B6-066 Pagets Disease Flashcards
what physiologic states can be associated with ALP elevation in adults? [2]
pregnancy
fed state
first test that can be used to help differentiate the source of elevated ALP
ggt
test that is a specific marker for bone osteoblast activity
bone ALP
**fractionated out to be bone specific
causes of elevated bone ALP [5]
primary hyperparathyroidism- check Ca
thyrotoxicosis- check TSH
osteomalacia- check vit. D
bone malignancy
Paget’s
what imaging might you want to evaluated for Pagets? [2]
Xray
radionucleotide bone scan
X ray features of Pagets [2]
coarsened trabeculae
thickened cortical bone
areas most commonly affected by Pagets [3]
femur, knee, and pelvis
Paget’s is caused by overactive […]
osteoclasts
**leads to compensatory increase in osteoblastic formation
describe the structural changes in bone induced by Paget’s
expanded, less compact, more vascular
**more susceptible to fracture
focal areas of increased and disorganized bone remodeling
Paget’s
inheritance pattern of familial Pagets
AD w/ incomplete penetrance
bone pain in Paget’s is due to [2]
increased metabolic activity
osteoarthritis
indications of treatment of Paget’s [4]
- symptoms from active disease
- pagetic lesions involving the weight bearing skeleton
- metabolically active pagetic lesions as defined by bone turnover and bone scan
- potential consequences of bony overgrowth (hearing loss)
treatment for Pagets
bisphosphonates
osteoclast takes it up, rendering it inactive
bisphosphonates
most common side effects of bisphosphonates [3]
upper GI irritation (oral)
acute phase reaction (IV)
severe MSK pain
acute phase reaction that occurs with IV bisphosphonate […] with subsequent doses
decreases
teeth extraction/dental abscess can be a risk factor for […] caused by bisphosphonates
osteonecrosis of the jaw
if a bisphosphonate is contraindicated, what can be used as treatment
calcitonin take indefinitely
in a younger patient with more limited disease, consider
oral bisphosphonates
oral bisphosphonates [2]
risedronate
alendronate
IV bisphosphonate
zoledronic acid
abnormal “mosaic” bone archteicture
Paget’s
[identify the condition based on the following lab values:
serum Ca+: high
Phos: low
ALP: high
PTH: high
primary hyperparathyroidism
what imaging is used to localize the disease?
bone scan
paget disease presents as […] in a majority of patients
incidental finding
ALP will begin to fall within […] days of treatment
10
[identify the condition based on the following lab values:
serum Ca+: normal
Phos: normal
ALP: high
PTH: normal
paget’s
[identify the condition based on the following lab values:
serum Ca+: low
Phos: high
ALP: high
PTH: high
secondary hyperparathyroidism
[identify the condition based on the following lab values:
serum Ca+: normal
Phos: normal
ALP: normal
PTH: normal
but decreased bone mass on DEXA
osteoporosis
osteoblast precursor cells
mesenchymal stem cells
ALP is higher in pregnancy due to
placental synthesis of ALP
**need to seek out the reference range for pregnant patients in order to adequately assess
[…] can be used to determine if elevated ALP is due to bony or hepatobiliary origin
GGT
**if elevated, suggests hepatobiliary
in Paget’s, osteoclast activity is […] and osteoblast activity is […]
increased
increased
**both are increased, however, osteoclast activity outweighs osteoblast activity
Paget typically onsets after what age?
55
what populations is Pagets more common in?
men
european descent
first-line medication for Paget
bisphosphonates
oral bisphosphonates should not be used in patients with […]
esophageal disorders
**use IV zolendronic acid
second line treatment for Pagets
calcitonin
**if bisphosphonates are contraindicated
bisphosphonates inhibit osteoclastic activity via attachment to […] sites on bony surfaces
hydroxyapatite
when the osteoclasts resorb bone impregnanted with bisphosphonates, it impairs the activity of the […]
ruffled border
**cannot adhere to surface
