Bone Disease Flashcards
What is the definition of Osteoporosis?
Metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone leading to increased risk of fractures, the bone is 2.5 SD away from being healthy
What are the secondary causes of osteoporosis?
Hyperparathyroidism Gh deficiency Malabsorption Malignanc Rheumatic drugs Amenorrhea Oestrogen Deficiency
What is the pathogenesis of osteoporosis?
Increased breakdown by osteoclasts and decreased production by osteoblasts
What is the presentation of Osteoporosis?
Fractures on low impact
Asymptomatic
Crushed vertebra Colles’s fractures
What is the GOLD standard investigation on osteoporosis? What does this scan look at?
Dexa Bone Scan
Bone mineral density
What are some other investigations to do in osteoporosis?
Plain radiograph
FBC’s
What are the prophylactic measures in OP?
HRT
Physiotherapy
Stop smoking and alcohol
Calcium and vitamin D for those on steroids
What are the 4 medical management options for osteoporosis?
Biphosphonates Vitamin D/ calcium Raloxifene Strotium ranelate Risk factor assessment
What is Rickets?
Severe vitamin D or calcium nutritional deficiency in children
Before the epiphyseal plates have closed
What is osteomalacia?
Severe vitamin D or calcium nutritional deficiency in Adults
After the epiphyseal plates have closed
What is the most common cause of rickets?
Lack of phosphate or vitamin D deficiency
What are the clinical features of rickets?
Stunted growth, curve in the spine, wide bones
Bowed legs
What are the clinical features of Osteomalacia?
Joint and bone pain, muscle weakness, abnormal gait, low calcium features = irregular heart, numbness and muscle spasms
what are your investigations for these 2?
Serum Vit D, Calcium, phosphate, PTH
X-ray
Bone biopsy
What are the managements?
Oral calcium and vitamin D
Bone correction surgery
What is Pagets Disease?
This is a disorder of bone remodelling after an initial event of excessive reabsorption, this leads to disorganised bone with more vascualtoyt and less compact meaning it can be fractures more easily
What are the causes of Paget’s disease?
This is familial in 30%
Can be caused by an environmental trigger
What bones are most commonly involved?
Femoral, pelvis and skull
What is the presentation of Paget’s disease
This is a condition in the over 40's, who have: Bone pain and deformity Excessive heat over the bone Neurological complications Can be complicated by osteosarcoma FH of pagers disease
What is THE diagnostic test in pagets disease?
Raised SERUM ALKALINE PHOSPHATASE
Bone Scan
X-ray/ bon biopsy
What is the management of Paget’s bone disease?
Minimal unless skull involvement
IV biphosphonate
What is osteogenesis Imperfecta
This is genetic connective tissue disorder where there is very fragile bones form mild trauma and daily living
What are the 4 types of OI?
1 = mild, presents in adults
Type 2 = can be lethal by age 1
3 = more severe and progressive
4 = adults but very severe very quickly
What re the clinical features of OI?
Growth deficiency Defective tooth formation Hearing loss Blue sclera Barrel chest Easy bruising OI
What is the clinical diagnosis and management of OI?
Skin biopsy and genetic testing
IV biphosphonates and that the fractures surgically
What is Marfan’s syndrome?
This is an autosomal DOMINANT condition in which there is loss of the elastic tissue
What is the cause of Marfan’s syndrome?
This is due to a defect in the fibrillar gene
What are the 3 diagnostic areas that are affected in Marfan’s syndrome?
MSK
Cardio
Occular
What MSK symptoms are seen in Marfan’s syndrome?
Caved chest Long and Thin limbs Scoliosis Thumb sign Back ache
What ocular symptoms are seen in Marfan’s syndrome?
Myopia and retinal detachment
What Cardio symptoms are seen in Marfan’s syndrome?
Aortic aneurysm - Dilatation/ dissection
Aortic/mitral valve murmur
Pneumothorax
What are the managements for Marfan’s Syndrome?
Antihypertensives Aortic root Sx Mechanical valve insertion Surgery for ocular symtoms Myopia = corrective lens Physio and analgesia
