Bone Diseases

Question 1

Osteoporosis is a quantitative/ qualitative disease

Answer 1

Quantatitive

Question 2

What are the main clinical features of osteoporosis?

Answer 2

Reduced bone mineral density

Increased porosity

Question 3

How is osteoporosis clinically defined?

Answer 3

< 2.5 sd. below the mean for young adults

Question 4

What is the intermediate stage of osteoporosis defined as?

Answer 4

Osteopenia

1-2.5 s.d

Question 5

Give the two main types of osteoporosis and clinical features of each

Answer 5

1. Post-menopausal (reduced oestrogen levels)
   Colles fractures, vertebral insufficiency
2. Old age (chronic disease and low vitamin D)
   Femoral neck and vertebral fractures

Question 6

What are some risk factors for the development of osteoporosis

Answer 6

Smoking
Alcohol
Reduced exercise
Diet
CCS
Malnutrition
CKD

Question 7

In type 2 osteoporosis, cells are found…

Answer 7

On the surface of bone

Question 8

Osteochondritis is mainly found in…

Answer 8

Children

Question 9

What is the aetiology of osteochondritis?

Answer 9

Increased activity and stress on bone leads to bleeding and oedema

Question 10

Outline the treatment for osteochondritis

Answer 10

Osteotomy

Question 11

What investigation is typically used to diagnose osteoporosis and what are the results?

Answer 11

DEXA scan
Reduced bone mineral density
Ca and PO4 normal

Question 12

Outline the management options for osteoporosis

Answer 12

Exercise
Diet
Ca and Vit D supplements
HRT
Anti-resorptive drugs

Question 13

What is the first line anti-resorptive drug used in osteoporosis? What are the alternatives?

Answer 13

Biphosphonates e.g. alendroate

Desonumab, strontium

Question 14

What is the mechanism of action of anti-resorptives?

Answer 14

Reduce osteoclast activity

Question 15

Osteomalacia and rickets are quantitative/ qualitative diseases

Answer 15

Qualitative

Question 16

Osteomalacia and rickets are mainly found in…

Answer 16

Children

Question 17

What are the main clinical features of osteomalacia and rickets?

Answer 17

Abnormal bone softening due to reduced minerals of osteoid (inadequate Ca and PO4)

Question 18

What are the classical symptoms and signs described in osteomalacia and rickets?

Answer 18

Bone pain
Soft bone deformity
Increased fractures
Hypocalcaemia (paraesthesia, cramps, irritability, fatigue, seizures, brittle nails)

Question 19

Osteoporosis leads to…

Answer 19

Bone fragility and fractures

Question 20

What investigations are used in the diagnosis of osteomalacia and rickets? What results would you expect)

Answer 20

Radiograph (‘Loosers zones’)

Serum bone biochemistry (Low Ca and PO4)

Question 21

Outline the management for osteomalacia and rickets

Answer 21

Vit D and Ca and PO4 supplements

Question 22

Outline the three main types of hyperparathryoidism and the biochemistry for each

Answer 22

PRIMARY: Increased Ca, increased PTH
SECONDARY Reduced Ca (hypocalcaemia), increased PTH
TERTIARY: Chronic secondary HPTM leading to increased Ca, increased PTH

Question 23

List the main causes of primary hyperparathyroidism

Answer 23

Benign adenoma
Malignancy
Hypercalcaemia

Question 24

Outline the management for hyperparathyroidism

Answer 24

Remove adenomatous gland
IV fluids
Biphosphonates
Calcitonin

Question 25

What is Paget's disease?

Answer 25

Paget's disease of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile and misshapen

Question 26

What are the main clinical features of Paget's disease?

Answer 26

Increased osteoclast activity leading to increased osteoblast activity, this results in the formation of new bone that doesn't remodel well

Question 27

Which viral infection can cause Paget's disease?

Answer 27

Paramyoxyvirus

Question 28

Paget's disease is usually asymptomatic and detected on XR. True/ False?

Answer 28

True

Question 29

Which bones does Paget's disease usually affect?

Answer 29

Pelvis Femur Skull Tibia

Question 30

What investigations are used in the diagnosis of Paget's Disease?

Answer 30

Radiography | Bone scans

Question 31

What bone biochemistry would suggest a diagnosis of Paget's Disease?

Answer 31

Increased ALP | Ca and PO4 normal

Question 32

Outline the management options for Paget's Disease

Answer 32

Biphosphonates Calcitonin Joint fractures Skeletal stabilization

Question 33

What is AVN?

Answer 33

Ischaemic bone necrosis/ disrupted blood supply leading to pathological fractures

Question 34

Where is AVN most common in the body?

Answer 34

Femur head | Scaphoid bone

Question 35

List some risk factors for AVN

Answer 35

Chronic alcoholism Steroid abuse High cholesterol Osteoarthritis

Question 36

How is AVN diagnosed? What results would you expect?

Answer 36

MRI | Large wedge-shaped discolouration, creeping substitution

Question 37

Outline the management options for AVN?

Answer 37

Joint replacement | Arthrodesis