ENDOCRINE - DISORDERS OF BONE METABOLISM

Question 1

What are the risk factors for developing osteoporosis?

Answer 1

• low body weight
• elderly
• smoking
• lack of exercise
• excess alcohol intake
• family history
• menopause
• long term corticosteroid use

Question 2

What should patients at risk be maintaining?

Answer 2

• adequate calcium and vit D intake

- correct any deficiencies with supplements or diet

Question 3

What is the treatment and prevention of corticosteroid induced osteoporosis?

Answer 3

• first line = alendronic acid or risedronate

- alternatives = IV zoledronic acid or teriparatide

Question 4

What is the prophylaxis of post-menopausal osteoporosis?

Answer 4

• 1st line = bisphosphonates (alendronic acid) - alternative = risedronate
• If 1st line cannot be given = strontium ranelate
• If all above cant be given = HRT - not 1st line in >60. raloxifene not recommended because its just prophylaxis

Question 5

What is the treatment for post-menopausal osteoporosis?

Answer 5

• 1st line - bisphosphonates. alternative - risedronate
• 2nd line - sodium ranelate/raloxefine
• 3rd line - teriparatide

Question 6

What do bisphosphonates do?

Answer 6

slow the rate of bone growth and dissolution by absorbing onto bone crystals

Question 7

Which bisphosphonates are used in bone meastases in breast cancer/severe hypercalcaemia of malignancy?

Answer 7

• pamidronate

- zolendronic acid - IV and most potent

Question 8

What are examples of bisphosphonates used in prevention and treatment?

Answer 8

• alendronic acid
• risedronate
• ibandronic acid
• sodium clodronate

Question 9

What are the counselling points of alendronic acid?

Answer 9

• 70mg weekly or 5mg daily
• swallow whole with lots of water
• while sitting or standing upright
• on an empty stomach 30 mins before breakfast or oral meds
• remain upright 30 mins after

Question 10

What are the counselling points for Risedronate?

Answer 10

• 35mg weekly or 5mg daily
• leave 2 hour gap between food, drink, antacids, calcium containing products
• stand or sit upright for 30 mins

Question 11

What are the side effects of bisphosphonates?

Answer 11

• oesophageal reactions - ulcers, erosions - report worsening heartburn
• atypical femoral fractures - report hip/thigh/groin pain, greater risk with long term therapy
• osteonecrosis of external auditory canal - report ear pain/ear discharge/

Question 12

What are the side effects of strontium ranelate?

Answer 12

• Serious CVD - CVD risk assessment before initiating + every 6-12 months
• Severe allergic reaction - DRESS - Drug rash, Eosinophilia, Systemic symptoms, Stop and report