Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

SL32111 - Meds Op > Osteoporosis and Fracture Prevention > Flashcards

Osteoporosis and Fracture Prevention Flashcards

(80 cards)

Start Studying
1
Q

What is osteoporosis?

A

A long-term condition characterized by low bone mass and micro-architectural bone deterioration, leading to an increased risk of fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three most common fracture sites in osteoporosis?

A

The wrist, spine (vertebrae), and hip.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is osteoporosis commonly diagnosed?

A

Commonly undiagnosed until after a fall or fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the nature of bone remodeling?

A

Active process, constant remodelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which cells control bone remodeling?

A

Controlled by osteoblasts and osteocytes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the balance in a normal adult skeleton?

A

Balance between bone resorption by osteoclasts and bone formation by osteoblasts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What characterizes an osteoporotic skeleton?

A

Bone loss occurs because bone resorption (osteoclast activity) is greater than bone formation (osteoblast activity).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the peak bone mass age range?

A

Peak bone mass is between 25 and 35.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the normal bone density loss after age 40?

A

Normal bone density loss is 1% per year after the age of 40 years in both men and women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does menopause affect bone density in women?

A

Menopause accelerates the decline in BMD to 3-4% per year.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define bone mineral density

A

Is a measure of the amount of minerals (mainly calcium and phosphates) contained in a certain volume of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is osteoporosis defined as by the WHO?

A

Osteoporosis is defined as having a BMD of >2.5 standard deviations below the average value for a young adult.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most used imaging technique for diagnosing osteoporosis?

A

DEXA scan is the most used imaging technique for diagnosing osteoporosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does a DEXA scan measure?

A

A DEXA scan measures an individual’s BMD by estimating the amount of bone at certain sites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which sites are most commonly assessed in a DEXA scan?

A

The most commonly assessed sites in a DEXA scan are the spine, forearm, and hip.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is osteopenia?

A

Osteopenia is defined as a reduction in bone density at the spine or hip between 1.0 and 2.5 standard deviations below the average for healthy young adults (T-score between -1 and -2.5).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is osteopenia measured?

A

Osteopenia refers to a quantitative loss of bone mineral density usually measured at the hip or spine with dual energy X-ray absorptiometry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Are scans always needed to diagnose osteopenia?

A

Scans aren’t always needed; if an elderly person presents with a fracture from a very low impact injury, it is usually fair to assume that they are osteoporotic and treatment will be initiated if appropriate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for osteoporosis?

A

Gender and age
Body weight
Physical inactivity/sedentary lifestyle
Extraskeletal risk
Alcohol consumption and cigarette smoking
Medicines
Secondary causes of osteoporosis
Previous fracture or history of parent hip fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the role of Calcium in bone health?

A

Calcium is a major component in bone and is required for bone mineralisation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the role of Vitamin D in bone health?

A

Vitamin D increases intestinal absorption of calcium and has a role in bone mineralisation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the recommended daily intake of Calcium?

A

The recommended daily intake of Calcium is 700mg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the required Vitamin D status for bone health?
The required Vitamin D status is greater than 50nmol/L.
26
How can adequate Calcium and Vitamin D levels be achieved?
Adequate levels can be achieved through diet or supplements.
27
What effect does increasing Calcium intake have on Bone Mineral Density (BMD)?
Increasing calcium intake has shown to have some small effects in increasing BMD.
28
Does increasing Calcium intake reduce fracture risk?
There is no evidence to suggest that increasing calcium intake reduces fracture risk.
29
What supplements are recommended for osteoporosis?
Adcal D3 ONE twice a day (1200mg + 800iu Vit D3) and Accrete ONCE daily (1000mg calcium + 880iu Vit D3). ## Footnote There is poor adherence.
30
What are the treatment options for osteoporosis?
Bisphosphonates.
31
How do bisphosphonates work?
They inhibit osteoclast mediated resorption.
32
What is a concern regarding bisphosphonates?
They have poor oral absorption.
33
What position should bisphosphonates be taken in?
In an upright position to minimize gastro-oesophageal irritation.
34
Who should avoid bisphosphonates?
Those unable to sit upright and those with abnormalities of the oesophagus/oesophageal dysmotility.
35
What is a renal consideration for bisphosphonates?
Contraindicated if CrCl <30-35ml/min due to increased risk of renal failure.
36
What are common side effects of bisphosphonates?
GI disturbance.
37
What are rare side effects of bisphosphonates?
Osteonecrosis of jaw or atypical femoral fractures. ## Footnote Advised to have a dental check before starting bisphosphonates.
38
What happens to bone density after discontinuation of bisphosphonates?
Bone density is maintained for a period after discontinuation.
39
When should oral bisphosphonate tablets be taken?
Oral tablets should be taken ideally after an overnight fast at least 30 minutes before the first food and drink (other than tap water) and any other medications.
40
How should bisphosphonate tablets be taken?
The tablet should be swallowed with a whole glass of water while sitting upright or standing.
41
How long should a patient remain upright after taking bisphosphonates?
The patient needs to remain upright for at least 30 minutes.
42
How often are bisphosphonates usually taken?
Bisphosphonates are usually taken on a weekly basis.
43
What checks should be performed prior to starting bisphosphonate treatment?
1. Does the patient have abnormalities of the oesophagus/ Barrett's oesophagus? 2. Does the patient have difficulty swallowing? 3. Does the patient have stomach problems? 4. Does the patient have cognitive impairment? 5. Is the patient able to sit upright for 30-60 minutes after taking oral bisphosphonates? 6. What is the appropriate formulation for the patient? 7. What is the patient's renal function? 8. What is the patient's adjusted calcium and vitamin D level? 9. Does the patient have good dental hygiene? 10. Has the patient used a bone-sparing agent previously?
44
What should be reviewed for patients at high risk of fracture after treatment with alendronate, risedronate, or ibandronate?
Treatment should be reviewed after 5 years. For zoledronic acid, review after 3 years.
45
What should be considered after 5 years of treatment if a patient's fracture risk falls below the threshold?
Consider a medication pause if hip BMD is greater than -2.5.
46
How long can treatment generally be continued for patients with high fracture risk?
Continuation of treatment up to 10 years can generally be recommended.
47
What is the evidence regarding treatment decisions beyond 10 years?
There is little evidence to guide decisions, and management should be considered on an individual basis.
48
What is denosumab?
A human monoclonal antibody that inhibits osteoclast recruitment, maturation, and development, reducing bone resorption.
49
How is denosumab usually administered?
It is usually secondary care initiated and given every 6 months.
50
Who is denosumab recommended for?
Recommended as primary prevention in menopausal women at increased risk of fractures who cannot comply with bisphosphonates or have contraindications.
51
What are the side effects of denosumab?
Side effects include skin infection (mainly cellulitis) and hypokalaemia.
52
What is a contraindication for denosumab treatment?
Hypocalcaemia is a contraindication, and risk increases in those with renal impairment.
53
What should be measured prior to denosumab treatment?
Adjusted serum calcium and vitamin D levels should be measured, and adequate supplementation provided.
54
What should be done if a patient is predisposed to hypocalcaemia before denosumab treatment?
Calcium levels should be rechecked within 2 weeks.
55
What is the risk associated with withholding or stopping denosumab treatment?
It may be associated with an increase in bone turnover and rebound increased risk of fractures.
56
What should be done regarding denosumab doses?
Denosumab doses should be at regular 6-month intervals, and do not stop or withhold without considering an alternative treatment plan.
57
How long can denosumab treatment generally be continued for patients with high fracture risk?
Continuation of denosumab treatment up to 10 years can generally be recommended.
58
What is the evidence regarding treatment decisions for denosumab beyond 10 years?
There is little evidence to guide decisions, and management should be considered on an individual basis.
59
What is Teriparatide?
Recombinant human parathyroid hormone used in severe osteoporosis under specialist guidance.
60
How does Teriparatide affect bones?
Stimulates bone formation by osteoclasts and helps strengthen bones, reducing the risk of breaking a bone.
61
Who should not use Teriparatide?
Contraindicated in patients with hypercalcaemia, metabolic bone diseases other than osteoporosis, severe renal impairment, prior radiation to the skeleton, or malignant disease affecting bone.
62
What are the side effects of Teriparatide?
Side effects include headache, nausea, dizziness, and postural hypotension.
63
How is Teriparatide administered?
Daily subcutaneous injection, via self-administration.
64
What is the monitoring requirements for bisphosphonates?
Check how and when patient is taking the agent Check that the patient is taking the agent with a glass of water to minimise risk of oesophageal irritation Check patients renal function regulary Check that the patients calcium is in the normal range (2.20-2.60mmol/L) regularly , especially in patients with a poor diet or those who are not tolerating supplements
65
What are the general monitoring required in patients with osteoporosis?
Check whether the patient has had a fracture while on treatment Check that the patient is taking appropriate supplementation Check that there has been no change in the patients health status Check the patients falls history Ensure that the patient is maintaining a good dentalk hygiene If the patient has been on treatment for longer than 2 years, monitor them for thigh, groin, or hip pain and ear symptoms
66
What are the monitoring requirements with denosumab?
Check the patients adjusted calcium, vitamin D level, renal function, and bone profile prior to each injection Check that the patient is having injections at 6-monthly intervals and that doses are not missed Check for skin infections
67
What is the relationship between dementia and fragility fractures?
Dementia and fragility fractures often co-exist in older people; dementia increases the risk of falls and fractures.
68
How does dementia affect motor function?
Patients with dementia have reduced dopamine activity, leading to a decline in motor function, gait, and balance.
69
What types of medications can increase the risk of falls in dementia patients?
Antipsychotics, sedatives, and cholinesterase inhibitors used in Alzheimer’s disease can increase the risk of falls and fractures.
70
What nutritional deficiency is more prevalent in dementia patients?
Patients with dementia have a higher prevalence of vitamin D deficiency, which should be addressed.
71
What environmental factor may impact dementia patients in care homes?
Care home living environments may affect the well-being of dementia patients.
72
How does renal function relate to dementia?
Reduced renal function may impact the health of patients with dementia.
73
What is a common issue regarding hydration in dementia patients?
Reduced fluid intake is a common concern among patients with dementia.
74
What are the factors contributing to increased fracture risk in patients with Parkinson's disease?
Gait disturbances, low BMD, recurrent falls, postural instability, postural hypotension, and polypharmacy.
75
What is required for the management of osteoporosis in patients with Parkinson's disease?
A holistic approach is required.
76
What are the components of the holistic approach to managing osteoporosis in Parkinson's disease?
Identifying and treating reversible factors, modifying patients’ lifestyle, ensuring correction of vitamin D and calcium levels, and recommending bone-protection agents.
77
How can reversible factors be addressed in patients with Parkinson's disease?
By reducing the contributory effects of postural hypotension leading to falls and reducing muscle deconditioning via in-depth occupational therapy and physiotherapy assessment.
78
What lifestyle modifications should be provided to patients with Parkinson's disease?
Dietary advice and smoking cessation advice.
79
What should be ensured regarding vitamin D and calcium levels in patients with Parkinson's disease?
Correction of vitamin D and calcium levels.
80
When should bone-protection agents be recommended for patients with Parkinson's disease?
Upon confirmation of osteoporosis on DEXA scan or for high-risk individuals.

SL32111 - Meds Op (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions