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LOCO > 5 - Ageing and Metabolic Bone Conditions > Flashcards

5 - Ageing and Metabolic Bone Conditions Flashcards

1
Q

What percent of bone mass is usually lost in a year from the age of 40+?

A

0.7% a year

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2
Q

After menopause, what is the percentage of bone mass loss in women?

A

2-9% a year

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3
Q

What is a T score

A

number of standard deviations from the mean young (30 yr) same gender and ethnicity

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4
Q

What is the Z score

A

number of standard deviations from mean aged, same gender and ethnicity

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5
Q

What is osteopenia

A

A precursor to osteoporosis

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6
Q

Where do you usually measure for osteoporosis

A

Neck of femur

Vertebral bodies

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7
Q

What does the DEXA scan measure

A

Bone density

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8
Q

Osteopenia T score

A

-1 to -2.4

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9
Q

Osteoporosis T score

A

below -2.5

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10
Q

What does DEXA stand for

A

Dual Energy X-ray Absorptiometry

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11
Q

Prevalence of osteoporosis

A

2% at 50 years

Greater than 25% at 80 years

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12
Q

What bones are more susceptible to osteoporotic bone loss

A

Neck of femur
Vertebral bodies
High proportion of trabecular bone

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13
Q

What treatments are given for osteoporosis?

A 
Calcium supplements
Vitamin D supplements
HRT
Selective oestrogen receptor modulator
Biphosphonates 
Denosumab
Teriparatide
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14
Q

What is the minimum time HRT is given for

A

5 years

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15
Q

Example of a Selective Oestrogen Receptor Modulator

A

Raloxifene

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16
Q

What is the MoA of biphosphonates

A 
Inhibitors of bone reabsorption
Inhibit osteoclast activity
Promote osteoclast apoptosis
Increase OPG production
Decrease RANKL expression
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17
Q

Complications of biphosphonates

A

Giant osteoclasts
Osteoncrosis of the jaw
Atypical fractures

18
Q

What is teriparatide

A

A recombinant PTH

Will activate osteoblasts without activating osteoclasts

19
Q

What is Denosumab + how often does it need to be given

A

Monoclonal antibody which binds to RANKL and prevents it’s signalling
therefore inhibits the formation of osteoclasts

Needs to be given every 6 months via subcutaneous injection

20
Q

What is osteomalacia

A

Insufficient calcium and phosphate to mineralise bone osteoid
The bones are softer and more liable to bend or fracture

21
Q

Cause of osteomalacia

A

Lack of vitamin D

22
Q

What is rickets and why is it more deforming

A

Childhood osteomalacia

More deforming as in children the epiphyseal growth plate is open

23
Q

What would lab results show in osteomalacia

A

Low serum calcium and phosphorus

High alkaline phosphatase

24
Q

Why is alkaline phosphatase high in osteomalacia

A

Due to high osteoblast activity

25
Q

What would an X-ray look like in someone with osteomalacia

A

Pseudofractures = unmineralised sections of bone

Areas of unmineralised bone

26
Q

What is the normal level of unmineralised osteoid?

A

<20%

27
Q

What colour is unmineralised and mineralised osteoid on biopsy

A

Orange - unmineralised (up to 100% in osteomalacia)

Green - mineralised

28
Q

How do you treat osteomalacia

A

Vitamin D supplements
Increase calcium in diet
Sun or UV exposure

29
Q

Calcium containing foods

A

Milk
Bread
Beans
Green leafy vegetables

30
Q

What is Pagets disease also called

A

Osteitis Deformans

31
Q

Percentage population with pagets

A

3% >50 y/o

32
Q

What are the 3 stages of Pagets disease

A

1) Increased rate of bone resorption (large no of giant osteoclasts)
2) Compensatory phase (Increased bone formation as woven bone, accelerated deposition in a disorganised manner)
3) Burn out phase (Sclerotic) - Bone hypercellularity may deminish leaving dense pagetic bone
Hypervascular bone marrow
Irregular thickened trabeculae
Bone marrow replaced by fibrovascular CT

33
Q

Which bones are most commonly affected in osteomalacia?

A 
Pelvis
Femur
Vertebrae
Skull
Tibia
34
Q

What is osteosarcoma?

A

A rare complication of pagets disease where a cancer forms

35
Q

Where are osteosarcomas usually

A

Long bone

Near the knee

36
Q

How do you treat osteosarcoma

A

Remove part of the bone

Limb amputation

37
Q

How do you treat osteomalacia

A

Biphosphates
Calcium and vitamin D supplements
Pain management
Surgery

38
Q

How long does an osteomalacia patient have to take biphosphates

A

Oral - 2-6 months

IV single infusion to 3 infusions

39
Q

What is sclerostosis also known as

A

Aka van buchem syndrome

40
Q

Genetics of sclerostosis

A

Autosomal recessive

41
Q

Features of sclerostosis

A

Endosteal hyperostosis
Resistance to fracture
Excessive height

42
Q

Pathophysiology of sclerostosis

A

Absence or reduced production of sclerostin

therefore osteoblasts are not inhibited

LOCO (25 decks)

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