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Musculoskeletal > Bone disease > Flashcards

Bone disease Flashcards

1
Q

What is osteoporosis?

A

A skeletal disorder characterised by decreased bone mass leading to decreased bone strength and increased fracture risk

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2
Q

What is the BMD definition of osteoporosis and osteopenia?

A

Osteoporosis - T score less that - 2.5

Osteopenia - T score between 1 and 2.5

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3
Q

What test is used to diagnose osteoporosis?

A

DEXA scan (usually of the lumbar spine and hip)

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4
Q

What is the brief pathophysiology of osteoporosis?

A

Imbalance between the rate of bone resporption and formation (osteoclast and osteoblast activity)

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5
Q

How do bisphosphonates work?

A

Inhibit osteoclasts and so stop resporption of bone.

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6
Q

How does raloxifene work?

A

It is an oestrogen receptor modulator that can be used in post menopausal women.

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7
Q

How does denosumab work?

A

A humanized monoclonal antibody against RANK ligand that reduces the formation of osteoclasts. It improves BMD and reduces fracture in post menopausal women

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8
Q

How does strontium work?

A

This is a second line agent when bisphosphonates aren’t tolerated and works by remodelling the bone structure with anti resorptive and bone formation effects.

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9
Q

What is an example of a bisphosphonate?

A 
Alendronic acid (oral)
Zolendronic acid (IV infusion)
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10
Q

How and why is zolendronic acid given?

A

5mg infusion once yearly in osteoporosis

5mg dose once in pagets disease

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11
Q

What is the first line treatment for osteoporosis?

A

Oral bisphosphonates (alendronic acid/risedronate)

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12
Q

What does the fracture risk have to be in someone who has not had a fracture in order to get a bisphosphonate?

A

10% in 10 years

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13
Q

What is teriparatide?

A

A recombinant form of PTH. It is an effective bone growing treatment used in severe osteoporosis, Small bursts of PTH increase osteopblast activity and are helpful for improving bone density

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14
Q

What drug is used in people with severe spinal osteoporosis?

A

Teriparatide. This is a recombinant PTH which is used to grow bone

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15
Q

Describe the treatment pathway for someone with newly diagnosed osteoporosis?

A
  1. Oral bisphosphonates (also calcium and vitamin D)
    If unable to tolerate/poor response
  2. IV bisphosphonates or denosumab (monoclonal antibody)
  3. HRT, tibolone, ibandronic acid or raloxifene
  4. Strontium
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16
Q

Which patients should not get strontium?

A

Ischaemic heart disease
Periperal artery disease
Cerebrovascular disease
Uncontrolled hypertension

17
Q

What is tibolone and how does it work in osteoporosis?

A

Has weak estrogenic, progestegenic and androgenic activity

18
Q

What is pagets disease?

A

A disorder of bone remodelling whereby there is a large increase in bone resprption , mediated by large multinucleated osteoclasts. The osteoblasts respond by producing weak disorganised bone. Repeated cycles of this lead to areas of bone becoming abnormally large and deformed.

19
Q

What are common sites for pagets to effects?

A 
Pelvis
Lumbar spine
Femur
Skull
Tibia
20
Q

What are some of the complications that can arise a result of pagets disease?

A
  1. Deafness (auditory nerve entrapment)
  2. Cranial nerve palsy
  3. Cardiac hypertrophy
  4. Spinal stenosis
  5. Secondary OA
  6. Fractures
  7. Osteosarcoma
  8. Tibial bowing
21
Q

How do you investigate pagets disease and what results will you see?

A

Blood: High alkaline phosphatase levels (correlate with the extent of skeletal involvement)
X Ray: Disorganised patterns of bone with areas of lysis and sclerosis
Isotope bone scan: Areas of focal increased uptake

22
Q

What is the treatment for pagets disease?

A

Bisphosphonates

Surgery if fracture or tumour

23
Q

What is rickets?

A

Failure of bone mineralisation in the growing skeleton of children. This causes poor mineralisation of cartilage in the epiphyseal growth plates of children. It is causes by vitamin D deficiency

24
Q

What is osteomalacia?

A

The softening of bones caused by impaired metabolism due to inadequate levels of phosphate, calcium and vitamin D

25
Q

How does rickets present?

A 
Bone pain 
Skeletal deformity 
Muscle wekness 
Fracture
Rarely tetany or convulsion due to hypocalcaemia
26
Q

How does osteomalacia present?

A

Bone pain
Muscle weakness
Fracture
Hypocalcaemia (chovsteks sign - abnormal reaction to facial nerve stimulation)

27
Q

What do they laboratory results show in osteomalacia/rickets?

A 
Low phosphate
Low calcium 
Raised Alk Phos 
Low Vitamin D 
Raised PTH
Low urinary calcium
28
Q

What radiological changes are seen in rickets?

A

Delayed opacification of the epiphyses
Widened growth plates
Thin cotices

29
Q

What radiological changes are seen in osteomalacia?

A

Loosers zones - spontaneous incomplete fractures

Musculoskeletal (15 decks)

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