How many fractures a year does osteoporosis cause
8.9 million fractures annually
how many fractures does osteoporosis cause in the UK
200,000
- costs £1.73 bn
describe the rise in prevalence of osteoporosis
- 10% of those over 60 years old
- 20% of those over 70 years old
- 40% of those over 80 years old
- 65% of those over 90 years old
what is the risk of osteoporotic fractures greater than
Risk of osteoporotic fractures in 1 year is greater than the combined risk of heart attack, stroke and breast cancer
what are the causes of osteomalacia
- vitamin D deficiency
- deficient sun exposure and vitamin D intake
- celiac disease
- hypophosphoatemic osteomalacia
- x linked
- bariatric surgery
What are the causes of osteoporosis
- menopause
- smoking
- diet
- emotional stress
- excessive alcohol use
- medication
what are the risk factors for osteoporosis
female
smoking
poor nutrition
malabsorption
low oestrogen levels
what does Terrance results show
- shows a decrease in vitamin D (25-OHD) this shows that osteomalacia is present
- calcium is normal
- phosphate is normal
- alkaline phosphatase is high
- parathyroid is normal
- the normal results show that osteoporosis is present
What does terrance have
- he has a mixture of osteoporosis and osteomalacia
what is the difference between osteoporosis and osteomalacia
Osteoporosis
- the ratio between unminerliased and mineralised remains the same but the amount of bone decreases
- this is because the osteoblasts are not producing more bone but osteoclasts are reabsorbing the bone
- everything remains normal
- biomarkers present is cathepsin K, C-telopeptide
Osteomalacia
- the amount of unmineralised bone increased in comparison to osteoporosis
- has low vitamin D
- low calcium
- low phosphate
- high PTH
- high ALP
- biomarter is osteocaltin
what is osteoporosis
Osteoporosis is a complex disorder characterised by an imbalance in the bone remodelling process, which is governed by intricate interactions between various hormones, cytokines and a novel regulatory system
What is the treatment of osteomalacia
- If they have a liver or kidney problem you may need to take vitamin D supplements for the rest of your life
- Dietary – increase calcium = calcium is found in milk, bread, beans and pulses, dried fruit and green leafy vegetables
- Sun or UV exposure = 15 minutes of sun on hands and face 2-3 times a week in spring and summer is sufficient
What is the treatment plan for osteoporosis
- if they are over 75 and have a low trauma fracture then start the patient on bisphosphonate, calcium and vitamin d
- if they are between the age of 50-75 and have had a low trauma fracture refer for a dexa scan
Dexa scan results
- aged 50-65, and the T score is less than -3.2 then start on bisphosphonate, calcium and vitamin D
- if aged 50-65 and the T score is between -2.5 and -3.2 and there is a clinical risk factor then start on bisphosphonate, calcium and vitamin d
- if aged 50-75, and the T score is greater than -2.5, start on calcium and vitamin D
- if age 65-75, and T score is less than -2.5 then start on bisphosphonate, calcium and vitamin d
name two other medication you can take for osteoporosis
- Teriparatide = Intermittent exposure to PTH will activate osteoblasts more than osteoclasts therefore increasing the amount of bone production compared to bone reabsorption
- Denosumab = antibody that binds to RANKL preventing the activation of osteoclasts therefore reducing bone reabsorption, giving as a subcutaneous injection every 6 months
What are problems with bisphosphonate
- Giant osteoclasts
- Osteonecrosis of the jaw
- Atypical fractures
How does bisphosphonate work
- inhibit osteoclast activity by preventing the osteoclasts from binding to the bone and promote osteoclast apoptosis
- increase OPG and decrease RANKL
what are the type of surgical management of the neck of the femur fracture
- intramedullary nail
- cannulated screws
- compression screws
- hemlarthroplasty
What is a physician associate
Physician associates support doctors in the diagnosis and management of patients. As a physician associate, you might work in a GP surgery or be based in a hospital
why is a DEXA scan used to measure bone mineral density
DEXA scans use two low energy x-rays beams (1 mark) this increases the sensitivity of the scan in measuring bone density (1 mark)
What type of bone is most susceptible to developing osteoporosis and explain why?
2 marks
Trabeculae bone 1 mark
Because it turns over quicker and more often than cortical bone.
Assuming that the vitamin D supplement is un- hydroxylated. State how and where it is converted to the most bioactive di-hydroxylated version in the body. You do no need to name the enzymes involved.
2 marks
First it is converted into 25 hydroxyl vitamin D in the liver. 1 mark This is converted in the kidney into the 1,25 dihydroxy vitamin D 1 mark
What is the usual age related bone loss per year for a man? 1 mark
1-2% per year
Explain why a patient with kidney problems is at higher risk of osteomalacia
The 1alpha hydroxylase that adds the seconf hydroxyl unit onto vitamin D is in the kidney. So kidney failure means that there is less of the active 1,25 dihydroxy vitamin D in the body.
