Bone Disorders

Question 1

what are the three main types of bone cells?

Answer 1

osteoclasts
osteoblasts
osteocytes

Question 2

what do osteoclasts do?

Answer 2

responsible for bone resorption

Question 3

what do osteoblasts do?

Answer 3

responsible for bone formation

Question 4

what is the primary cell of mature bone?

Answer 4

osteocytes

Question 5

name five factors that affect the ability to achieve peak bone mass

Answer 5

genetics 
being underweight 
sex hormones
diet 
exercise

Question 6

name six factors that increase the rate of physiological bone loss

Answer 6

sex hormone deficiency 
body weight 
diet 
immobility 
disease 
drugs

Question 7

what two types of drugs increase rate of physiological bone loss?

Answer 7

glucocorticoids

aromatase inhibitors

Question 8

when is peak bone mass usually attained?

Answer 8

around 30

Question 9

when does age related bone loss start?

Answer 9

around 50

Question 10

what is it called when the bone mass stays stable?

Answer 10

consolidation

Question 11

what causes a steep decline in bone mass in women?

Answer 11

menopause

Question 12

who has a higher bone mass throughout life - males or females?

Answer 12

males

Question 13

what is the major determinant of bone loss in women after the menopause?

Answer 13

oestrogen deficiency

Question 14

what are four common fracture sites in osteoporosis?

Answer 14

neck of femur
vertebral body
distal radius
humeral neck

Question 15

name two tools that can be used to assess fracture risk in osteoporosis?

Answer 15

QFracture

FRAX

Question 16

name some non modifiable risks for osteoporotic fractures

Answer 16

age 
gender 
previous fractures 
family history 
early menopause

Question 17

name some modifiable risks for osteoporotic fractures

Answer 17

bone mineral density 
alcohol 
weight 
smoking 
inactivity

Question 18

who should be assessed for osteoporosis?

Answer 18

> 50 with any risk factors

< 50 with very strong risk factors

Question 19

what are the very strong risk factors for osteoporosis?

Answer 19

early menopause

glucorticoids

Question 20

how should be referred for a DEXA scan?

Answer 20

patients with 10 year risk for osteoporotic fractures >10%

Question 21

what is the most common method for measuring BMD?

Answer 21

DEXA scan

Question 22

what two areas are scanned in a DEXA scan?

Answer 22

L1-L4

non dominant hip

Question 23

what is the Z score in a DEXA scan?

Answer 23

their BMD compared to the peak in a young population - assesses whether loss is age appropriate

Question 24

what is the T score in a DEXA scan?

Answer 24

BMD compared to their own age group

Question 25

what is normal on a DEXA scan?

Answer 25

BMD within 1SD of the young adult reference mean

Question 26

what is osteopenia on a DEXA scan?

Answer 26

BMD >1SD below the young adult mean

Question 27

what is osteoporosis on a DEXA scan?

Answer 27

BMD >2.5SD below the young adult mean

Question 28

what is severe osteoporosis on a DEXA scan?

Answer 28

BMD >2.5SD from young adult mean alongside a fracture

Question 29

what lifestyle advice is given for osteoporosis?

Answer 29

strength training low impact exercise alcohol and smoking avoidance fall prevention - OT

Question 30

what mineral do people with osteoporosis need to eat more than average of?

Answer 30

calcium eat 1000mg a day

Question 31

what is the first line drug management of osteoporosis?

Answer 31

calcium + vit D supplements | bisphosphonates

Question 32

when can calcium supplements not be taken?

Answer 32

within 2 hours of bisphosphonates

Question 33

how do bisphosphonates work?

Answer 33

anti resorptive agents - preventing bone loss

Question 34

name two bisphosphonates

Answer 34

alendronate | risedronate

Question 35

what are the complications of long term use of bisphosphonates?

Answer 35

osteonecrosis of the jaw oesophageal carcinoma atypical fractures

Question 36

what are the possible second line drugs for osteoporosis?

Answer 36

zoledronic acid denosumab teriparatide romosozumab

Question 37

what should be considered in patients with early menopause tor reduce fracture risk?

Answer 37

HRT

Question 38

what is the pathophysiology of Paget's disease of bone?

Answer 38

initially normal bone resorption followed by increased bone formation = results in abnormal structure with reduced strength

Question 39

what is it called when Paget's disease of bone affects one site?

Answer 39

monostotic

Question 40

what is it called when Paget's disease of bone affects more than one site?

Answer 40

polyostotic

Question 41

where does Paget's disease of bone usually affect?

Answer 41

long bones pelvis lumbar spine skull

Question 42

how does Paget's disease of bone present?

Answer 42

bone pain deformity deafness compression neuropathies

Question 43

what is a rare complication of Paget's disease of bone?

Answer 43

osteosarcoma

Question 44

how is Paget's disease of bone diagnosed?

Answer 44

x-ray isotope bone scan bloods

Question 45

what is seen on bloods in Paget's disease of bone?

Answer 45

raised ALP

Question 46

how is Paget's disease of bone managed?

Answer 46

analgesia | bisphosphonates

Question 47

what is osteogenesis imperfecta?

Answer 47

group of genetic disorder affecting bone

Question 48

what can osteogenesis imperfecta be associated with?

Answer 48

blue sclerae | dentinogenesis imperfecta

Question 49

how is osteogenesis imperfecta managed?

Answer 49

fracture fixation surgery for deformities bisphosphonates