Osteoporosis occurs in what frequency of:
a) 1 in 2
b) 1 in 6
What are the common sites for osteoporotic fractures?
- Femur neck
- Upper humerus
- Vertebral bodies
- Distal radius (Colles' fracture)
- Other long bones
What do vertebral fractures often lead to?
What are two key problems secondary to kyphosis as a result of vertebral fractures?
- GI symptoms e.g. reflux due to compression
- Pain due to ribcage on hip
Bone turnover is required for which two processes in the body?
- Skeleton healing
- Calcium homeostasis
Bone density will begin to decline after what age?
Peak bone mass is attributable to which factors?
- Body weight
- Sex hormones
Bone mass may be reduced in which situations?
- Increasing age
- Sex hormone deficiency
- Low body weight
- Drugs e.g. corticosteroids
Which modifiable risk factors exist for osteoporosis?
- High alcohol intake
- Physical activity
- Drug use (corticosteroids)
What is osteopenia?
Low bone density
T score between -1.0 and -2.5 SD below adult mean
How is osteoporosis defined?
BMD < 2.5 SD below that of a young adult
Usually dietary calcium should equal ________ per day, but in someone with osteoporosis it should equal at least _________
Usually dietary calcium should equal 700mg per day, but in someone with osteoporosis it should equal at least 1000mg
Most patients will be given what if they have, or at at risk of osteoprosis?
Vitamin D and calcium supplements
How do bisphosphonates work?
Reduce osteoclast activity
Give two examples of bisphosphonates
Why are bisphosphonates taken for 5-10 years and then stopped for about 2 years before restarting again?
To prevent excessive build-up in the bones which increases risks of rare side effects (osteonecrosis of the jaw (ONJ), AF, oesophageal cancer)
This is possible because the levels remain high enough in this time to still have an effect and maintain treatment
Which bisphosphonate is given by IV yearly?
What is the benefit for some patients of using denosumab in osteoporosis?
It can be used in renal failure unlike other treatments
Which osteoporotic treatment can trigger osteoblastic activity?
(a synthetic parathyroid hormone)
When should teriparatide be used?
Generally reserved for patients with highest risk of vertebral fractures
Why do corticosteroids contribute to osteoporosis?
- Reduce osteoblast activity and lifespan by
- Suppress replication of osteoblastic precursors
- Deplete Ca2+ levels
What is Paget's disease?
A condition involving abnormal osteoclastic activty followed by increased osteoblastic activity
There is reduced bone strength and abnormal structure
Which bones are affected most in Paget's disease?
- Long bones
- Lumbar spine
Generally, Paget's is a disease of the ________
Generally, Paget's is a disease of the elderly
How does Paget's disease present?
- Bone pain
- Compression neuropathies
On a blood test, what will be raised for Paget's disease?
What is a rare, but serious, association with Paget's disease?
How can Paget's disease be treated?
Which deformity of the tibia is associated with Paget's, how will it present and what is there a high associated risk of?
Hot (due to increased vasculature), deformed (curved like a saber sword)
Osteogenesis imperfecta is a __________ condition
Osteogenesis imperfecta is a genetic condition