osteoporosis and disorders of bone metabolism

Question 1

what are the cells responsible for the bone composition ?

Answer 1

osteocytes
osteoclasts
osteoblasts

Question 2

what receptor is responsible for the regulation of bone remodeling balance ?

Answer 2

RANKL

Question 3

what does RANKL do ?

Answer 3

makes sure the osteoblast activity is equal to the osteoclast activity

Question 4

what does the remodeling balance look like in growth ?

Answer 4

formation > resorption

Question 5

what does the remodeling balance look like in aging ?

Answer 5

formation < resorption

Question 6

what is osteoporosis ?

Answer 6

brittle bone disease where bone mineral density of more than 2.5 standard deviation below that of normal adult mean value

Question 7

what is osteopenia ?

Answer 7

level just before osteoporosis

where the bone mineral density of more than 1 standard deviation below that of normal adult mean value

Question 8

what are the types of osteoporosis ?

Answer 8

primary

secondary

Question 9

what are the causes of secondary osteoprosis ?

Answer 9

hyperthyroidism 
adrenal disease 
Rheumatoid Arthiritis 
Malignancy 
Immobilization 
Prolonged corticosteroid therapy

Question 10

what do brittle bone disease increase the risk of ?

Answer 10

fractures

Question 11

where are the common sites of fractures ?

Answer 11

neck of femur
vertebral fracture
wrist ( Colle’s fracture )

Question 12

what are the modifiable risk factors of osteoprosis ?

Answer 12

Vitamin D deficiency 
smoking 
chronic alcohol use 
low physical activity 
corticosteroids and PPI

Question 13

which entity of people are at higher risk of developing osteoporosis ?

Answer 13

females after menopause

Question 14

why is vitamin D deficiency a risk factor for osteoprosis ?

Answer 14

decreased vit D levels results in increased PTH causing increased bone resorption

Question 15

what can we give patients who are at higher risk ?

Answer 15

calcium ( 1000-1500mg/day)
vitamin D ( 400-800 IU/day)
 alongside 
Biphosphonates 
RANKL inhibitor ( denosumab)
Parathormone analogue 
Strontium ranelate 
Selective estrogen receptor modulator

Question 16

what are the side effects of biphosphonates ?

Answer 16

osteonecrosis of the jaw
oesophaghitis
atypical femur

Question 17

what is the pharamacological name of RANKL inhibitors ?

Answer 17

Denousmab

Question 18

what is the mechanism of denosumab ?

Answer 18

inhibitionn nnof RANKL receptors thus inhibition bone resorption

Question 19

what are the side effects of denosumab ?

Answer 19

wekaness , muscle pain
constipation n
rash
decrease calcium levels

Question 20

what is the pharma name for parathormone analogue ?

Answer 20

teriparatide

Question 21

what are the side effects of teriparatide ?

Answer 21

nausea, limb pain, headache

may be related to an increase risk of osteosarcoma

Question 22

what are the side effects of strontium ranelate ?

Answer 22

nausea, diarrhea
increased risk of DVT
increased cardiovascular risk

Question 23

what is the pharma name of selective estrogen receptor modulator ?

Answer 23

raloxifen

Question 24

when is raloxifen indicated ?

Answer 24

in postmenopausal women

Question 25

what are the side effects of Raloxifen ?

Answer 25

increased risk of DVT | increased cardiovascular risk

Question 26

what does a DEXA scan interpretation tell us ?

Answer 26

T score : is used to compare to a young healthy adult of the same gender used to identify osteoporosis Z score : compared to a healthy person of the same age and gender mainly used to identify secondary osteoporosis

Question 27

what is Pagets disease ?

Answer 27

localized disorder of the bone metabolism with osteoblastic and osteosclerotic areas ( localized osteosclerosis)

Question 28

what are the symptoms of pagets disease ?

Answer 28

nerve compression n bone deformities fractures high output cardiac failure

Question 29

what are the common sites for metastatic bone disease ?

Answer 29

``` breasts lung prostate kidney thyroid ```

Question 30

in which areas of bone metastasis may the calcium be normal ?

Answer 30

breasts and prostate

Question 31

what investigations can we perform for Pagets ?

Answer 31

ALP high normal bone profile normal liver profile

Question 32

what can raise ALP ?

Answer 32

``` liver affection pregnancy during growth vitamin D deficiency hyperparathyroid ```

Question 33

where would we need to do an X-ray ?

Answer 33

pelvis | long bones

Question 34

what are the risk factors for osteonecrosis ?

Answer 34

``` fracture smoking, alcohol steroids sickle cell anemia radiation decompression sickness ```