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MSK > Biochemical Disorders of Bone > Flashcards

Biochemical Disorders of Bone Flashcards

1
Q

Biochemical Disorders

A

Osteoporosis
osteomalacia
hyperparathyroidism
Paget’s disease of bone

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2
Q

Osteoporosis

A

Qualitative defect in bone

Bone mineral density less than 2.5 SD below the mean

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3
Q

Osteoporosis Characteristics

A

Increase bone porosity
Decreased bone mineral density
- normal bone quality just less of it

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4
Q

Osteoporosis Types

A

Post-menopausal Osteoporosis

Osteoporosis of old age

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5
Q

Post- menopausal Osteoporosis Aetiology

A

Increased osteoclastic response after the menopause

Decreased oestrogen

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6
Q

Post-menopausal osteoporosis risk factors

A 
Early menopause
Genetics
Alcohol
White caucasian
Smoking
Lack of exercise
Poor diet
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7
Q

Post Menopausal Osteoporosis Fractures

A

Colle’s Fracture

  • Fracture involving the distal radius where the fractured bone is bent backwards
  • Can be responsible for carpal tunnel syndrome

Vertebral Insufficiency Fracture

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8
Q

Osteoporosis of Old Age Risk Factors

A 
Females
Genetics
White Caucasian
SMoking
Alcohol
Lack of exercise
Poor diet
Chronic disease
Lack of sunlight
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9
Q

Osteoporosis of Old Age Fractures

A

Femoral Neck Fracture

Vertebral Fracture

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10
Q

Osteoporosis of Old Age can be secondary to:

A 
Corticosteroids
Alcohol Abuse
Malnutrition
Chronic Disease
- Malignancy
- CKD
- Rheumatoid Arthritis

Endocrine Disorders

  • Cushing’s
  • Hyperthyroidism
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11
Q

Osteoporosis Complications

A

Increased fracture risk

Fragility of bone

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12
Q

Osteoporosis Diagnosis

A

DEXA bone scan

Normal serum calcium and phosphate

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13
Q

Osteoporosis Treatment

9

A

Calcium Supplements

Vitamin D

Biphosphonates

  • Reduced osteoclast activity
  • Best treatment option
  • Alendronate, Risedronate, Etidronate

Desunomab

  • Monoclonal Antibody
  • Decreases osteoclast activity

Strontium

  • Increased. osteoblast replication
  • Decreases osteoclastic activity

Zoledronic Acid
- Once yearly IV biphosphonate

Raloxifene

  • Oestrogen receptor modulator
  • Risk off DVT

Hormone Replacement

Intranasal Calcitonin

  • Increased risk of breast and endometrial cancer and DVT
  • Not preferred
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14
Q

Osteomalacia

A

Qualitative defect in bone

Abnormal softening of bone due to deficient mineralisation of osteoid

Decrease phosphate and calcium

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15
Q

Osteomalacia Aetiology (6)

A

Insufficient Calcium

  • Lack of intestinal uptake
  • low dietary intake
  • malnutrition

Deficiency or resistance to Vit. D

  • Malabsorption
  • lack of sunlight

Phosphate Deficiency

  • Increased renal loss
  • Refeeding syndrome
  • Alcohol abuse

Long term anticonvulsant use

Chronic Kidney Disease

Inherited Disease

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16
Q

Osteomalacia Symptoms

A

Bone Pain

  • Pelvis
  • Spine
  • Femur

Deformities from soft bones

Pathological fractures

Hypocalcaemia

  • Paraesthesia
  • Muscle cramps
  • Irritability/ anxiety
  • Fatigue
  • Seizures
  • Brittle nails
  • Heart failure

Pseudofractures

17
Q

Pseudofractures common sites

A

Pubic rami
Proximal femur
Ulna
Ribs

Looser Zones

  • incomplete stress fractures that transverse across the bone
  • Usually at right angle to associated cortex

Milkman Lines

18
Q

Osteomalacia Biochemistry

A

Decrease phosphate
Decreased calcium
Increased ALp

19
Q

Osteomalacia Treatment

A

Vitamin D therapy
Calcium Supplementation
Phosphate supplementation

20
Q

hyperparathyroidism

A

Overactivity of parathyroid glands resulting in increased PTH

21
Q

Hyperparathyroidism Aetiology

A

Primary

  • Benign adenoma
  • Hyperplasia
  • Malignant neoplasm

Secondary

  • Physiological overproduction of PTh as a result of hypocalcaemia (Hypocalcaemia as result of Vit. D deficiency, CKD)
  • Decreased phosphate excretion and inactive activation of Vitamin D (can lead to osteomalacia, sclerosis of bone and calcification of soft tissues0

Tertiary
- Patients with secondary hyperparathyroidism who develop an adenoma

22
Q

hyperparathyroidism Consequences

A

Hypercalcaemia

  • Fatigue
  • Depression
  • Bone pain
  • myalgia
  • nausea
  • thirst
  • polyuria
  • renal stones
  • osteoporosis

Fragility fractures

Lytic lesions in bone: brown tumours (potential skeletal stabilisation may be required)

23
Q

Hyperparathyroidism biochemistry

A

Increased PTH
Increased calcium
Normal/ low phosphate

24
Q

Hyperparathyroidism Treatment

A

Removal of adenomatous gland

Treatment of underlying cause
-Vitamin D supplement

Treatment of hypercalcaemia

  • Iv fluids
  • biphosphonates
  • calcitonin
25
Q

Paget’s disease of Bone

A

Chronic disease of bone causing thickened, brittle and misshaped bone

26
Q

Paget’s disease of Bone Aetiology

A

Viral infection with paramyxoviruses

Genetic defects

27
Q

Paget’s disease of Bone epidemiology

A

Elderly

28
Q

Paget’s disease of Bone pathophysiology (4)

A
  1. Potentially due to exaggerated Vitamin D response, there is increased osteoclast activity
  2. In response, osteoblasts become more active. to compensate
  3. New bone is formed yet fails to successfully remodel
  4. Resulting bone is thicker and more brittle
29
Q

Paget’s disease of Bone- bones affected

A 
Pelvis
Femur
Skull
Tibia
Ear Ossicles
- Conductive deafness
30
Q

Paget’s disease of Bone Consequences

A 
Arthritis
Pathological fractures
Deformities
Pain
High output cardiac failure
31
Q

Paget’s disease of Bone

A

Often asymptomatic

32
Q

Paget’s disease of Bone Appearance on X-ray

A

Enlarged bone
thickened cortices
thickened and coarse trabeculae
Mixed areas of lysis and sclerosis

33
Q

Paget’s disease of Bone biochemistry

A

Raised Alp
normal calcium
Normal phosphate

34
Q

Paget’s disease of Bone treatment

A

Biphosphonates
Calcitonin
Joint replacement
Stabilisation of femoral fractures with long intramedullary nails

MSK (35 decks)

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