PBL 1 Flashcards
(29 cards)
whats the pathology of osteoporosis?
bone resorption > bone formation so we get decreased bone density
what are the 3 possible mechanisms for osteoporosis?
inadequate peak in bone mass
excessive bone resorption e.g. lack of oestrogen or excessive PTH
inadequate formation of new bone during remodelling e.g. calcium and vit d deficiency
what are the risk factors for osteoporosis?
postmenopause alcohol smoking immobility malnutrition e.g. low BMI or ED malabsorption e.g. crohns disease or coealic white or asian race Fhx hypogonadal states endocrine disorders rheumatologic disorders meds such as corticosteroids, antiepileptics, anticoagulants, L-thyroxine
what are common fractures in those with osteoporosis?
vertebral column, ribs, hips and wrists
what are some signs of compression fractures of the vertebral column?
loss of height hunched posture kyphosis sudden back pain radicular pain spinal cord compression cauda equina syndrome
how do we diagnose osteoporosis?
DEXA scan to show decreased bone mineral density
blood test
check for Ca2+, PO3-, creatinine, vit D, TSH levels
what are treatment options for osteoporosis?
Ca2+ and vit D supplementation oral bisphosphonates e.g. alendronate or risedronate denosumab teriparatide SERM e.g. raloxifene Parathyroid hormone fracture management lifestyle changes
what is alendronate used to treat??
corticosteroid induced osteoporosis
pagets disease
preventing osteoporosis in postmenopausal women
how do nitrogen containing bisphosphonates work?
they inhibit farnesyl pyrophosphate synthase in osteoclasts what reduces their activity, reducing bone resorption.
outline the function of RANK-L?
it binds to RANK receptors on monocytes which causes them to fuse together to form and activate osteoclasts
how do osteoclasts cause bone resorption?
they secrete lysosomal enzymes, mainly collagenase, and HCL to digest collagen and dissolve the hydroxyappetite crystals into Ca2+ and Phosphta eions
what are side effects of oral and IV bisphosphonates?
oral - upper GI effects
IV - osteonecrosis of the jaw
how does denosumab work?
it inhibits RANK-L which prevents maturation and activation of osteoclasts
what is the pathology of avascular necrosis?
when blood flow to a bone is interrupted or reduced, causing bone death
what areas does avascular necrosis usually affect?
hips and shoulders
what could cause avascular necrosis?
injury fracture damage to blood vessels long term med use excessive alcoholism
in a nof fracture, what arteries are damaged to cause avascular necrosis?
retinacular arteries (or foveal in pediatric cases)
what are the economic consequences of hip fractures?
Annual cost of fragility fractures in the UK is 4.4 billion and hip fractures account for around 2 billion of this.
how can falls be prevented?
staying physically active testing eyes and ears knowing side effects of medication getting enough sleep limiting alcohol standing uo slowly using an assistive device proper foot care wearing good shoes immediately removing hazards slowly coming off antipsychotics well lit rooms occupation therapists assessing the home being on <4 meds
why are anti-psychotics linked to falls?
they have been associated with hypotension, sedation and gait abnormalities
what is the mental capacity act?
a framework to empower and protect people who may lack capcity to maje some decisions for themselves
whats the criteria for having capacity?
being able to understand, retain, weigh up informatuon and communicate a decision
what are the 5 statutory principles of mental capacity?
presumption of capacity
right to be supported to make their own decisions
rught to make eccentric or unwise decisions
health care providers should make decisions for others based on their best interests
health care providers making a decision for someone should choose the least restrictive option
what is an advanced statement of wishes?
written statement that sets down your preferences, wishes, beliefs and values regarding your future care. - not legally binding!
