Flashcards in Osteoporosis, nutrition and fragility fractures Deck (25):
What is a Fragility ( Low Energy ) Fracture?
A Fracture which occurs without excessive trauma
or follows a fall from standing height or less
What is the problem of an ageing population?
More frequent fractures
Name some long term consequences of hips fractures
Unable walk independently
Unable to continue activities of daily living
How much do fractures cost per year?
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
Describe fracture prevention in children and adults
Children / Adolescents / Young Adults
Optimize Peak bone Mass
Prevent deterioration of bone quality
How do you optimize bone mass
How do you identify people with a high fracture risk
Light weight ( BMI < 18 )
Family History of osteoporosis
Many medical Disorders
How do you predict a frailty fracture?
Steroids > 3 months
Use Preventative Treatment
What are rheumatoid nodules associated with?
Chronic inflammatory conditions
List some medical disorders predisposing to osteoporosis
Conditions causing Nutritional Deficiency
Many chronic general medical conditions
What does 1 standard deviation below the BMD for young adults do?
Doubles the risk of fracture
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
Name a class of drug used to treat osteoporosis in both men and women
What is the function of bisphosphonates
Inhibit Osteoclast action
by inhibiting an important enzyme
Name some Oral Nitrogen Containing Bisphosphonates
Prevent Hip & Spine fracture
- Generic Alendronate ( weekly )
- Generic Risedronate ( weekly )
Prevention of spine fracture only
Ibandronate ( monthly )
How to Take Alendronate, Risedronate & oral Ibandronate
In the morning
With a full glass of water
Do not lie down after
No food for 30 minutes
Food inhibits absorption
What can alendronate cause?
What is denosumab?
Fully human monoclonal antibody
Binds to RANK Ligand
No complement activation
26 days ( 34 days with max dose )
6 monthly injection
Cleared by Reticuloendothelial system
No renal excretion
Reduces spine & Hip Fractures
Describe anabolic treatment for osteoporosis
Daily s/c Injection
Pulse of PTH
Anabolic to bone
Describe fracture prevention
EXERCISE – bone build
Identify risk of…
Posture & balance classes
What can happen if fractures are ignored?
Can get progressively worse
What causes 95% of hip fractures?
What is the personal impact of fractures
Role in society / family
Unable to drive
Isolation = depression = decrease activity levels = poor physical recovery
Effect of long hospital stay
Can age someone very quickly