Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UIDC > Problem 13 > Flashcards

Problem 13 Flashcards

1
Q

What is the definition of osteoporosis

A

a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

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

What are the most typical osteoporotic fractures

A

hip and vertebral

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

Anti-resorptive drug

A

so reduced remodelling
denosumab (RANK-L inhibitor) and bisphosphonates (Alendronate, risedronate, and zoledronic acid)
and SERM

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

Anabolic drugs

A

teriparatide stimulates modelling-based bone formation and remodeling with over-filling of remodeling units
In cortical bone, the effects vary according to site; increased total bone area, increased cortical porosity, and the formation of hypomineralised new bone can occur in the early stages of treatment, which results in little change, or a decrease in BMD at sites such as the hip and radius. However, increased bone strength has been reported with longer-term treatment in the hip, and cortical thickness mapping has shown localised increases at sites that are subjected to mechanical loading

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

Sclerostin

A

an osteocyte-derived inhibitor of bone formation. The anabolic effects of sclerostin inhibition are mediated through an early and transient increase in bone formation combined with a sustained decrease in
bone resorption.

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

Risk assessment

A

BMD strongly correlates with risk of fracture
age, sex, previous fractures
FRAX
important to identify patients that we want to treat

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

Prise en charge de l’osteoporose

A

-lifestyle measures: good nutrition, regular physical activity, avoiding harmful lifestyle habits
Comprehensive fall prevention programmes, including
exercise programmes for muscle strengthening, balance training, and correction of visual impairment, can reduce fall frequency but have not been shown to reduce fracture risk
-meds: for high risk patients

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

EI des biphosphonates

A

Common: upper gastrointestinal adverse reactions with oral dosing, acute phase reaction with intravenous dosing
uncommon: bone, joint and muscle pain
rare: eye inflammation, femoral shaft or subtrochanteric
fractures with atypical radiographic features, osteonecrosis of the jaw

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

EI denosumab

A

Uncommon: skin rash
rare: cellulitis, femoral shaft or subtrochanteric fractures with atypical radiographic features, osteonecrosis of the jaw

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

EI oestrogene

A

Breast pain, headache, oedema

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

EI selective oestrogen receptor modulator

A

Common; vasomotor symptoms, muscle cramps uncommon: venous thrombosis

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

EI PTH receptor agonist

A

Common: muscle cramps, increased serum or urine calcium or serum uric acid
uncommon: orthostatic hypotension

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

Example of SERM

A

raloxifene

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

What is sarcopenia

A

loss of muscle mass and function
associated with increased adverse outcomes including
falls, functional decline, frailty, and mortality

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

Symptoms of sarcopenia

A

falling, weakness, slowness, self-reported muscle wasting, or difficulties carrying out daily life activities

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

What score to use for sarcopenia

A

The SARC-F has a low sensitivity but high specificity. This screening instrument has five questions addressing strength, assistance in walking, rising from a chair, climbing stairs, and falls.

17
Q

How to diagnose sarcopenia

A
  • measuring muscle mass (DXA)
  • measuring muscle strength (grip strength)
  • measuring physical performance (timed up and go)
18
Q

The 3 main differential diagnosis for sarcopenia

A

malnutrition (usually normal muscle strength but mass diminue)
cachexia (severe weight loss and muscle wasting associated with cancer, HIV and AIDS, or end-stage organ failure)
frailty

19
Q

Pathophysiology of sarcopenia

A

Ageing appears to result in an imbalance between muscle protein anabolic and catabolic pathways, leading to overall loss of skeletal muscle. Cellular changes in sarcopenic muscle include a reduction in the size and number of myofibers, which particularly affects type II fibers. This is partly due to transition of muscle fibers from type II to type I with age, together with intramuscular and intermuscular fat infiltration (myosteatosis), and a decreased number of type II fiber satellite cells. Molecular changes in sarcopenic muscle involve alterations to the complex signalling pathway that includes insulin-like growth factor 1 and others. Deregulation in skeletal muscle gene expression, probably mediated through epigenetic changes and modulated via microRNAs.

20
Q

ttt of sarcopenia

A
  • non pharmacological: physical activity, vitamin D and nutrients, eating proteins
  • pharmacological: vitamin D, ostrogen-progesteron, DHEA, GH, GHRH, IGF-1, testosterone…
21
Q

Which meds if taken by patients are considered high risk and so have to take osteoporosis meds

A

corticoids
anti-aromatase
androgen suppression therapy

22
Q

Meds for osteoporosis

A

-antiresorptives, namely, selective oestrogen receptor modulators (SERMs: raloxifene, basedoxifene), bisphosphonates (alendronate, risedronate, ibandronate, zoledronate)
and monocloncal antibodies (denosumab)
-bone forming agents (teriparatide)
-and, very recently approved in Switzerland, a new monoclonal antibody, romosozumab, with dual antiresorptive and anabolic effects.

23
Q

Which med is in first line for high risk patients

A

anti-resorptive

24
Q

Which med is in first line for very high risk patients

A

anabolic drugs

25
Q

Risk stratification of patients

A 
taking into consideration:
-previous fractures
-BMD
-age and other risk factors
FRAX
\+ evaluation of risk of falls (parkinson, urinary incontinence, previous fall)
26
Q

When are patients considered in imminent risk

A

recent osteoporotic fracture if they are >65 years

27
Q

How to treat patients with imminent risk or very high risk with vertebral fracture

A

teriparatide followed by an anti-resorptive

we can give romosozumab (if no cardiac risks)

28
Q

How to treat patients with imminent risk or very high risk with hip fracture

A

zoledronate if renal function is okay
if not, denosumab
we can give romosozumab (if no cardiac risk)

29
Q

How to treat patients with high risk

A

anti-resorptive

not denosumab for corticoid induced osteoporosis

30
Q

How to treat patients with moderate risk

A

SERM if they don’t take any hormonal replacement

biphosphonate

31
Q

How to treat patients with low risk

A

lifestyle changes
vitamin D
calcium if necessary

32
Q

What is Rhabdomyolysis

A

Rhabdomyolysis due to muscle ischemia can develop in persons who are unable to get up after a fall and are
“found down” after a long period

33
Q

Risk factors for falls

A
  • deficits in gait and balance
  • medications
  • alcohol
  • visual deficits
  • impairments in cognition and mood
  • environmental hazards
  • cardiovascular disease (syncope)
34
Q

2 of the most at risk patients if they fall

A

osteoporitc

and patients on anti-coagulants (risk of bleeding)

35
Q

When is a timed up and go test considered pathological

A

> 12 seconds

36
Q

How to manage patients with a risk of falling

A
  • exercise
  • physiotherapy
  • vision exams
  • testing cognition
  • reviewing their meds
  • testing for orthostatic hypotension
  • vitamin D
  • ergotherapy

UIDC (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions