bone diseases

Question 1

define arthritis

Answer 1

inflammation of joints

Question 2

define arthrosis

Answer 2

non-inflammatory joint disease

Question 3

define arthralgia

Answer 3

joint pain

Question 4

what tissue forms bone?

Answer 4

mineralised connective tissue - load bearing, dynamic and self repairing

Question 5

which cell resorbs bone?

Answer 5

osteoclasts

Question 6

which cell deposits bone?

Answer 6

osteoblasts

Question 7

where is calcium stored?

Answer 7

bone and teeth

Question 8

how does parathyroid hormone affect serum calcium levels?

Answer 8

increase in parathyroid hormone when calcium levels fall to maintain serum calcium level

Question 9

what effect does parathyroid hormone have on calcium release from bone and renal calcium excretion?

Answer 9

increases Ca release from bone
decreases renal Ca excretion

Question 10

how does hypoparathyroidism affect serum calcium?

Answer 10

low serum calcium

Question 11

how does primary hyperparathyroidism occur?

Answer 11

gland dysfunction for example a tumour leading to high serum calcium and inappropriate activation of osteoclasts

Question 12

how does secondary hyperthyroidism occur?

Answer 12

low serum calcium levels leading to higher levels of parathyroid hormone to activate osteoclasts

Question 13

what is the active version of vitamin D?

Answer 13

1, 25 dihyroxycolecalciferol

Question 14

what vitamin is necessary for calcium and phosphate absorption in the gut?

Answer 14

vitamin D - active version 1, 25 dihydroxycolecalciferol

Question 15

where can you get vitamin D?

Answer 15

sunlight
milk
orange juice
fish
supplements

Question 16

what causes vitamin D problems ?

Answer 16

low sunlight exposure - housebound or dark skin
poor GI absorption due to nutrition to small intestine disease
drug interactions

Question 17

what is osteomalacia?

Answer 17

bone formed normally but poorly mineralised osteoid matrix and poorly mineralised cartilage growth plate - soft bone

Question 18

what is osteoporosis?

Answer 18

reduced quantity of normally mineralised bone
reduced bone mass
loss of mineral and matrix
age related and inevitable

Question 19

what is the result of osteomalacia during bone formation?

Answer 19

rickets disease

Question 20

what is the result of osteomalacia after bone formation?

Answer 20

osteomalacia

Question 21

osteomalacia and rickets are related to what deficiency?

Answer 21

calcium deficiency

Question 22

what is the effect of osteomalacia on bone clinically?

Answer 22

bones bend under pressure causing bow legs in children and vertebral compression in adults
bones ache

Question 23

when assessing osteomalacia serum calcium and serum phosphate are decreased if there is calcium deficiency but what is very high?

Answer 23

alkaline phosphatase - measure of bone turnover

Question 24

how is osteomalacia managed?

Answer 24

correct the cause - restore into diet or control GI disease
sunlight exposure 30min 5x weekly
dietary vitamin D

Question 25

describe some osteoporosis risk factors

Answer 25

age female endocrine - oestrogen and testosterone deficiency, cushings genetic - family history smoking inactivity poor dietary calcium medications - steroids and antiepileptics

Question 26

describe some osteoporosis risk factors

Answer 26

age female endocrine - oestrogen and testosterone deficiency, cushings genetic - family history smoking and alcohol inactivity poor dietary calcium medications - steroids and anti-epileptics

Question 27

what age does peak bone mass occur?

Answer 27

24-35 years

Question 28

what effect does oestrogen have on bone mass?

Answer 28

oestrogen withdrawal during menopause increases bone mass loss rate in women

Question 29

what are the effects of osteoporosis?

Answer 29

increased bone fracture risk vertebrae - height loss, kyphosis (forward bend of spine), scoliosis and nerve root compression (back pain)

Question 30

how is osteoporosis prevented?

Answer 30

build maximal peak bone mass through exercise and dietary calcium intake reduce the rate of bone mass loss by exercise and Ca intake reduce hormone related effects through oestrogen HRT reduce drug related effects bisphosphonates - end in ronate - to prevent rate of bone loss

Question 31

what are the risks of oestrogen only HRT?

Answer 31

reduces risk of osteoporosis and ovarian cancer increases risk of breast and endometrial cancer increased DVT risk