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Musculoskeletal > Biochemical disorders of bone > Flashcards

Biochemical disorders of bone Flashcards

1
Q

What is osteoporosis?

A

A quantitative defect of bone characterised by reduced bone mineral density and increased porosity i.e. the bone is of normal quality, there is just not enough of it

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2
Q

What is the risk associated with osteoporosis?

A

Increased risk of fracture with little or no trauma

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3
Q

What is the definition of osteoporosis on bone mineral density scan?

A

Less than 2.5 standard deviations below the mean peak value of young adults of same race and sex

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4
Q

What is osteopenia?

A

An intermediate stage where bone mineral density is between 1 to 2.5 standard deviations below mean peak value

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5
Q

What is type 1 osteoporosis?

A

Post‐Menopausal Osteoporosis with an exacerbated loss of bone in the post‐menopausal period

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6
Q

What increases risk & severity of type 1 osteoporosis?

A 
Early menopause
White/Caucasian
Lack of exercise
Smoking
Alcohol abuse
Poor diet
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7
Q

What is type 2 osteoporosis?

A

Osteoporosis of old age with a greater decline in bone mineral density than expected

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8
Q

What fractures are particularly likely with type 1 osteoporosis?

A

Colles fractures

Vertebral insufficiency fractures

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9
Q

What increases risk & severity of type 2 osteoporosis?

A 
White/Caucasian
Lack of exercise
Smoking
Alcohol abuse
Poor diet
Lack of vitamin D/sun exposure
Chronic disease
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10
Q

Which fractures are particularly associated with type 2 osteoporosis?

A

Vertebral fractures

Femoral neck fractures

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11
Q

What conditions can osteoporosis occur secondary to?

A

Corticosteroid use
Alcohol abuse
Malnutrition
Chronic disease e.g. CKD, malignancy, rheumatoid arthritis
Endocrine disorders e.g. Cushing’s, hyperthyroidism, hyperparathyroidism

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12
Q

What happens to the levels of serum calcium and phosphate in osteoporosis?

A

They remain the same

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13
Q

What pharmacological treatments can be used to try and prevent further fragility in osteoporosis?

A

Calcium & vitamin D supplements
Bisphosphonates
Desunomab
Strontium

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14
Q

What are the names of some bisphosphonates and how do they help in osteoporosis?

A

Alendronate, risedronate, etidronate

Reduce osteoclastic resorption

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15
Q

What is desunomab?

A

A monoclonal antibody which reduces osteoclast activity

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16
Q

How does strontium help in osteoporosis?

A

Increases osteoblast replication and reduces resorption

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17
Q

What is osteomalacia?

A

A qualitative defect of bone with abnormal softening of the bone due to deficient mineralization of osteoid (immature bone) secondary to inadequate amounts of calcium and phosphorus

18
Q

What is Ricket’s?

A

Osteomalacia in children: abnormal softening of bone due to inadequate amounts of calcium and phosphorus, resulting in deformity of the growing skeleton

19
Q

What are the main causes of osteomalacia and rickets?

A

Insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of or resistance to the action of vitamin D
Phosphate deficiency caused by increased renal losses

20
Q

What are some of the more specific causes of osteomalacia and ricket’s?

A

Malnutrition (Ca & vit D)
Malabsorption (low vit D absorption)
Lack of sunlight exposure
Hypophosphateamia (re‐feeding syndrome, alcohol abuse – impairs phosphate absorption, malabsorption, renal tubular acidosis)
Long term anticonvulsant use
Chronic kidney disease (reduced phosphate resorption & failure of activation vitamin D)

21
Q

What are some of the presenting complaints of osteomalacia & rickets?

A

Bone pain in femur, pelvis or spine
Bone deformity (particularly in rickets)
Fractures easily
Symptoms of hypocalcaemia

22
Q

What are some of the symptoms of hypocalcaemia?

A 
Paraesthesiae
Muscle cramps
Irritability
Fatigue
Seizures
Brittle nails
23
Q

What serum bone biochemistry abnormalities can be seen in osteomalacia?

A

Low calcium
Low serum phosphate
High serum alkaline phosphatase

24
Q

What is the treatment for osteomalacia and rickets?

A

Vitamin D and calcium supplements

25
Q

What is hyperparathyroidism?

A

Overactivity of the parathyroid glands with high levels of parathyroid hormone

26
Q

What are the causes of primary hyperparathyroidism?

A

Benign adenoma
Hyperplasia
Malignant neoplasia

27
Q

What does high levels of hyperparathyroid hormone result in?

A

Hypercalcaemia

28
Q

What are some of the symptoms of hypercalcaemia?

A 
Fatigue
Depression
Bone pain
Myalgia
Nausea
Thirst
Polyuria
Renal stones
Osteoporosis
29
Q

What does biochemistry show in hyperparathyroidism?

A

High levels of PTH
High levels of calcium
Phosphate normal or low

30
Q

What are the causes of secondary hyperparathyroidism?

A

Secondary to hypocalcaemia:
Vitamin D deficiency
CKD

31
Q

What is tertiary hyperparathyroidism?

A

A condition seen in patients with chronic secondary hyperparathyroidism (usually CKD) who develop an adenoma which will continue to produce PTH despite biochemical correction

32
Q

What are some of the complications of hyperparathyroidism?

A

Fragility fractures

Lytic lesions in bone known as Brown tumours or osteitis fibrosa cystica which may need skeletal stabilisation

33
Q

What is the treatment for hyperparathyroidism?

A

Removal of adenomatous gland

Treatment of underlying cause e.g. vitamin D supplementation

34
Q

How is high levels of serum calcium treated?

A

As an emergency:
Iv fluid
Bisphosphonates
Calcitonin

35
Q

What is Paget’s disease?

A

A chronic disorder which results in thickened, brittle and misshapen bones

36
Q

What is the pathological process in Paget’s disease?

A

Increased osteoclast activity results in abnormally increased bone turnover
Osteoblasts try to correct this, forming new bone but failing to remodel the bone sufficiently
This results in increased thickness of bone with low density

37
Q

How might Paget’s disease present?

A 
Asymptomatic 
Incidental finding on Xray
Arthritis
Pathologic fractures
Deformity
Pain
High output cardiac failure (due to increased blood flow through pagetic bone
38
Q

Which bones are commonly affected by Paget’s disease?

A 
Pelvis 
Femur
Skill
Tibia
Ear ossicles
39
Q

What are the radiographic features of Pagets disease

A

Enlarged bone
Thickened cortices
Coarse, thickened trabeculae
Mixed areas of lysis and sclerosis

40
Q

What does biochemistry blood tests show in Paget’s disease?

A

Serum alk. phos. raised
Calcium normal
Phosphorus normal

41
Q

How is Paget’s disease treated?

A

Bisphosphonates

Calcitonin if extensive lytic disease

Musculoskeletal (19 decks)

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