Bone health

Question 1

what is osteoprosis

Answer 1

progressive skeletal disease characterized by low bone mass and deterioration of the bone tissue, with increase in bone fragility and fracture risk

Question 2

which gender is more common female or male in osteoporosis

Answer 2

female

Question 3

is osteoporosis asymptomatic or has symtoms

Answer 3

assymptomatic

Question 4

where are common fracture sites in the body

Answer 4

neck of femur, vertebral body, distal radius, humeral neck

Question 5

how much of the skeleton is remodeled each year

Answer 5

10%

Question 6

what is normal transitioning between osteoblasts and osteoclasts

Answer 6

osteoclast- osteoblast numbers the same, rapid turnover and regeneration

Question 7

what causes fractures?>

Answer 7

BREAKS IN THE INFRASTRUCTURE LEAD TO WEAKNESS CAUSING FRACUTRES

Question 8

WHEN DO YOU TYPICALLY HAVE PEAK BONE MASS

Answer 8

LATE 20S

Question 9

what factors can lead to bone loss

Answer 9

glucocorticoids, diet, weight, sex hormone deficiency, diseases, immobility

Question 10

what is the major determinant of bone loss after the menopause?

Answer 10

oestrogen deficinecy

Question 11

what does the fracture risk calculator do?

Answer 11

predicts 10 yearr fracture risk of major osteoporotic fractureses

Question 12

when would you use the risk factor assessment?

Answer 12

over 50s, and under 50s that have history with glucocorticoid involvement and early menopause

Question 13

when shouda DEXA scan be performed?

Answer 13

anyone who gets a fracture score of 10% or more

Question 14

what does DEXA do?

Answer 14

measures bone density independently of anything else

Question 15

what advice should you give for managing osteoporosis

Answer 15

high intensity strength training, low impact weight bearing, avoid alcohol, avoid smoking, fall prevention

Question 16

what should post menopausal women aim for in calcium intake

Answer 16

1000mg

Question 17

what drugs are used in the treatment of osteoporosis

Answer 17

calcium and vit D supplements, bisphosphonates, denosumab,, HRT, testosterone

Question 18

what do calcium and vit D reduce the risk of?

Answer 18

non vertebral fractures

Question 19

what are the guidelines for taking calcium and vit D supplements

Answer 19

cannot take calcium within 2 hours of oral bisphosphonates. If calcium in diet is adequate, vit D may be preferred for OP treatment

Question 20

what are bisphosphonates and what do they do?

Answer 20

antiresorptive agents, prevent bone loss at all sites vulnerable to OP, reduce risk of hip and spine fracutre

Question 21

how do bisphosphonates work chemically?

Answer 21

ingested by osteoclasts which lead to cell death thus inhibiting bone resorption. Slows bone growth

Question 22

what T score must OP patients have to use bisphosphonates ?

Answer 22

less than -2.5

Question 23

how long should bisphosphonates be used

Answer 23

5 years

Question 24

how often can patients take Zoledronic acid

Answer 24

1 yearly IV infusion for 3 years

Question 25

what is zoledronic

Answer 25

a bisphosphonate that can be taken IV

Question 26

what is denosumab

Answer 26

monoclonal antibody that targets and binds with high affinity and specificity to RANKL- inhibits development and activity of osteoclasts, decreasing bone resoprtion and density

Question 27

how is denosumab taken?

Answer 27

sub cut injections 6 monthly

Question 28

what are some side effects of denosumab

Answer 28

hypocalcaemia, eczema, cellulitis

Question 29

when is strontium ranelate used

Answer 29

3rd line treatment as fracture reduction risk not as high, contraindicated in thromboembolic disease, peripheral artery disedase, uncontrolled hypertension. DONT USE IF ALTERNATIVE METHOD AVAILABLE

Question 30

what is teriparatide

Answer 30

a parathyroid hormone

Question 31

what does teripatide do?

Answer 31

stimulates bone growth as opposed to oppresss cell death

Question 32

in what patients would you use teriparatide

Answer 32

>65 with T score of

Question 33

what effects do corticosteroids have on bone

Answer 33

reduce osteoblast formation, suppress osteoblast precursors, reduce calcium absorption. Indirectly inhibit gonadal and adrenal steroid production

Question 34

what si pagets disease of bone

Answer 34

abnormal osteoclast activity and increased osteoblast activity. bnormal bone structure with reduced strength and increased fracture risk. single or multiple sites.

Question 35

what bones does pagets disease effect

Answer 35

long bones- femur, pelvis, lumbar spine, skull

Question 36

what would you present with pagets disease

Answer 36

bone pain, deformity, neuropathies, raised ALP,

Question 37

What imaging would you use

Answer 37

isotope bone scan, XR ALP raised

Question 38

how would you treat pagets disease

Answer 38

bisphosphonates if not responding to analgesia

Question 39

what is osteogenesis imperfecta

Answer 39

rare group of genetic disorders affecting bone due to collagen mutation, usually autosomal dominant

Question 40

what can osteogenesis be confused with

Answer 40

non accidental injury due to fracture risk as children