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CP3 @ UoN - Musculoskeletal & MDD > Bone Disease > Flashcards

Bone Disease Flashcards

1
Q

What is Osteoporosis?

A

Disease characterised by reduced bone mineral density & microarchitectural deterioration of bone tissue
-leads to inc bone fragility/inc risk fractureq

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2
Q

How does bone mass change over a normal lifetime?

A

Bone mass peaks at 20-30yrs
Falls in post menopausal women
-due to oestrogen deficiency

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3
Q

What are the risk factors for Osteoporosis?

A 
Age
Female sex
Genetics
Low peak bone mass
Disuse
Smoking
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4
Q

What are the secondary causes of Osteoporosis?

A 
Primary hyperparathyroidism
Thyrotoxicosis
Steroid-induced
Cushing's disease
Anorexia nervosa
Malabsorptive conditions
Chronic inflammatory/neoplastic disease
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5
Q

How does Primary Hyperparathyroidism cause Osteoporosis?

A

High PTH increases bone turnover

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6
Q

How does Thyrotoxicosis cause Osteoporosis?

A

Increases bone turnover

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7
Q

How do Steroids cause Osteoporosis?

A

Dec intestinal Ca absorption & inc renal Ca excretion
-leads to 2o hyperparathyroidism
Direct inhibition of osteoblast activity & stimulation of osteoblast apoptosis

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8
Q

How does Cushing’s Disease cause Osteoporosis?

A

As per steroids

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9
Q

How does Anorexia Nervosa cause Osteoporosis?

A

Ca deficiency
Wt loss
Hypogonadism

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10
Q

How do Malabsorptive conditions cause Osteoporosis?

A

Ca deficiency

2o hyperPTH

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11
Q

How does chronic inflammatory/neoplastic disease cause Osteoporosis?

A

Increase bone resorption

Suppress bone formation

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12
Q

How does Osteoporosis present?

A 
Mainly asymptomatic
Fragility fractures
Back pain
Height loss
Kyphosis
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13
Q

What are the most common sites for osteoporotic fractures?

A

Wrist (Colles)
Neck of Femur
Spine (vertebral crush/wedge fracture)

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14
Q

What investigations may be appropriate in suspected Osteoporosis?

A 
BMD measurements using DEXA
   -measured at lumbar spine/iliac crest
   -gives T-score
Serum Ca/phosphate
TFTs
ESR
Sex hormone panel
Vit D/PTH
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15
Q

What T-scores reflect Osteopenia?

A

-1 to -2.5

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16
Q

What T-scores reflect Osteoporosis?

A
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17
Q

What is a FRAX score?

A

Screening tool used in GP for pts >50yrs

-estimates risk of fragility fracture

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18
Q

What lifestyle advice should pts w/ osteopenia be given?

A

Stop smoking
Limit alcohol intake to <20 units/week
Increase exercise
Increase dietary Ca intake

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19
Q

What management is available for pts w/ osteoporosis?

A 
Weekly bisphosphonates (aldendronic acid) 1st line
Vit D
HRT
Testosterone replacement therapy
Calcitonin
Recombinant PTH
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20
Q

How do bisphosphonates work?

A

Decrease bone resorption

Allow mineralisation of existing bone

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21
Q

What are the main s/e of bisphosphonates?

A

GI s/e

Osteonecrosis of jaw

22
Q

What is Osteomalacia?

A

Inadequate bone mineralisation

-usually caused by Vit D defiency

23
Q

How does Osteomalacia present?

A

Bone pain
Bone fragility/fractures
Malaise/weakness (can be insidious onset)

24
Q

What is Rickets?

A

Syndrome resulting from osteomalacia in growing skeleton

-bone deformity and sx of osteomalacia

25
Q

How is Vit D synthesised?

A

7-dehydrocholesterole in skin + UV light = cholecalciferol

26
Q

How is Vit D metabolised?

A

Cholecalciferol metabolised in liver/kidneys

  • produces 1,25-dihydroxycholecalciferol (calcitriol)
  • inc ca uptake, dec ca excretion
27
Q

What is the underlying pathophysiology of Osteomalacia?

A

Vit D deficiency –> low plasma Ca –> 2o hyperPTH
-stimulates osetoclastic bone resorption
-decreases ca excretion
-increases phosphate excretion
Progressive loss of Ca/PO4- from bone –> defective mineralisation

28
Q

What are the common causes of Vit D deficiency?

A

Inadequate dietary intake (vegans, malabsorption)
Inadequate synthesis (housebound pts, muslim women)
Renal disease (CKD)
Liver disease
Drugs

29
Q

What are the features of Vit D deficiency?

A

Insidious onset

  • bone pain
  • pathological fractures
  • general malaise
  • proximal muscle weakness, waddling gait
30
Q

What blood tests should be done in a pt presenting w/ Osteomalacia?

A 
U&amp;Es 
ALP (high)
Plasma Ca (normal/low)
Serum PO4 (low)
Serum PTH (high)
Serum Vit D (low)
31
Q

What are the X-ray signs of Osteomalacia?

A 
Normal
Looser zones of defective mineralisation
   -long bone
   -pelvis
   -ribs
Widening of epiphyseal plate (children)
32
Q

What is the management of Osteomalacia?

A

Oral Vit D replacements

-high dose for 4 weeks, then maintenance

33
Q

What are the rare causes of Osteomalacia?

A

Hypophosphataemia
Bisphosphonates
Fluoride/Aluminium intoxication

34
Q

What is Paget’s Disease of Bone?

A

Common disease of unknown origin affecting bones in elderly

35
Q

How common is PDB?

A

10% at 85yrs

36
Q

What is the underlying pathophysiology of PDB?

A

Excessive uncontrolled resorption of bone by large, abnormal multinucleated osteoclasts
Destruction of cortical/trabecular bone in waves
New bone is women, non-lamellar w/ fibrosis of marrow spaces

37
Q

What are the clinical features of PDB?

A 
80% asymptomatic
Waxing/waning bone pain
Bone deformities (bowed tibia/skull changes)
Cranial nerve palsies (CN VIII)
Cardiac failure
38
Q

What is the classical presentation of PDB?

A

Bone pain
Pathological fractures
Deafness

39
Q

What is the main complication of PDB?

A

30x inc risk of developing osteogenic sarcoma

40
Q

What investigations may be appropriate in suspected PDB?

A

Bloods - ALP, Ca, PO4 (normal)
Urine - raised hydroxyproline
XR - variable presentation, sclerotic & lytic lesions
Bone scans

41
Q

What use are bone scans in PDB?

A

Show extent of bone involvement

Cannot differentiate b/w Paget’s & Sclerotic Mets

42
Q

What is the management of PDB?

A

Analgesics
Bisphosphonates
Monitor serum ALP
Surgery for 2o joint disease/neurological complications

43
Q

What is Osteonecrosis?

A

General term for ischaemic bone necrosis

44
Q

How long does Ischaemia take to cause Osteonecrosis?

A

W/ ischaemia bone marrow dies w/i 12hrs, bone cells die b/w 12-24hrs

45
Q

Describe osteonecrosis in the shaft of a long bone

A

Bone infarction

Involves trabecular bone & bone marrow in medulla

46
Q

Describe osteonecrosis in the epiphysis of a long bone

A

Avascular necrosis

Involves trabecular bone, bone marrow & cortical bone

47
Q

What are the common causes of osteonecrosis?

A

Interrupted arterial supply (fractures)
Interrupted venous drainage
Retrograde arterial stoppage

48
Q

What are the risk factors for osteonecrosis?

A

Fracture (subcapital NOF, scaphoid fracture)
Idiopathic (Perthe’s, AVN of fem head)
Bone marrow infiltration (malig)
Alcohol abuse
Cushing’s/exogenous corticosteroids/chemo
Infection (SA)

49
Q

Which bones are most susceptible to osteonecrosis?

A

Head of femur
Proximal scaphoid
Lunate
Body of talus

50
Q

How does osteonecrosis present?

A

Pain
Stiffness
Swelling in local joint/over bone

51
Q

What are the XR signs of osteonecrosis?

A

Distinctive segment of inc bone density

-present after 6mo

52
Q

What is the management of osteonecrosis?

A 
Eliminate cause
Prevent complications (potential surgical intervention)

CP3 @ UoN - Musculoskeletal & MDD (26 decks)

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