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MDD > Bone Disease > Flashcards

Bone Disease Flashcards

1
Q

what is the definition of osteoporosis

A

a decrease in bone mineral density and microarchitecture deterioration of bone tissue, leading to increased bone fragility and increased chance of fracture

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2
Q

how does the bone density of someone with osteoporosis differ to the normal bone density, in terms of standard deviation

A

bone density >2.5 SD below what is normal for that of a young adult male

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3
Q

how does the bone density of someone with osteopenia differ to the normal bone density, in terms of standard deviation

A

1-2.5 SD below what is normal for a young adult male is defined as osteopenia

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4
Q

what are risk factors for osteoporosis

A

Age

Female

Genetics

Low peak bone mass
Limited early exercise
Limited early calcium intake
Limited body habitus

Disuse

Smoking

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5
Q

what are secondary causes of osteoporosis

A

Primary hyperparathyroidism

Thyrotoxicosis

Long term glucocorticoid use

Cushings disease

Anorexia nervosa

Malabsorptive conditions (Ca2+ deficiency and secondary hyperparathyroidism)

chronic inflammatory disease/neoplastic disease

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6
Q

what are the most common osteoporitic fractures

A

colles

wedge spinal fractures

neck of femur

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7
Q

if osteoporosis is suspected what investigations should be done (usually done when someone presents with a pathological fracture)

A

DEXA of lumbar spine and iliac crest - gold standard

if osteoporosis confirmed, bloods for causes should be done: calcium phosphate, TFTs and ESR, sec hormones if <50, Vit D, PTH

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8
Q

what screening is available for patients at risk of decreased bone density and what is done with the results

A

any patient >50 should be assessed with a FRAX tool

low risk = reassurance

intermediate = DEXA scan

high = treatment started

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9
Q

what lifestyle advice is given to patients with osteopenia

A

Stop smoking

Limit alcohol to <20 units a week

Increase exercise and dietary calcium intake

Repeat DEXA scans should be offered to the group

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10
Q

what is the medical management for osteoporosis

A

weekly bisphosponates (alendronic acid)

Vit D + calcium - if found to be deficient

HRT - only for premature menopausal women

testosterone replacement - only hypogonadism males

repeat DEXA scans and FRAX scores every 2 years

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11
Q

what are some side effects of bisphosphonates

A

GI disturbance

rare - osteonecrosis of the jaw

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12
Q

what does NICE recommend switching to if the GI effects of alendronic acid are too much for the patient

A

risdronate

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13
Q

what is osteomalacia

A

inadequate bone mineralisation commonly caused by vitamin D deficiency

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14
Q

what are symptoms of osteomalacia

A

Bone pain

Bone fragility

Fractures

Malaise

Weakness

Proximal muscle weakness

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15
Q

whats the difference between osteomalacia, osteopenia and osteoporosis

A

osteopenia is a less severe form of osteoporosis which is reduced bone mineral density - usually has few symptoms. XR often abnormal, biochemistry usually normal

osteomalacia is impaired bone mineralisation, usually caused by a vitamin D deficiency - usually more symptomatic. XR often normal, biochemistry always derranged.

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16
Q

what is rickets

A

osteomalacia in children

17
Q

whats the difference between a T score and a Z score from DEXA scans

A

T Score = standard deviation of bone density from a healthy adult male

Z score = standard deviation of bone density from a member of the same age/gender population

18
Q

what are good sources of dietary vitamin D

A

oily fish, fortified cereals, red meat, egg yolks

19
Q

whats the pathophysiology of osteomalacia

A

absence of vitamin D leads to impaired calcium uptake in gut and increased renal calcium secretion

low serum calcium leads to increased parathyroid hormone which increases resorption of calcium from the bone, decreases calcium excretion/increases phosphate excretion leading to impaired mineralisation

20
Q

what are common causes for inadequate vitamin D levels

A

diet - vegans most at risk in developed world

inadequate sunlight

liver disease

drugs - bisphosphonates, fluoride/aluminium toxicity

CKD

21
Q

what investigations should be done if osteomalacia is suspected

A 
Bloods 
U+E for renal screen
LFTs for ALP (raised = increased osteoblasts) 
plasma calcium - normal to low
serum phosphate - low 
serum PTH - raised 
serum vit D - low

XR - often normal, widened epiphyseal plates in kids

iliac crest biopsy required if tests do not confirm

22
Q

whats the treatment for osteomalacia

A

Vitamin D replacement

high dose for 4 weeks then maintenance

IV if issue is malabsorption

activated Vit D if the issue is renal disease

23
Q

what is pagets bone disease

A

increased destruction and formation of bone leading to disordered architecture

24
Q

what is the characteristic pattern of abnormal bone for pagets bone disease

A

woven, non-lamellar pattern with fibrosis of the marrow spaces

25
Q

what are the clinical features of pagets bone disease

A

Up to 80% are asymptomatic, despite radiological evidence

Waxing/waning bone pain

Bone deformities

Cranial nerve palsy due to compression
Classically CN8

Cardiac failure due to increased bone blood flow

The ‘textbook’ presentation is
Bone pain
Pathological fractures
Deafness

26
Q

how is Pagets bone disease investigated

A

XR - lytic and sclerotic lesions

LFT - raised ALP
Ca, Phosphatee - normal - normal high

raised urinary hydroxyproline due to increased bone turnover

bone scans show extent of disease but arent specific for pagets

27
Q

what cancer is 30x more likely in pagets bone disease

A

osteogenic sarcoma

28
Q

what is the treatment for pagets bone disease

A

Simple analgesics for pain

Bisphosphonates for disease modification (IV or oral) (Monitor serum ALP as a disease marker)

Surgery may be required to deal with secondary joint disease or neurological complications

29
Q

what is osteonecrosis

A

bone necrosis of all types

30
Q

what is osteonecrosis of the epiphyses of long bones called

A

avascular necrosis

31
Q

what is osteonecrosis of the shaft of a long bone called and what parts of bone are affected

A

bone infarction - trabecular bone and bone marrow

32
Q

what are common causes of osteonecrosis

A

Interrupted arterial supply (fractures)

Interrupted venous drainage and retrograde arterial stoppage

33
Q

what are risk factors for osteonecrosis

A

Fractures

Perthes disease - AVN of femoral head

Bone marrow infiltration – malignancy

Alcohol abuse

Cushings/exogenous corticosteroids/chemo

Infection – septic arthritis

34
Q

which bones are more at risk for osteonecrosis

A

head of femur - #NOF

proximal scaphoid - distal wrist fracture

the lunate - following dislocation

body of talus - talar neck fracture

35
Q

what are symptoms of osteonecrosis

A

pain
stiffness
swelling

36
Q

when do radiological changes occur in osteonecrosis and what do they look like

A

6 months of disease

increased bone density

37
Q

what is the treatment for osteonecrosis

A

Eliminate cause

Prevent complications
Fractures
Via weight relief/splinting

Potential surgical intervention if debilitating

MDD (22 decks)

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