Osteoporosis, nutrition and fragility fractures Flashcards Preview

Module 204 Theme 2 > Osteoporosis, nutrition and fragility fractures > Flashcards

Flashcards in Osteoporosis, nutrition and fragility fractures Deck (25):
1

What is a Fragility ( Low Energy ) Fracture?

A Fracture which occurs without excessive trauma
or follows a fall from standing height or less

2

What is the problem of an ageing population?

More frequent fractures

3

Name some long term consequences of hips fractures

Death
Permanat disability
Unable walk independently
Unable to continue activities of daily living

4

How much do fractures cost per year?

£2billion

5

Why do people break bones?

Bone strength is reduced - Sub optimal peak bone mass, Reduced bone quality, Reduced bone Mineral ( Calcium ), Deteriorating architecture, Change in crystal size & composition, Abnormal collagen

6

Describe fracture prevention in children and adults

Children / Adolescents / Young Adults
Optimize Peak bone Mass
Adults
Prevent deterioration of bone quality
Prevent falls

7

How do you optimize bone mass

Diet
Exercise
Sex Hormones

8

How do you identify people with a high fracture risk

Increasing Age
Previous Fracture
Light weight ( BMI < 18 )
Family History of osteoporosis
Smoking
Alcohol
Many medical Disorders

9

How do you predict a frailty fracture?

Steroids > 3 months
65 years
Use Preventative Treatment

10

What are rheumatoid nodules associated with?

Chronic inflammatory conditions

11

List some medical disorders predisposing to osteoporosis

Endocrine disorders
Thyrotoxicosis
Hyperparathyroidism
Pituitary disease
Conditions causing Nutritional Deficiency
Malabsorption conditions
Eating disorders
Alcoholism
Inflammatory conditions
Many chronic general medical conditions

12

What does 1 standard deviation below the BMD for young adults do?

Doubles the risk of fracture

13

What are the objectives of drugs for osteoporosis?

Prevent bone breakdown - Inhibit Osteoclasts

Stimulate Bone Build up - Stimulate Osteoblasts and Modify Osteocyte activity

Prevent all types of fracture

14

Name a class of drug used to treat osteoporosis in both men and women

Bisphosphonates

15

What is the function of bisphosphonates

Inhibit Osteoclast action
by inhibiting an important enzyme

16

Name some Oral Nitrogen Containing Bisphosphonates

Prevent Hip & Spine fracture
- Generic Alendronate ( weekly )
- Generic Risedronate ( weekly )
Prevention of spine fracture only
Ibandronate ( monthly )

17

How to Take Alendronate, Risedronate & oral Ibandronate

Take
In the morning
With a full glass of water
Standing up
Do not lie down after
No food for 30 minutes
Food inhibits absorption

18

What can alendronate cause?

Contact stomatitis
Oesophageal ulcer

19

What is denosumab?

Fully human monoclonal antibody

IgG2 isotype
Binds to RANK Ligand
Decoy Receptor
High affinity
High specificity
No complement activation


Rapidly absorbed
Long half-life
26 days ( 34 days with max dose )
6 monthly injection
Cleared by Reticuloendothelial system
No renal excretion
Reduces spine & Hip Fractures

20

Describe anabolic treatment for osteoporosis

Daily s/c Injection
Pulse of PTH
Anabolic to bone
Reduces Fractures
Vertebral
Non-vertebral

21

Describe fracture prevention

EXERCISE – bone build
FALLS PREVENTION
Identify risk of…
Education
Posture & balance classes

22

What can happen if fractures are ignored?

Can get progressively worse

23

What causes 95% of hip fractures?

falls

24

What is the personal impact of fractures

Role in society / family
Unable to drive
Carer

Decrease confidence
Isolation = depression = decrease activity levels = poor physical recovery
Effect of long hospital stay

Can age someone very quickly

25

What do physiotherapy do?

Improve gait and balance