L17: Osteoporosis & MBD Flashcards by Ahmed Farag

Q

Def of Osteoporosis

A

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Q

Pathogenesis of Osteoporosis

A

Osteoporosis results from imbalance between bone formation and resorption due to:

Increased bone breakdown by osteoclasts
Decreased bone formation by osteoblasts.

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Q

Types of Osteoporosis

A

primary & secondary

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Q

Types of 1ry Osteoporosis

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Type I (Postmenopausal osteoporosis)

A

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Type II (Senile osteoporosis)

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Secondary osteoporosis

A

Affects males and females at any age as a result of disease process or medications.

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Q

General Risk factors of Osteoporosis

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General Risk factors of Osteoporosis

Age

A

Affects 30% of over 50 years

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General Risk factors of Osteoporosis

Sex

A

Female ( Women four times more affected than men)

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Q

General Risk factors of Osteoporosis

Race

A

Caucasian and Asian

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Q

Diseases predisposing to Secondary Osteoporosis

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Q

Diseases predisposing to Secondary Osteoporosis

Endocrine

A

Cushing – Hyperparathyroidism – Thyrotoxicosis –
Hypogonadism - Diabetes mellitus.

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Q

Diseases predisposing to Secondary Osteoporosis

Rheumatologic

A

RA arthritis - ankylosing spondylitis.

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Q

Diseases predisposing to Secondary Osteoporosis

Deblitating Diseases

A

Chronic kidney disease (Renal Osteodystrophy) - Chronic liver disease - Chronic obstructive pulmonary disease.

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Q

Diseases predisposing to Secondary Osteoporosis

Hematologic

A

myeloma - lymphoma and leukemia – hemophilia - sickle-cell disease and thalassemia.

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Q

Diseases predisposing to Secondary Osteoporosis

Inherited

A

Osteogenesis imperfecta - Marfan syndrome

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Q

Medications predisposing to Secondary Osteoporosis

A

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Medications predisposing to Secondary Osteoporosis

Hormonal

A

Steroid-induced, L-Thyroxine, progesterone, Thiazolidinedione, Anti- androgens.

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Q

Medications predisposing to Secondary Osteoporosis

CNS

A

Barbiturates, phenytoin, antiepileptics, lithium.

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Q

Medications predisposing to Secondary Osteoporosis

Antimetabolite drugs

A

Methotrexate

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Q

Medications predisposing to Secondary Osteoporosis

Anticoagulant drugs

A

heparin and warfarin.

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Q

Medications predisposing to Secondary Osteoporosis

Antacids

A

Proton pump inhibitors and chronic oral antacids

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Q

CP of Osteoporosis

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INVx for **Osteoporosis**

- Rads - Labs

Rad INVx of **Osteoporosis**

- Conventional X-ray - Dual energy X-ray absorptiometry (DEXA)

x-Ray in **Osteoporosis**

Shows vertebral compression fracture, cortical thinning, decrease in the number of trabeculae and increased radiolucency.

DEXA in ****Osteoporosis****

- Is the gold standard in osteoporosis diagnosis usually of the lumbar spine and proximal femur - It is precise, accurate, uses low dose of radiation.

T-Score in DEXA for **Osteoporosis**

Z-Score for DEXA in **Osteoporosis**

Matches BMD to age matched control

Labs in **Osteoporosis**

TTT of **Osteoporosis**

- Non-Drug Therapy & Drug Therapy

Non-Drug Therapy of **Osteoporosis**

Drug Therapy of **Osteoporosis**

- Anti-Resorptive Therapy - Anabolic Therapy

Types of Anti-Resorpative Theray

- Bisphosphonates - Hormone replacement therapy (HRT) - Selective estrogen receptor modulator (SERMs) - Androgen - Calcitonin - Supplementation with calcium and vitamin D

MOA of Bisphosphonates

are potent inhibitors of osteoclast activity.

Examples of **Bisphosphonates**

SE of **Bisphosphonates**

- ...... has been associated with renal toxicity - Bisphosphonates are not recommended for patients with impaired renal function.

Zoledronate

In which type of osteoporosis is Hormone replacement therapy (HRT) Used?

type I osteoporosis

MOA of **Hormone replacement therapy (HRT)**

Estrogen suppresses bone resorption by inhibiting osteoclasts.

SE of **Hormone replacement therapy (HRT)**

Because of adverse effects, HRT is a second-line option for osteoporosis except ......

in early postmenopausal women at high fracture risk who also have perimenopausal symptoms.

Example of **Selective estrogen receptor modulator (SERMs)**

Raloxifene

Indications of Selective estrogen receptor modulator (SERMs)

(Type I osteoporosis)

MOA of **Selective estrogen receptor modulator (SERMs)**

- It is not a hormone, it activates estrogen receptors in bone but has no stimulatory effect on the endometrium. - So it inhibits the effect of PTH on osteoclast without trophic effect on breast or uterus

SE of **Selective estrogen receptor modulator (SERMs)**

May cause or worsen hot flushes and also increase the risk of thromboembolic disease

Indications of **Androgen** in osteoporosis

In men with osteoporosis who have clinical and biochemical evidence of hypogonadism, testosterone replacement is used.

Calcitonin in TTT of Osteoporosis

- Nasal or subcutaneous: it Slows bone loss - Occasional nausea, vomiting, flushing may occur.

Supplementation with calcium and vitamin D in TTT of Osteoporosis

- In those with low dietary calcium intake and at risk from vitamin D insufficiency, calcium and vitamin D supplements should be advised, - The recommended dose is 800 IU of vitamin D and 1–1.2 g calcium daily

Examples of **Anabolic Therapy** in TTT of Osteoporosis

Recombinant human parathyroid hormone peptide - Teriparatide

MOA of **Anabolic Therapy** in TTT of Osteoporosis

Anabolic agents that stimulate bone formation.

Indications of **Anabolic Therapy** in TTT of Osteoporosis

Indicated in severe cases of vertebral osteoporosis or in women who fail to respond to other therapies.

Examples of **Metabolic Bone Disease**

1) Osteoporosis 2) Osteomalacia (see rheumatology) 3) Paget disease of the bone (Osteitis deformans)

Another name of **Paget's Disease**

Osteitis deformans

Def of ****Paget's Disease****

- Is a disorder of increased bone resorption with compensatory increased bone formation (structurally abnormal)

Epidemeology of **Paget's Disease**

- It affects men and women (2 : 3) over the age of 40 years. - The prevalence of Paget disease increases with age ( Affects up to 10% of persons older than 80 years )

Etiology & Pathogenesis of **Paget's Disease**

CP of ****Paget's Disease****

Complications of **Paget's Disease**

INVx in **Paget's Disease**

TTT of **Paget's Disease**