Osteoporosis

26 important questions on Osteoporosis

What does bone lose with aging?

It's load baring function

What are the three determinants of bone strength (e.g. fracture resistance)?

  • amount of bone material
  • quality of the bone material
  • structural organisation of the bone material

Why do women are more susceptical to the effects of osteoporosis than men?

Women have less bone mass than men and their bone mass drops significantly after the menopause. This is caused by the decrease in estrogen levels after the menopause.
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Which cells are the major contributors to bone homeostasis?

  • Osteoclasts
  • Osteoblasts
  • Osteocytes
  • Bone lining cells

Do osteoblasts and osteoclasts have the same lineage?

No, they both stem from the bone marrow but osteoclasts are derived from heamatopoietic precursors (which are also the precursors of several immune cells) and osteoblasts are derived from Osteoblastic progenitors.

Name the difference between acute osteoporosis and chronic osteoporosis in terms of the bone formation/resorption balance.

Both are skewed towards bone resorption, however, in acute osteoporosis the bone formation is enhanced too, though too little to make up for the increased bone resorption. In chronic osteoporosis bone formation is dramatically reduced and bone resorption dramatically increased.

Name two risk factors for osteoporosis.

  1. loss of estrogen (menopause)
  2. chronic low grade inflammation

What are the two key molecules regulating bone resorption?

  1. RANK-L
  2. OPG

Which of the four major cells in bone homeostasis can influence both bone formation and bone resorption?

The Osteocyte. The osteocyte makes the most RANKL, which inhibits osteoclast bone resorption, and they produce Sclerostin, which inhibits osteoblast bone formation!

Which cells sense mechanical load?

Osteocytes

What kinds of mechanical loading are distinghuised by osteocytes?

Strain and Sheer-stress

What is the role of prostaglandins in bone biology?

Prostaglandins are produced by osteocytes and mediate stimulation of osteogenic differentiation of stem cells.

What is the role of IL-6 in bone biology?

IL-6 is produced by osteocytes and acts as a signaling molecule:
IL-6 is essential for osteoblast differentiation
but an excess directly stimulates osteoclasts.

Which inflammatory cytokines disrupt the mechanosensing signaling of osteocytes?

TNFa and IL-1b both influence the NO response of osteocytes

How can exercise reduce the effects of inflammatory cytokines on the bone homeostasis?

Exercise enhances mechanical loading of the bone, which counterweight the effects of the inflammatory cytokines.

What does osteocalcin do in cells outside of the bone?

Increase glucose sensitivity of many cell types.

How do osteoblasts communicate with osteoclasts?

Mostly by RANKL and OPG

How does exercise affect bone remoddeling?

Mechanically loaded bones and shear stress stimulates the osteocytes. The osteocytes, in turn, decrease the production of sclerostin and increase the expression of RANKL, IL-6 NO and Prostaglandin E2

Explain the decreased sensitivity to mechanical loading in osteocytes by inflammation?

Osteocytes signal via cytokines from which the balance can be influenced by inflammation and could therefore decrease osteocyte sensitivity.

What makes Rheumatoid arthritis so hard to treat?

RA is a systemic disease with high inflammation markers

What can be said in about RANKL in active RA synovial tissue?

It is dramatically elevated.

What is a good immune indicator of RA severity?

High levels of CRP

How can the effects of RA be somewhat blocked?

by creating antibodies or conventionals

How effective are the medicines used to treat RA?

Pretty much the same effect after a year on treatment.

Why should you use the QCT over DEXA?

It can also measure trabecular bone structure AND microfractures

From what phase in the pathology of RA is ACPA?

The autoimmune phase as it 'primes' the synovial and increases fenestration of the bone

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