Bones
Osteoporosis is Latin for what?
Porous bones
Osteoporosis can be diagnosed by a DEXA scan. What T score indicates osteoporosis?
< - 2.5
What are the two types of primary osteoporosis?
Postmenopausal and Senile
Calcium and vitamin D supplements should be given to:
A) Everyone
B) Only those who are frail and institutionalised
C) Those who are deficient in calcium and/or vitamin D
C) Only those who are deficient in calcium and/or vitamin D
Bones are made up of which two types of bone?
Cortical bone & Trabecular (cancellous) bone
Name three risk factors for osteoporosis.
Non-modifiable:
History of minimal trauma fracture. Family history of hip fracture. Height loss >3cm and/or back pain suggestive of vertebral fracture. Female. Older age. Premature menopause or hypogonadism.
Modifiable:
Low body weight (BMW < 20), low muscle mass and strength, low physical activity/sedentary lifestyle, poor balance, smoking, high alcohol intake, suboptimal vitamin D and calcium levels, co-existing medical conditions, prolonged medication use (e.g. glucocorticoids).
Approximately what percentage of women die within one year of fracturing a hip?
20%
What three components should an exercise program for someone with osteoporosis consist of?
A) Moderate-high intensity progressive resistance training
B) Weight-bearing impact exercise
C) Challenging balance training
What are the four 'purposes' of bone?
1. Locomotion/muscle attachment
2. Protection of internal organs
3. Blood cell formation
4. Regulation of mineral homeostasis
Apart from a DEXA scan, how else can a 'presumptive diagnosis of osteoporosis' be made?
Individuals over 50 who sustain a minimal trauma fracture
In Australia what percentage of women over 70 years have osteoporosis?
43% (will accept 40-45%)
What protein intake is recommended for frail and institutionalised older people to help prevent fracture?
1-1.2g/kg body weight per day
What are the three types of bone cells and their roles?
Osteoclasts: resorb bone tissue
Osteoblasts: deposit bone
Osteocytes: mixed role in initiating and driving bone remodelling
What is the FRAX and what does it tell us?
'Fracture risk assessment tool'.
Calculated your 10-year probability of suffering a fracture
The average reduction in BMD during the menopausal transition period is __%
10%
What class of pharmacological medications are considered first-line therapy for most patients with osteoporosis?
Bisphosphonates
It's estimated that an increase in peak bone mass of 10% can delay osteoporosis by how many years?
13 years
Why is a T score (or the results of a DEXA scan) not the whole picture when it comes to osteoporosis and fracture risk?
A DEXA scan only tells you the quantity of bone over a scanned area. The result is your bone mineral density (BMD).
However, a DEXA scan doesn't give you any information regarding the quality of bone over the scanned area. It cannot distinguish between cortical (dense outer shell) and trabecular (spongy interior) bone structure or provide details about the plates, rods, and connectivity of the inner bone.
Briefly describe the pathophysiology of post-menopausal osteoporosis.
Characterised by a decline in estrogen levels.
Estrogen helps supress the activity of osteoclasts (the cells that break down bone) whilst also supporting the function and survival of osteoblasts (the cells that lay down new bone).
Romosozumab is the most recent pharmacological therapeutic addition.
What makes Romosozumab different from pre-existing pharmacological interventions?
Romosozumab is a bone anabolic agent. Meaning it increases bone formation as well as reducing bone resorption.
Other pharmacological interventions (bisphosphonates and denosumab) work by reducing bone resorption only.