoclast has a receptor for the OPG molecule and the OPG has a receptor for RANK-L
    3.
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18
Q

what happens if rank-l and opg are working well

A

you get the same amount of bone formation and resorption

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19
Q

what happens if the osteoblast is only secreting RANK-L

A

we get osteoclast simulation- this is why a rank-l inhibitor may be helpful

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20
Q

what is the issue with bone homeostasis

A

can go wrong-
usually occurs with age naturally
also can be because of disease process- eg osteoporosis

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21
Q

what is osteoporosis

A

pores forming in the bone- not as much bone and the remaining bone is not as well calcified meaning it is weak

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22
Q

what is the result of osteoporosis in the long bone

A

massive pores in the bone- meaning when weight is applied stress is not applied evenly and more concentrated leading to fractured bone

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23
Q

what is a common compression fracture in the spine

A

a osteoporotic wedge fracture- causes a hunched spine

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24
Q

if you were to break a bone what could happen

A

calcium released into the blood
travels to the heart
causes heart dysrhythmia
leading to a heart attack

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25
what is a distal radius fracture also known as
Colles fracture
26
which gender is in much more of a risk of severe osteoporosis
female due to the fact of menopause
27
who is at risk of osteoporosis
female-post menopause elderly long term corticosteroids
28
give examples of corticosteroids
hydrocortisone | predisolone
29
why might people take corticosteroids
asthma | RA
30
what other diseases can we get in bones
bone cancer- eg breast, prostate and lung cancer can spread to the bone and metastasise hypercalcaemia pain pathological fracture
31
what is myeloma
bone cancer( cancer of the bone marrow)
32
what can multiple bone metastasis lead to
pathological fracture- which causes pain
33
what is the symptoms of hypercalcaemia in the GI tract
nausea vomiting loss of apatite constipation
34
what is the symptoms of hypercalcaemia in the CV system
bradycardia cardiac arythmias hypertension
35
what is the symptoms of hypercalcaemia in the kidneys
kidney stones nephrogenic diabetes insipidus kidney failure
36
what is the symptoms of hypercalcaemia in the brain
fatigue- mild hyperglycaemia memory loss, depression and anxiety- moderate hypercalcaemia extreme drowsiness coma death- severe hyperglycaemia
37
what is Pagets disease
too much bone laid down
38
What are the symptoms of Paget’s disease
Can get pathological fracture As the bone is thicker leading to limb deformities Compression of nerves Pain
39
What is osteogenesis imperfects
Weak bones which can break very easily
40
What is the main take home message for people with osteoporosis
``` Stay active Sunlight- vitamin D deficiency Drink sensibly and don’t smoke Healthy balanced diet Hormone replacement therapy And bisphosphonates ```
41
What are bisphosphonates
Given to people to stabilise bones and minimise effects of osteoporosis
42
What are two phosphate molecules together called
Pyrophosphate
43
What do pyrophosphate molecules bind to
Bone-HAP
44
for how long do people need to take bisphosphonates for osteoporosis
oral or yearly injection
45
for how long do people need to take bisphosphonates for cancer/myeloma
intravenous- once a week/once a month depending
46
disadvantages of bisphosphonates
reduced activity of osteoclasts and osteoblasts reduced healing ability pain dead bone pathological fracture can also affect other cells, keratinocytes and fibroblasts
47
what is BRONJ
BISPHOSPHONATE RELATED OSTEONECROSIS OF THE JAW- used to be discussed a lot
48
what is ARONJ
anti resorptive related necrosis of the jaw such as with denosumab
49
what is MRONJ
medicated related osteonecrosis of the JAW- can get it with anti angiogenecis such as avastin sutent and zaltrap
50
what is the half life of bisphosphonates
years- takes a long time to release from the bone
51
do we advise a patient to stop taking bisphosphonates when a tooth is getting extracted
no as the dosage in the bone takes years to reduce | we might advise a drug holiday- haven't been on it for long but might stop it for 6 months
52
when do we review out patient if we have extracted a tooth and they are taking bisphosphonates
``` in 8 weeks and we check for Exposed bone Pain Infection Radiographic changes Pus discharge ```
53
if we find out a patient is taking bisphosphonates in the MH what follow up questions do we ask
Why are you taking it? What kind of medicine are you taking? How long have you taken it for? Other risk factors
54
what is the risk of MRONJ in osteoporosis
less than 0.15%
55
what is the risk of MRONJ in cancer
3%
56
what is the risk of MRONJ in myeloma
7%
57
does alendronate have a high or low risk of MRONJ
low
58
does zolendronate have a high or low risk of MRONJ
high
59
what is the relative efficacy of Etidronate
1
60
what is the relative efficacy of Clodranate
10
61
what is the relative efficacy of Pamidronate
100
62
what is the relative efficacy of Alendronate
500
63
what is the relative efficacy of Risedronate
2000
64
what is the relative efficacy of Zolendrote
10000
65
what are the risks of MRONJ
``` 60% risk after dental extraction Untreated gum disease- we can help this Untreated decay- we can help this Poorly fitting dentures- we can help this Smoking Alcohol Steroids (think about patients if they have rheumatoid arthritis!) ```

intro to biomedical sciences IBMS (35 decks)

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