osteoporosis

Question 1

define osteoporosis

Answer 1

progressive systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with subsequence increase in bone fragility and susceptibility to fracture

Question 2

explain how osteoporosis occurs on a molecular level

Answer 2

osteoclasts - break down (old) bone
osteoblasts- bone formation

osteoblasts release RANKL (rank ligand) and OPG (osteoprogeterin)

• RANKL bings to receptor on osteoclast to activate bone reabsorption/breakdown
• OPG binds to RANKL (as decoy receptor) to inhibit activation of osteoclasts
• when proportion of RANKL is much greater than that of OPG, there is increase rate of bone break down/reabsoption = osteoperosis

Question 3

what hormone can stimulate osteoprogetrin (OPG)

Answer 3

oestrogen

Question 4

what are the 2 categories of primary osteoperosis

Answer 4

type 1 = post menopausal

type 2 = senile (age related) (70+)

Question 5

what type of bone is affected in type 1/2 primary osteoporosis

Answer 5

1= exclusively cancellous bone

2= cancellous and cortical

Question 6

what is secondary osteoporosis

Answer 6

due to something else e.g chronic disease, medication, nutritional deficiency etc

Question 7

what score/ tool is used to measure risk of fragility fracture

Answer 7

FRAX score

fracture risk assessment tool

Question 8

what age F AND M are called to do FRAX soring

Answer 8

females= 65+

males= 75+

Question 9

what is done for patients classed with FRAX score at low, intermediate or high risk

Answer 9

low= lifestyle advice given + reassured

intermediate = offer BMD test

high = offer bone protection treatment

Question 10

what is the gold standard scan for BMD testing and what does it provide

Answer 10

bone mineral density

• DEXA scan
• give a T-score
  (diagnosis of osteopenia/osteoperosis)

Question 11

only when 30-50% of bone density lost can osteoporosis be seen on xeray

Question 12

know what it looks like and signs of osteoporosis on xray e.g cortical thinning, fragility fractures, shape deformity

Question 13

what are some typical areas of fragility fractures

Answer 13

NOF
distal radius
vertebral body

Question 14

what is difference between osteopenia and osteoperosis

Answer 14

Osteopenia is a condition where people’s bone density is lower than is usual for their age. Osteoporosis is a more severe case of bone loss that weakens the bones and makes them more likely to fracture.

Question 15

WHAT IS A T-SCORE and what is a good t-score

Answer 15

the difference between your bone mineral density and 0, which is the bone mineral density of a healthy young adult (of ur age range)

• good = b/w -1 and 0
• bad = b/w -1 and -2.5 (osteopenia)

Question 16

treatments of osteoporosis?

Answer 16

• diet
• weight training
• no alcohol or smoking

meds:
- vit d/calcium
- biphosphonates
-denosumab

Question 17

what medication can cause osteoperosis

Answer 17

corticosteroids

Question 18

what is an issue of using biphsophnates as med for osteoporosis

Answer 18

can cause osteonecrosis of jaw

• part of your jawbone pokes through your gum. The area that’s exposed doesn’t receive blood, causing it to die.
• can also cause atyipcal fracture

Question 19

what is oesophagitis

Answer 19

swelling and irritation, called inflammation, of the tissues that line the esophagus

Question 20

how does denosumab and biphosphonates help osteoporosis

Answer 20

denosumab binds to RANKL preventing activation of osteoclasts

biphosphonates bine to bono which then get absorbed by osteoclasts resulting in apoptosis (death of osteoclast)