bone diseases

Question 1

the bone is

Answer 1

Mineralised Connective tissue
Load bearing
Dynamic
Self Repairing

Calcium
Phosphate
Vitamin D

Question 2

parathyroid hormone

Answer 2

Maintains serum calcium level
RAISED if calcium levels fall
Increases calcium release from BONE

Reduces RENAL calcium excretion

Hypoparathyroidism = Low serum calcium

Hyperparathyoidism
Primary
Gland dysfunction – tumour
High serum calcium RESULTS

Secondary
low serum calcium CAUSES

Both result in increased bone reabsorption
Radiolucencies & reabsorption

Question 3

vitamin d problems

Answer 3

Low Sunlight Exposure

Poor GI Absorption
Poor nutrition
Small intestinal disease - malabsorption

Drug interactions
Some antiepileptic drugs
Carbamazepine, Phenytoin

Often a combination of factors

Question 4

osteomalacia is

Answer 4

During bone formation = “RICKETS”

After Bone formation completed = “Osteomalacia”

Both related to CALCIUM DEFICIENCY
Serum calcium preserved at expense of bone

Question 5

osteomalacia effects

Answer 5

Bone Effects
Bones bend under pressure
‘bow legs’
Vertebral compression in adults
Bones ‘ache’ to touch

Hypocalcaemia effects
Muscle weakness
Trousseau & Chvostek signs positive
Carpal muscle spasm
Facial twitching from VII tapping

Question 6

management of osteomalacia

Answer 6

Correct the cause
Malnutrition
Control GI disease

Sunlight exposure = 30 mins x 5 weekly

Dietary Vitamin D

Question 7

what is osteoporosis

Answer 7

A REDUCED QUANTITY of normally mineralized Bone

An age related change

Inevitable

Question 8

osteoporosis risk factors

Answer 8

AGE
Female sex = oestrogen withdrawal increases bone mass loss rate in women
Endocrine
Oestrogen & testosterone deficiency
Cushings syndrome
Genetic
Family history
Race – caucasian & asian women
Early menopause

Patient factors
Inactivity
Smoking
Excess alcohol use
Poor dietary calcium

Medical Drugs use
steroids
antiepileptics

Question 9

osteoporosis prevention

Answer 9

Build maximal Peak Bone Mass
Exercise
High dietary calcium intake


Reduce rate of Bone Mass loss
Continue exercise and calcium intake

Reduce hormone related effects
Oestrogen Hormone replacement therapy
MOST effective if early menopause


Question 10

hormone replacement therapy

Answer 10

Oestrogen only
Reduces osteoporosis risk
Increases breast cancer risk
Increase endometrial cancer risk
Patients who have NOT had a hysterectory
Combine with a progestogen to reduce risk
May reduce ovarian cancer risk
Increases DVT risk

Benefit lost after HRT stops!
5yrs post treatment BMD ‘normal’

Question 11

bisphosphonates

Answer 11

Non-Nitrogenous
Etidronate (1)
Clodronate (10)
Tildronate (10)


Nitrogenous
Pamidronate (100)
Neridronate (100)
Olpadronate (500)
Alendronate (500)
Ibandronate (1000)
Risedronate (2000)
Zoledronate (10000)

Alendronate or Risedronate in an osteoporosis risk population

Reduce vertebral fracture risk by 50%
Reduce other fractures by 30-50%
benefit lost if drug discontinued

Can be combined with HRT