Osteoporosis Flashcards by Romana J

? What happens to the bone

Decreased bone density

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What is the name of the outer layer of the bone

Coritical bone

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What is the stronger inner the honey comb like mesh called

Trabecualr bone

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Bone is made up by protein hardened by calcium cells? T or F

True

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Bone is alive and constantly changes to stay healthy? T or F

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Renewal process - which cells promote resporbtion and cream down bone tissue

Osteoclast cells

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Renewal process - which cells rebuild cells

Osteoblast cells

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In childhood which cells work faster

Osteoblast works harder than osteoclast

Increasing bone density and strength

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Between watch ages do bone stop growing in length

16 - 18

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Up until what age does bone breakdown and formation keep in balance

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After 35 there is a shift in this balance - what is the new balance

Bone is broken down faster than it is build - osteoporosis

Bone thinning/tissue decreases

The holes in the honeycomb like structure becomes bigger

Both layers thin

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What factors does bone remodeling depend on

• parathyroid hormone
• oestrogen/testosterone
• calcitonin
• vit d

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Parathyroid hormone function in bone remodeling

It increases bone resorption which increase blood calcium

Because when bone is broken down there is more calcium in the blood

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Role of calcitonin?

Reduced bine resorption

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Oestrogen and testosterone function

Maintains bone density

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Vit D function

Helps absorption of calcium and bone growth

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What is osteopenia?

The stage before osteoporosis

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Which gender is it more common in

Females

Rapid loss of bone after menopause - decrease in estrogen

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There are usually no symptoms of osteoporosis so when would you be able to tell

After a fracture occurs

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Common fracture sites?

Wrists
Hips
Spine

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What is the most common complication of osteoporosis (site)

Spinal complications

Kyphosis (forward curve)

Scoliosis (sideways)

Kyphoscoliosis (both)

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What tool can asses risk of osteoporosis

Q fracture tool

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What does this to tool assess

Risk of osteoporotic fracture over the next 10 years

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A DEXA scan is used to test for bone density - what does it do

X ray of spine, hips and wrist

Compares the individuals bone density vs a normal adults of the same age

The difference is calculated as a SD - called t score

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What does a T score of -1 and over indicate?

Normal bone density

T score of -1 to -2.5 ?

Osteopenia (low bone density)

T score of under and equal to -2.5

Osteoporosis

High body weight is a risk factor of osteoporosis- true or false

FALSE - less bone tissue and fat around the hips - making fractures more likely

Afro caribbeans have stronger, larger bones reducing fracture risk? T or f

Which drugs can increase risk of osteoporosis

• glucorticosteroids - over 3 months • anti-epileptics (carbamazepine, phenytoin) • methotrexate • HIV meds • prostate cancer drugs • breast cancer drugs - aromsatase inhibitors - anastrozole, letrozole

Which are some non pharmacological managements

• weight baring exercise- walking, jogging • resistance training - resistance bands, lifting weight • balance - yoga • smoking cessation, alcohol reduction

What are the first line pharmacological management for men, postmenopausal wormb, and glucortico induced osteoporosis?

Oral - alendronic acid or Risedronate Of oral CI give IV • ibandronic or zoledronic or denosumab

How often does Risedronate need to be reviewed

5yrs

How often does zolendronic acid need to be reviewed

3 years

How often does alendronic acid need to be reviewed

5 years

How often does ibondronic acid need to be reviewed

5 years

Biphosphantes MOA

They are absorbed onto hydroxyapatite crystals in the bone, slowing down rate of growth, thus bone turn over - maintains bone density

ARDs

Oral - osophagal irritation - heart burn - swallowing difficulties Iv - osteonectosis of jaw

Councelling

Take full table with water 30 mins before breakfast or other meds Stay in up right position for at-least 30 mins (do not eat or drink in this time) Visit dentist before and after treatment Don’t take vit d or calcium supplements at the same time

Monitoring

Correct hypocalcemia And correct vid d deficiency beofre

Which are given orally or IV

Orally • alendronic acid • Risedronate • ibandronic acid Iv Zoledronic acid Ibandronic acid

Which tools or test are used to assess the effectiveness of biphosphonates

DEXA PINP - biomarker for bone turn over

What factors make cause PIMP to be high

• fractures • vit d deficiency

Which drugs are used second line (They are not Biphosphantes)

• denosumab • teriparatide (PTH analogue) • strontium ranelate • selective estrogen receptor modulators

Which of those drugs stimulate only osteoblast

Teriparatide

Which of those drugs stimulates osteoblasts & inhibitors osteoclasts

Strontium ranelate

Which of those drugs is a human monoclonal antibody which inhibits osteoclast and this decreasing resportion

Denosumab

What are examples of SERMs from the for drugs

Tamoxifen, raloxifene

Why are they not recommended <<

Increase risk of VTE and stroke

Which drug of those have the highest risk of hypercalcermja

Teriparatide

What are vertebral fractures

Spinal fractures

Osteoporosis risk factors

• female • early and post menopause • smoking • LOW bmi • long term corticosteroid use > 3 months • white ethnicity • vit D deficiency • calcium deficiency

In which cause can oral biphophasphantes be given for prophylactic?

If in long term corticosteroids

Which iv biphosphante is given yearly

Zoledronic acid

Which is heaven everything 3 months?

Ibandronic acid

What to do if a patient has dysphasia (breathing difficulties) or heartburn

STOP taking them

Biphosphantes and disturb electrolytes of calcium and magnesium- what happens do they increase or decrease?

HYPOCALCEMIA HYPO-MAGNESIA

Can Biphosphantes be used in pregnancy

AVOID Women of child bearing age should use contraception

Is Denosumab a Biphosphante?

NO So can be used if patient cannot take biphosphonates

What is the reccomebd daily intake of calcium for those with risks of fractures

1000mg

Which drug is used for serve cases

Teriparatide (Also known as an anabolic therapy)

Which drugs can cause atypical femoral fractures

Biphosphantes- patients should inform if they have hip, thigh pain or groin

How much vit D would you prescribe

400 units Cocecalciferol 400 units

Why are these vits given

Calcium helps with bone strength Vit d helps calcium absorption

In which type of osteoporosis are SERMS used

Postmenopausal - but can increase risk of VTE

Osteoporosis Flashcards

(65 cards)