Bone Disease

Question 1

List some common bone disorders:

Answer 1

• hyperparathyroidism
• osteomalacia
• paget’s disease
• osteoporosis

Question 2

What is Primary parathyroidism?

Symptoms?

Answer 2

Primary Parathyroidism: excess PTH

• usually ademona in parathyroid gland

Symptoms:

• hypercalcaemia (high blood calcium)
• confusion, depression, constipation, adbominal pains, bone pains, kidney stones

Untreated hypercalcaemia –> cardiac dysrhythmia and death

Question 3

How is hyperparathyroidism diagnosed and managed?

Dental considerations:

Answer 3

Diagnosis: blood tests, x-rays

Management: parathyroidectomy, drugs

Dental considerations:

Effects of bone resorption:

• giant cell lesions
• loss of lamina dura around roots

May have had treatment with bisphosphonates

Question 4

Issues surrounding vitamin D deficiency:

Consequences in adults?

Children?

Answer 4

Vitamin D deficiency causes poor bone mineralisation

• lack of sunlight
• poor intake (lack of oily fish, eggs, red meat)
• malabsorption in intestine

Osteomalacia in adults

Rickets in children

Question 5

What groups of patients are at risk of osteomalacia?

Signs and symptoms:

Diagnosis:

Treatment:

Answer 5

• darker skin in less sunny climate –> increases risk
• frail elderly/institutionalised patients
• increased demand (babies, children under 5, pregnancy, breastfeeding)

Signs and symptoms:

• diffuse bony pains
• proximal muscle weakness
• bone fragility due to defective mineralisation

Diagnosis: history, x-rays, blod tests

Treatment: oral calcium and Vit D supplements

Question 6

What is Pagets disease?

Symptoms?

Diagnosis?

Answer 6

Paget’s disease: abnormal bone remodelling

• abundant new bone formation
• structurally abnormal
• prone to fracture

Symptoms: most commonly asymptomatic

• bone deformities
• enlargement of skull
• nerve compression: deafness, spinal cord compression
• fractures

Diagnosis:

• clinical, x-rays characteristic

Question 7

Dental considerations for Paget’s disease?

Answer 7

Initial diagnosis:

• recognition of radiological features/dental changes

Established diagnosis:

• care with oral surgery to bone (infection and fracture risk)
• may be hypercementosis of teeth making extraction difficult
• awareness of osteosarcoma risk
• may be treated with bisphosphonates

Question 8

Which bones are most affected in osteoporosis?

What is osteoporosis due to?

Answer 8

Weight bearing bones, especially the spine

• kyphosis - fracture of spine and curvature

Osteoporosis is due to loss of bone mass (all components, not just calcium) –> increased fracture risk

Question 9

List some risk factors for osteoporosis:

Diagnosis:

Treatment:

Dental considerations:

Answer 9

Risk factors: female, white, ageing, thin, smoking, alcohol, lack of exercise, steroids, short menstrual history, malabsorption, hyperthyroidism, hypogonadism

Diagnosis:

DEXA - bone density scan

Treatment:

• calcium and vitamin D
• bisphosphonates

Dental considerations:

• bisphosphonates –> risk of osteonecrosis of the jaw