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MSK CORTEXT > 1- Biochemistry > Flashcards

1- Biochemistry Flashcards

1
Q

What is osteoporosis

A

Quantitative defect of bone

Reduced bone mineral density & increased porosity

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2
Q

What are some complications of osteoporosis

A

Fragility of bone

Increased fracture risk occurring after little or no trauma

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3
Q

Describe the physiological loss of bone density

A

Starts around 30 due to a slowing of osteoblast activity
Women lose more bone density after menopause as osteoclast activity increases due to loss of oestrogens protective effects

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4
Q

What are the 2 types of primary osteoporosis

A

Type 1 - post-menopausal osteoporosis

Type 2 - osteoporosis of old age

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5
Q

What are the risk factors for Type 1 primary osteoporosis

A 
Early menopause 
Familial influence 
White Caucasian 
Smoking 
Alcohol abuse 
Lack of exercise 
Poor diet
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6
Q

What is Type 1 primary osteoporosis

A

Post-menopausal osteoporosis
Exacerbated loss of bone in the period after menopause
Colles fractures and vertebral insufficiency fractures tend to occur in this group

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7
Q

What is Type 2 osteoporosis

A

Osteoporosis of old age
Greater decline in bone density than expected

Femoral neck fractures and vertebral fractures predominate in this group

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8
Q

What are the risk factors for type 2 osteoporosis

A

Similar to type 1
Chronic disease
Reduced vitamin D - sunlight or diet
Inactivity

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9
Q

What are some secondary causes of osteoporosis

A 
Corticosteroid use 
Alcohol abuse 
Malnutrition 
Chronic disease 
Endocrine disorders
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10
Q

How do you diagnose osteoporosis

A

DEXA scan to measure bone mineral density

Compare to standard peak values for age, sex etc

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11
Q

How do you treat osteoporosis

A

No treatment can increase density so aim to slow deterioration
Exercise, diet and sun exposure to reduce risk
Calcium and/or vit D supplements
Bisphosphonates
Desunomab - reduces osteoclast activity

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12
Q

Name some bisphosphonates

A

alendronate,
risedronate,
etidronate

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13
Q

What is Osteomalacia

A

Qualitative defect of bone
Abnormal softening of bone due to deficient mineralisation of immature bone
Due to inadequate amounts of phosphorus and calcium

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14
Q

What is rickets

A

Osteomalacia occurring in children

Has effects on the growing skeleton

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15
Q

What are the causes of Osteomalacia and rickets

A

Insufficient calcium or phosphate
Can be malnutrition, malabsorption, lack of sunlight exposure, hypophosphateamia, long term anti-convulsant use and chronic kidney disease

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16
Q

How do Osteomalacia and rickets present

A

Bone pain
Deformities in soft bone
Pathological fractures
Hypocalcaemia symptoms

17
Q

What are symptoms of hypocalcaemia

A 
paraesthesia
Muscle cramps
Irritability
Fatigue
Seizures
Brittle nails
18
Q

How do you treat Osteomalacia and rickets

A

Vitamin D therapy with calcium and phosphate supplementation.

19
Q

What is hyperparathyroidism

A

Overactivity of the parathyroid glands with high levels of parathyroid hormone

20
Q

What are some causes of primary hyperparathyroidism

A

Benign adenoma
Hyperplasia
Rarely a malignant neoplasia

21
Q

What does overproduction of PTH lead to

A

Hypercalcaemia

22
Q

What are the symptoms hypercalcaemia

A

fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis

23
Q

What causes secondary hyperparathyroidism

A

Physiological overproduction of PTH due to hypocalcaemia

Caused by vitamin D deficiency or CKD

24
Q

What is tertiary hyperparathyroidism

A

Seen in people with chronic secondary who then develop an adenoma that continues to overproduce PTH despite treatment

25
Q

What are some complications of hyperparathyroidism

A

Fragility fractures

Lytic lesion in bone - Brown tumours

26
Q

How do you treat hyperparathyroidism

A

Remove the adenomatous gland

Treat underlying cause

27
Q

What is Paget’s disease

A

Chronic disorder that causes thickened, brittle and misshaped bones

28
Q

What causes Paget’s disease

A

Viral infection

Genetic defects

29
Q

Describe the pathogenesis of Paget’s

A

Osteoclast activity increases leading to increased bone turnover
Osteoblasts become more active to compensate but the new bone formed fails to remodel properly
The resulting bone is thicker but brittle and fractures easily

30
Q

How does Paget’s present

A 
Can be asymptomatic and presents as incidental finding on X-ray 
Arthritis 
Pathological fracture
Deformity 
High output cardiac failure
31
Q

Which bones are commonly affected by Paget’s

A

Pelvis, femur, skull, tibia and sometimes the ear ossicles

32
Q

How do you treat Paget’s

A

Bisphosphonates - inhibit osteoclasts
Calcitonin
Joint replacement may be necessary if serious

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