Bone Disease Part 2

Question 1

1. What are the four main acquired bone diseases

Answer 1

• Osteomalacia/ Rickets
• Osteoporosis
• Hyperparathyroidism
• Paget’s disease

Question 2

2. What are acquired bone diseases also called and why

Answer 2

Also called metabolic bone disease as they result from an imbalance between bone formation and resorption

Question 3

3. What is osteoporosis

Answer 3

Loss of bone mass although mineralisation is normal

Question 4

what happens to trabecular and eventually cortical bone in Osteoporosis

Answer 4

Trabeculae are thinned and eventually cortex is thinned also

Question 5

5. Give 5 risk factors of osteoporosis

Answer 5

• Old age
• Post menopausal decrease in oestrogen
• Disuse and reduced activity
• Prolonged steroid use (especially in RA)
• endocrine disease e.g. Cushings

Question 6

6. What age do you have peak bone mass

Answer 6

30 years old

Question 7

7. What is the rate of average bone loss per year after the age of 30

Answer 7

0.7% average bone loss/year after 30 years old

Question 8

8. In Post-menopausal osteoporosis, by how much percent can natural bone loss be increased in cortical and trabecular bone

Answer 8

in Post-menopausal osteoporosis, natural bone loss rate can be increased:

• 2% in cortical bone
• 9% in trabecular bone

Question 9

9. At what point can we identify that someone has osteoporosis?

Answer 9

When 30-40% reduction in bone mass is seen radiologically

Question 10

10. Give 3 clinical outcomes of osteoporosis

Answer 10

• Pathological fractures due to falls in the elderly
• Back pain and kyphosis due to compression fractures
• Hip replacements due to fractured neck of femur

Question 11

11. Give 4 treatments for osteoporosis

Answer 11

• Prevention (diet and exercise)
• Bisphosphonates
• Oestrogen receptor agonists
• PTH

Question 12

What is Osteomalacia known as in growing bones (children)?

Answer 12

Rickets

Question 13

13. What is rickets known as in mature bones (Adults)?

Answer 13

Osteomalacia

Question 14

14. What can cause osteomalacia/rickets?

Answer 14

Vitamin D deficiency or abnormal metabolism

Question 15

15. What is the pathophysiology in osteomalacia/rickets

Answer 15

Normal osteoid and architecture of bone but failure of correct mineralisation of osteoid leading to soft bones (cortical and trabecular)

Question 16

1. Give 2 types of symptoms of osteomalacia/rickets

Answer 16

Symptoms:
- bone pain (pelvis, back, legs)
- structural abnormalities such as bowing of the legs if untreated

Question 17

17. How is osteomalacia/rickets diagnosed

Answer 17

X ray and labs show low serum vitamin D

Question 18

18. What 2 treatments can be used against osteomalacia/rickets

Answer 18

• supplementation
• advice on prevention