27. Bones Flashcards
Hormones that affect calcium?
Increase - PTH (phosphate trashing hormone - decreases phosphate), calcitriol (raises it the most)
Decrease - calcitonin (made in parafollicular cells of thyroid)
What is primary hyperparathroidism?
Parathyroid adenoma or hyperplasia
Gland produces lots of PTH, causes increase calcium and low phosphate
What is secondary hyperparathroidism/osteomalacia?
Vitamin D deficiency.
CKD.
Liver disease.
Causes osteomalacia.
Where there’s a lack of active vit d (calcitriol) so low calcium. Increase phosphate only in CKD though.
What is tertiary hyperparathroidism?
Long-term PTH stimulation through secondary.
Causes hyperplasia where you get autonomous secretion of PTH with no negative feedback.
Causes of high calcium?
Primary and tertiary hyperparathyroidism
Malignancy e.g. MM
Sarcoidosis
Thiazine diuretics
Signs and symptoms of high calcium?
Stones, bones, thrones, abdo moans and psy groans.
Stones, bone pain, polyuria, abdo pain, psych conditions
It can cause pancreatitis too
Causes of low calcium?
Secondary hyperparathyroidism (vit d deficiency)
Surgical complications - thyroid surgery
Autoimmune hyperparathyroidism
Signs and symptoms of low calcium?
CATs go numb
Trousseau’s sign
Chvostek’s sign
What is saponification?
Build up of calcium in pancreatitis where it forms salts. This depletes calcium levels, so patients have low calcium levels.
Risk factors and symptoms for primary hyperparathyroidism?
MEN-1 or MEN-2
Hypertension
Signs of hypercalcaemia
On X-RAY -
Subperiosteal bone resorption
Acro-osteolysis
Pepper pot skull
Secondary hyperparathyroidism signs and symptoms?
This is a lack of vit d, so causes osteomalacia/rickets
Fractures Bone pain Proximal myopathy (cushing's, osteo, thyrotoxicosis can cause) Fatigue Hypocalcaemia symptoms
In kids - bowed legs and knock knees
Hyperparathyroidsism investigations?
Bloods - U&Es, LFTs (for liver cause of secondary), calcium, phosphate, PTH
Management of primary hyperparathyroidism?
Acute hypercalcaemia
- IV fluids
- Bisphosphonates
- Total parathyroidectomy (risk recurrent laryngeal nerve damage)
- Cinacalcet if not suitable for surgery
How do we manage secondary hyperparathyroidism?
IV calcium infusion (calcium gluconate)
- Vitamin D (inactive)
- Treat CKD and give active vit d
What is paget’s disease and its phases?
A genetic disorder of bone remodelling
- Lytic phase with hyperactive osteoclasts
- Mixed phase - compensation with osteoblasts
- Sclerotic phase - hyperactive osteoblasts cause abnormal bone formation
Onset is insidious
Can affect nerves (cause hearing problems)
Investigations for paget’s disease?
Basic bloods.
Calcium, phosphate and PTH will all be normal.
However, ALP will be increased.
Serum CTX and P1NP are bone resorption and formation markers respectively.
X-rays Bone scan (Tec 99)
How do we manage paget’s disease?
Largely supportive
Bisphosphonates (alendronic acid/zoledronic acid) for symptomatic patients
What is osteoporosis and causes?
Reduced bone density
Primary - post-menopausal, elderly
Secondary - drugs (steroids, thyroxine), cushing’s disease, hyperPTH, hyperT
GI - coeliac’s, IBD
Signs and symptoms of osteoporosis?
Often asymptomatic
Fragility fractures
Back pain
NOF, colles, vertebral most common (there’s a 4th)
Investigations for osteoporosis?
Bloods (usually all normal) X-rays DEXA scan - T score - less than -2.5 is Osteoporosis. between that and -1 is osteopenia - Z score (same as T but age matched)
FRAX score is 10 year risk of developing fragility fractures.
How to treat osteoporosis?
Bisphosphonates
Calcium and vitamin D supplements
SLIDE IMAGES!!!!! THE TABLE looks so helpful pls
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