Bone

Question 1

Definition of ONJ

Answer 1

Exposed necrotic bone that doesn’t heal after eight weeks in the absence of a history of radiation

Question 2

Risk factors for ONJ

Answer 2

Dosage and duration of bisphosphonates
IV bisphosphonates
Glucocorticoids
Cancer and chemo
Smoking
Poorly fitting dentures
Invasive dental procedures.
Pre-existing dental disease

Question 3

Stages of ONJ
Year of guideline

Answer 3

2014 - AAOMFS
0-non-specific clinical findings, no exposed bone
1-exposed bone, no symptoms or infection
2-exposed bone with infection
3-exposed bone with infection and at least one of:
Exposed and necrotic bone causing fracture.
Fistula or communication outside oral cavity.
Osteolysis beyond mandible or sinus floor

Question 4

Which fractures does Ralixifene reduce?

Answer 4

Vertebral

Question 5

Contraindication to anabolic treatment

Answer 5

History of skeletal radiation.
Pageants disease
Unexplained elevation of alk phos

Question 6

Contraindications to Evenity

Answer 6

MI Or stroke within the proceeding year

Question 7

Change in growth plate with Rickets

Answer 7

Smaller and cupped

Question 8

All phos in XLH vs nut rickets

Answer 8

Both high, esp XLH

Question 9

FGF23
Mechanisms

Answer 9

Peptide made in bone
Bonds
Dec renal phos reabsorption
Dec serum phosphate
Decreases 125D
Can be Inappropriately nl

Question 10

FGF23 mediated Rickets causes

Answer 10

XLH
ADHR
ARHR
TIO
Fibrous dysplasia/Mccune Albright

Question 11

Gene XLH

Answer 11

PHEX

Question 12

Inheritance XLH

Answer 12

Often sporadic
Can look sporadic bc of var penetrance

Question 13

XLH mimic

Answer 13

Ankylosing spondylitis due to enthesopathy

Question 14

XLH manifestations

Answer 14

Craniosynostosis
SN hearing loss ? Moa
Dental probs - gingival dz, abscesses

Question 15

risk of giving phos alone to XLH

Answer 15

Raises PTH

Question 16

TARGETS

Answer 16

Phos mid range ok if mild low to avoid stones

Heck ca if giving calcitriol