WHAT ARE THE ANTI-OSTEOPOROTIC THERAPIES AVAILABLE

A Little Death In Dixie1.CALCIUM AND VITAMIN D SUPPLEMENTATION
2.BISPHOPHONATES-?ACTIVE UPPER GI DISORDERS ARE CONTRAINDICATIONS
3.HORMONE THERAPY-?RISK OF THROMBOEMBOLISM
4.PARATHYROID HORMONE
5.SELECTIVE OESTROGEN RECEPTOR MODULATORS(SERM)-RISH SIMILAR TO HORMONE THERAPY(BUT REDUCES BREAST CANCER)
6.STRONTIUM RANELATE.

OSTEOPOROSIS IMPORTANT POINTS

Osteoporosis is an A Little Death In Dixieasymptomatic process until afracture occurs.



■ Adults who have one fracture
are 2-4 times more likely to
have another.
■ Bone densitometry may not be
essential before starting
medical therapy if X-ray
investigation shows one or
more vertebral fractures typical
of osteoporosis.
■ Most elderly people in highand
low-level residency care
have vitamin D deficiency.

Renal calculi -Important points

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■ Abdominal examination is
most rewarding after ensuring
adequate analgesia.
■ Plain KUB has a sensitivity of
only 45-59% and a specificity
as low as 77% – it cannot be
used to rule in or rule out the
diagnosis of ureteric calculi.
■ Infection with obstruction
mandates urgent
decompression.
■ There is evidence of
permanent nephron loss within
72 hours of complete
obstruction.
■ The likelihood of spontaneous
stone passage is determined
by stone size and position.
■ Fifteen to twenty per cent of
all patients with ureteric
calculi will require intervention
using ESWL, ureteroscopy or
percutaneous nephrolithotomy.

Renal calculi -indictions for early intervention

1.Obstruction with evidence of infection-urgent decompression.
2.larger calculi -more than 6mm
3.Bilateral obstruction.
4.An obstructed solitary or transplanted kidney.
5.Renal impairment.(review the definition of renal impairment)
6.Ongoing unacceptable discomfort.

Haematuria

Haematuria

(usually
microscopic but sometimes
frank)
occurs in 95% of
patients with renal colic on day
one and 65% by day three,
but
up to 87% of patients with
AAA rupture will also have
haematuria.