bone disorders (?) Flashcards
what type of scan 50yrs> low level fracture
DEXA
what does DEXA test for
bone mineral density
osteoporosis BMD mean
BMD > 2.5 sd below young adult mean
what conditions can increase the risk of osteoporosis
hyperthyroidism
hyperparathyroid
coeliac
menopausal
management of osteoporosis
diet - calcium aim for 700mg/d and 1000mg for women over 30
strength weight training
low bearing weight exercise ie standing on one foot
drug tx
calcium and vit D supplementation
biphosphonates
what are biphosphonates
> MoA reduce osteoclast activity and development
> alendronate and risedronate
what is zoledronic acid
what is denosumab
slows bonal reabsorption
slows down activation of RANKL
what is teriparatide
anabolic drug
stimulates bone growth
recombinant parathyroid hormone
only considered in severe osteoporosis
think spinal fracture
what is romosozumab
sclerostin (?)
anabolic drug
contraindicated in CV/MI
how do steroids impact bone health - direct
how do steroids impact bone health - indirect
Paget’s
new bone mass that is more robust and is more likely to fracture, and reduced strength - to do with increased osteoclast activity > osteoblastic
affects long bones, pelvis, spine, skull
can be monostotic to polyostotic
more common in older generations
presents : with bone pain, bony deformity/swellig (often tibia), compression neuropathies, local inflammation
usually an incidental finding
diagnosis : isotope bone scan XR, biochem - raised alkaline phosphatases , LFTs
tx : biphosphonates
osteogenesis imperfecta aka brittle bone disease
genetic - rare
COL1A1, COL1A2 mutations - collagen genes
autosomal dominant inheritance
at least 8 types - varying on severity
associated with blue sclerae and dentinogenesis imperfects (often not compatible with life)
presents : fractures in childhood, FTF, do not grow to full height
there is no cure
