Osteoporosis Flashcards

Question

What are the modifiable risk factors of OP?

Answer 1

Smoker (>20 a day) Excess alcohol (no more than 4 standard drinks a day) Less than 30 mins of physical activity/day Less than 30 mins of outdoors in sunlight/day High caffeine intake Low Ca diet Long term use of certain medications including steroids and anticonvulsants

Answer 2

Common fractures: vertebrae, proximal femur and distal radius 2/3 of the back fractures are asymptomatic The remainder present with mod to severe back pain that radiates down a leg Kyphosis

Answer 3

The curving of the spine leading to hunchback or slouching with posture. Can experience respiratory problems due to the compression of the thoracic region

Answer 4

OP is usually asymptomatic until fractures appear. Fractures can result in pain, deformity and disability Diagnose with measurement of BMD by dual energy X-ray absorptiometey (DEXA scan) A T score is obtained which compares the patients measured BMD to the BMD of. Health young, sex matched white reference population The T score is the number of SDs roar mom the mean of the reference population so If Tscore > -1 = normal bone mass - 1 to -2.4 = osteopenia - 2.5 = osteoporosis

Answer 5

Prevention is the primary goal Optimising skeletal development and peak bone mass in childhood, adolescence and early adulthood will reduce future incidence of osteoporosis Once osteopenia or osteoporosis develops objective is to stabilise or improve bone mass and strength and prevent fractures. Go as in a patients who have already suffered osteoporotic fractures include reducing future falls and fractures, improving functional capacity, reducing pain and deformity, improving quality of life.

Answer 6

``` Calcium and vitamin D supplementation Calcitriol BisphosphonTes Raloxifen or Demosumab Calcitonin Teriparatide HRT Strontium ranelate ``` Thiazide diuretics Fluroide Statins Vitamin K

Answer 7

Intended to prevent OP and reduce incidence of fracture | Should be advised with every line of treatment

Answer 8

1-1.5g/day orally | Treat constipation with water intake

Answer 9

This is vitamin d and regulates levels of Ca and P in the body and in the mineralisation of bone I.e. It facilitates intestinal absorption of calcium

Answer 10

In the skin by exposure to the sun. | This is then metabolised to the active form by the liver of the kidney

Answer 11

It can decrease vitamin D levels

Answer 12

Usually 300,000 IU to start with, then 50,000IU once a month | Note that 1IU= 0.025μg

Answer 13

The biologically active form of vitamin D3 | For people with renal or liver impairment

Answer 14

Increases Ca absorption in gut Regulates bone mineralisation by stimulating osteoblast activity Indicated for post menopausal OP and prevention of CS induced OP

Answer 15

0.25μg bd concomitant with Ca supplementation

Answer 16

Pyrophosphate mimics. They bind to hydroxyapatite in the bone and decrease resorption by inhibiting osteoclast adherence to bone surfaces. Bisphosphonates become incorporated into the bone

Answer 17

An endogenous bone resorption inhibitor

Answer 18

Up to 10 years

Answer 19

They are poorly absorbed. (<1%) They should be taken while fasting with a glass of water. Patient must remain upright and fasting for 30 minutes or may experience GI side effects or inadequate absorption

Answer 20

Oesophageal reactions Abdominal pain and distension Dyspepsia Regurgitation

Answer 21

By kidneys. | Hence they are contraindicated in renal impairment with CrCl <30mL/min

Answer 22

``` Alendronat Etidronate Palmier onto Zolendronate Risedronate ```

Answer 23

Non N containing bisphosphonate Inhibits energy production of osteoclasts Not specific for osteoclasts vs. Osteoblasts Should be given in cycles (not continuously) e.g. Every 2 weeks every 3 months

Answer 24

400mg daily for 14 days followed by Ca supplementation for 76 days Take on an empty stomach and sit upright for at least 30 mins after

Answer 25

N containing bisphosphonate Binds and blocks farnesyl disphosphate synthetase which would normally cease the inhibition of orotein pentobarbitone which affects many proteins found in osteoclasts. Alendronate prevents osteoclasts from adhering to the bone surface leading to reduced bone resorption

Answer 26

Now give 70mg orally once a week. Take on an empty stomach with water Avoid milk or Ca for 4 hours It is 1000x more potent than etidronate with half life of 10 years

Answer 27

N containing bisphosphonate Suppresses accession of osteoclast precursors onto bone and their subsequent transformation into mature resorting osteoclasts.

Answer 28

30mg infusion every 3 months | It is not funded in the community so is mainly adminstered in the hospital

Answer 29

It is give in as IV due to oesophageal indication

Answer 30

The most potent bisphosphonate and given as an infusion Give if suspected non compliance. At low doses it maintains bone mass, reduces bone porosity and increases mechanical bone strength without affecting bone mineralisation It also inhibits farnesyl pyrophosphate synthetase

Answer 31

5mg/100ml IV infusion once per yea reduce dose in impaired renal function. Only use if benefit > risk where CrCl <30ml/min

Answer 32

Demosumab is a human monoclonal antibody that inhibits osteoclast formation function and survival Raloxifene is a selective estrogen receptor modulator and mimics the beneficial effects of oestrogen on bone and lipids without stimulating estrogen receptors in breast and endometrium

Answer 33

Inhibits vertebral bone loss by blocking activity of cytokines which stimulate bone resorption

Answer 34

May cause hot flushes and increase risk of VTE | However it is associated with a decreased breast cancer risk

Answer 35

60mg OD (NS)

Answer 36

Targets RANKL and inhibits development and activity of osteoclasts Decreases bone resorption and increases BMD

Answer 37

60mg subcutaneously every 6 months

Answer 38

``` Infections of respiratory and urinary tract Constipation Rashes Joint pain Osteo necrosis of the jaw ```

Answer 39

A hormone produced naturally in the thyroid that is a powerful inhibitor of osteoclasts It has opiate mediated analgesic properties for bone pain and increases urinary excretion of Ca but also increased BMD significantly

Answer 40

GI discomfort Rhinitis Congestion Redness and epistaxis (nasal spray)

Answer 41

200units in one nostril OD | Funded

Answer 42

Bone pain | Crushed vertebrae?

Answer 43

Synthetic form of human parathyroid hormone

Answer 44

Increases intestinal absorption of Ca, Increases tubular resorption of Ca Increases excretion of P by the kidneys Stimulates bone formation by direct effects on osteoblasts Causes greater increase in BMD than antiresorptives Improves bone micro architecture

Answer 45

``` Hypercalcaemia Raised uric acid levels Leg cramps Nausea Headaches ```

Answer 46

20mg SC OD

Answer 47

Hormone replacement therapy

Answer 48

Oestrogen helps maintain and increase bone mass after menopause HRT should only be used short term in women who need oestrogen therapy for menopausal symptoms such as not flushes

Answer 49

Increases risk of pulmonary embolism Stroke Breast cancer Dementia Hence only reserved for women <60

Answer 50

It has a dual action on the skeleton by stimulating bone formation and decreasing bone resorption Resulting in marked increase in bone mass, size and strength of bone with decreased risk of vertebral fractures

Answer 51

``` Nausea Diarrhoea VTE Headache Dermatitis Dress ``` Also not funded in nz

Answer 52

Quite a potent bisphosphonate. (5000x) | Used in fosamax with alendronate

Answer 53

Increase urinary Ca reabsorption therefore decreasing excretion of Ca

Answer 54

Potent osteoblast mitogen which stimulates bone formation and significantly increases BMD. It has not been shown to reduce fractures

Answer 55

Stimulate bone formation and have a potential to decrease fracture risk, though more trials are required

Answer 56

Plays a role in bone metabolism

Answer 57

Balanced diet rich in Ca energy vitamins If inadequate dietary intake cannot be achieved, Ca supplements are necessary Smoking cessation to help optimise peak bone mass, minimise bone loss and ultimately reduce fracture risk Limit alcohol consumption Weight bearing aerobic and strengthening exercises can decrease eisk of falls and fractures by improving muscle strength, coordination, balance and mobility Limit caffeine consumption as it increases Ca excretion Caffeine intake should ideally be limited to 2 servings per day (2-4 servings a day concerning if adequate Ca is not achieved) Hip protectors can decrease force of impact form a side ways fall

Osteoporosis Flashcards

(81 cards)