BONE DISEASES

Question 1

What is arthritis?

Answer 1

Inflammation of joints

Question 2

What is arthrosis?

Answer 2

non-inflammatory joint disease

Question 3

what is arthralgia?

Answer 3

joint pain

Question 4

what cells cause removal of bone?

Answer 4

osteoclasts

Question 5

what cells cause deposition of bone?

Answer 5

osteoblasts

Question 6

what are the three aspects that are crucial in good bone formation?

Answer 6

• calcium
• phosphate
• vitamin D

Question 7

how is parathyroid hormone related to calcium?

Answer 7

• It maintains serum calcium level (if calcium levels fall, parathyroid hormone levels increase)
• increases calcium release from BONE
• reduces renal calcium excretion

Question 8

if a patient suffers from hypoparathyroidism, what may their calcium levels look like?

Answer 8

low serum calcium

Question 9

what do primary and secondary hyperparathyroidism both result in?

Answer 9

increased bone resorption

Question 10

how is vitamin D related to bone health?

Answer 10

vitamin D allows calcium absorption in the gut

Question 11

why might a person have low vitamin D levels?

Answer 11

• low sunlight exposure
• poor GI absorption
• drug interactions

Question 12

what drugs can reduce vitamin D levels?

Answer 12

Antiepileptic drugs:
- carbamazepine
- phenytoin

Question 13

what is osteomalacia?

Answer 13

Normal amounts of osteoid HOWEVER:
- poorly mineralised osteoid matrix
- poorly mineralised cartilage growth plate

Question 14

what is osteoporosis?

Answer 14

Loss of mineral and matrix
- reduced bone mass

Question 15

if osteomalacia occurs during bone formation what is this known as?

Answer 15

RICKETS

Question 16

what are rickets and osteomalacia both related to?

Answer 16

calcium deficiency

Question 17

what are some features of osteomalacia?

Answer 17

BONE EFFECTS
- bones bend under pressure (bow legs in kids, vertebral compression in adults)
- bones ache to touch
HYPOCALCAEMIA EFFECTS
- muscle weakness
- Trousseau & Chvostek signs positive

Question 18

how is osteomalacia managed?

Answer 18

Correct the cause!
- malnutrition = control GI disease
- sunlight exposure = 30 mins x 5 weekly
- dietary = vit D supplements

Question 19

what are some generalised risk factors that make a patient more likely to develop osteoporosis?

Answer 19

• AGE
• female
• Cushing’s syndrome
• family history
• race = caucasian and asian women
• early menopause

Question 20

what are some patient specific factors that can contribute to osteoporosis?

Answer 20

• inactivity
• smoking
• excess alcohol use
• poor dietary calcium

Question 21

what medications can contribute to development of osteoporosis?

Answer 21

steroids & antiepileptics both affect Ca levels

Question 22

at what age does a person have peak bone mass?

Answer 22

between 24-34 y/o

Question 23

what % of women suffer from osteoporosis at age 50?

Answer 23

15%

Question 24

what % of women suffer from osteoporosis at age 70?

Answer 24

30%

Question 25

what % of women suffer from osteoporosis at age 80?

Answer 25

40%

Question 26

why might women be at a higher risk than men of developing osteoporosis?

Answer 26

• males have higher peak bone mass
• oestrogen withdrawal increases bone mass loss rate in women (eg menopause!)

Question 27

what are the effects of osteoporosis?

Answer 27

• increased bone fracture risk
• height loss
• kyphosis (spine bends forwards)
• scoliosis
• nerve root compression (back pain)

Question 28

how can osteoporosis be prevented?

Answer 28

• build maximal peak bone mass (exercise & high calcium intake)
• reduce rate of bone mass loss (continue exercise)
• reduce hormone related effects e.g oestrogen hormone replacement therapy

Question 29

what might women suffering from menopause related osteoporosis do to prevent/help them?

Answer 29

use HRT (hormone replacement therapy)

Question 30

what are the effects of HRT?

Answer 30

• reduced osteoporosis risk
• increased breast cancer risk
• increased endometrial cancer risk
• increases DVT risk
• may reduce ovarian cancer risk

Question 31

what ‘osteoporosis prevention’ drugs may be used?

Answer 31

BISPHOSPHONATES
- non-nitrogenous
- nitrogenous

Question 32

what are examples of non-nitrogenous bisphosphonates?

Answer 32

• etidronate
• clodronate
• tildronate