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PBL SEM 1 > Case 8 - Ageing > Flashcards

Case 8 - Ageing Flashcards

1
Q

what is the menopause and what age does it begin

A

no periods for 12 consecutive months
can’t get pregnant naturally
45-55, ave 51

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2
Q

what is primary hypogonadism and give 2 examples

A

problem w ovaries
POI - menopause before age 40
natural menopause

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3
Q

what are the patterns of results for primary hypogonadism

A

low estradiol

high fsh/lh

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4
Q

what is secondary HGadism and examples

A

problem with PT and HT
eg hypothalamic disease bc anorexic
pituitary tumours = non functioning hormones

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5
Q

pattern of results for secondary HGadism

A

low estradiol

low fsh and lh

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6
Q

5 symptoms of menopause?

A 
joint pain
mood swings
vasomotor symptoms
insomnia
vaginal and urogenital dysfunction
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7
Q

what happens w bone loss in menopause and why?

A

lose 20% of BD

estrogen inhibits resorption of bone so low estrogen = resorption of bone

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8
Q

how can you improve bone loss in menopause

A

limit alcohol and smoking
healthy diet w adequate calcium and d3
weight bearing exercise

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9
Q

4 treatments for menopause

A

prescription
HRT
natural = phytoestrogens and acupuncture
lifestyle

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10
Q

how long for and when do you take HRT

A

in perimenopause you can start

5 years max

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11
Q

3 negatives of HRT

A

increased risk of breast and womb cancer, VTE and stroke

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12
Q

what HRT do u take with a uterus and why

A

combined

bc oestrogen causes proliferation of endometrium, progesterone has anti-prolif effects

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13
Q

what HRT do you take if you have had a hysterectomy

A

oestrogen only

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14
Q

best method of estrogen? what are the other ways of delivering it?

A

best = transdermal bc no cancer or VTE risk

patch, gel, orally

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15
Q

what is micronized progesterone and why is it good

A

natural, body identical progesterone

no androgenic or gcc effects like synthetic

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16
Q

what does HRT reduce

A

all symptoms of menopause basically

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17
Q

what are prescription remedies for HRT

A

anti-depressants
clonidine - anti hypertensive
developing: neurokinin 3 receptor antagonist, reduces hot flushes and insomnia

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18
Q

when do you give androgen therapy to women

A

if loss of libido and sexual drive

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19
Q

what is osteomalacia

A

loss of bone mineral
associated w lack of vitamin d3
can still produce collagen

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20
Q

osteomyelitis?

A

infection of bone bc of bacterial origin

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21
Q

osteoarthritis?

A

mechanical in origin, disease of joints

22
Q

osteoporosis?

A

loss of entire bone substance including extra-cellular matrix and minerals
fractures of non-traumatic origin are sustained

23
Q

what is the WHO definition of OP and what are T and Z scores?

A

BMD 2.5 SD away from a normal healthy control
T score - BMD matched to control
Z - age matched BMD

24
Q

how is BMD measured

A

DEXA of lower spine and hips

2 streams - absorbed by total body and one by soft tissue, subtract to get bone

25
Q

OP in men and women figures

A

men - 1/12

women 1/3

26
Q

what is the osteoid

A

unmineralized matrix, laid down by OB

27
Q

what is bone remodelling

A

resp for maintaing mechanical integrity of skeleton in adult life
removes defective bone
responds to mechanical signals

28
Q

what is the bone metabolic unit

A 
osteoblasts on one side
OC on other
signalling going on between them
osteoid laid down
collagen type 1 formed in circles, lamella formed around outside
29
Q

what is bone modelling

A

resp for growth and shaping of bones through childhood and adolescence

30
Q

what does an 18 y old bone look like

A

epiphyseal plates open
trabeculae thick
corticies visible and thick

31
Q

bone at menopause?

A

thinner trabeculae and corticies

fused EP plates

32
Q

bone after 80?

A

no corticies, large gaps in trabeculae

33
Q

what effect does oestrogen reduction have on bone

A

increases OC
too many for OB to keep up
esp bc sudden reduction
BMD deficit

34
Q

what does oestrogen do normally on OB

A

increases alkaline phosphate expression
incr collagen and tf GF synthesis eg IGF
causes reg cell division and proliferation of OB
receptor for colecalciferol is a marker for OB differentiation is stim by oestrogen

35
Q

what does oestrogen do normally on OC

A

incr apoptosis
suppresses proliferation
acts on OC via OB bc of rank/l protein

36
Q

impact of peak bone mass on OP

A

higher PBM = stronger bones later in life

37
Q

impact of genetics on PBM

A

afro-caribean higher than asians and whites

38
Q

why do men have lower OP levels

A

bc higher PBM and oestrogen levels decreases slower bc no menopause

39
Q

what are the bone markers used for OB and OC

A

alkaline phosphatase and collagen breakdown products

40
Q

why can’t we use biochem to test for OP

A

bc disease of bone remodelling, takes approx 9 months to see

DEXA and BMD done every year reflect entire section of skeleton

41
Q

OP in men risk and risk factors

A

25% lifetime risk of fractures

HGadism, smoking, alcohol, steroid therapy

42
Q

effect of oestrogen on bone mass in men

A

required

bc mutation in aromatase or oestrogen receptors on OB and OC = OP

43
Q

what is CCS therapy used for

A

asthma, RA, AID and inflammtory diseases like crohn’s disease

44
Q

calcium regulation in terms of 1,25 D etc

A

o Calcium hormone decreases, PTH goes up
o PTH acts in kidney to metabolise 25OH (vitamin D) to 1,25 D (cole-calciferol)
o Vitamin D production in skin;
o Transformed in liver to 25 OH D3
o Major target for active form of vitamin d3: calcium resorption in the gut
o In the gut: many receptors for active form of vitamin D; enable calcium resorption to return calcium levels to normal

45
Q

how do CCS affect calcium levels

A

prevents reabsorption through gut, increased levels of PTH left

46
Q

how to classify fractures

A

by location - epi,di, metaphyseal

by type: open/closed, complete/incomplete

47
Q

what is a fracture

A

condition that changes bone contour

48
Q

stage 1 of wound healing?

A

haematoma formation
BV rupture = bleeding
clot forms, closes off injured vessels and leaves meshwork in damaged area

49
Q

stage 2?

A

FC callus formation
external callus - organises w in medullary cavity, between broken ends of shaft
external - forms bone at level of fracture
centre: chondrocytes form hyaline cartilage
edges: diff into OB and bridge broken ends together

50
Q

stage 3?

A

bony callus formation
OB replace cartilage w spongy bone
struts of sb join broken ends and hold in place

51
Q

stage 4?

A

remodelling,

PBL SEM 1 (4 decks)

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