Bone Disorders

Question 1

What are the main bone disorders

Answer 1

Osteomalacia
Osteopenia
Osteoporosis
Primary hyperparathyroidism
Rickets
Paget disease

Question 2

What are the main clinical features of osteomalacia

Answer 2

Wide spread bone pain
Lower limb weakness

Question 3

Diagnosis or lab values for osteomalacia?

Answer 3

Low calcium
Low phosphate / high phosphate
High ALP and high PTH

Question 4

Cause of osteomalacia

Answer 4

Reduce vit d
Which then has reduction of calcitriol ( active Vit D which 1,25 dihydroxy vitamin D )
Which then reduces the calcium re absorption from kidneys and intestines

Or

Insufficient calcium absorption from the intestine due to lack of calcium in diet

Question 5

X

Answer 5

C

Question 6

X

Answer 6

X

Question 7

X

Answer 7

X

Question 8

X

Answer 8

X

Question 9

Lab values for osteoporosis / osteopenia ?

Answer 9

These are not quantifiable lab disorders
Normal calcium
Normal phosphate
Normal ALP
Normal PTH

Question 10

Biggest cause for osteoporosis ?

Answer 10

Steroid consumption
Risk when taking atkeast 7.5mg of prednisolone or more every day for atleast 3 months

Question 11

DEXA scan management in steroid induced osteoporosis ?

Answer 11

Between 0 and -1.5
Repeat bone density scan in 1-3 years

Less than -1.5
Offer bone protection

Question 12

X

Answer 12

X

Question 13

X

Answer 13

X

Question 14

X

Answer 14

X

Question 15

What is paget disease

Answer 15

bone remodelling disorder characterised by increased bone resorption, bone formation, and remodelling, which may lead to major long-bone and skull deformities.

Question 16

What are the clinical features of Paget disease

Answer 16

Majority of patients are asymptomatic. Symptomatic patients typically experience pain localised to the bone or joint, either from the pagetic lesion

Neurological symptoms due to bone overgrowth with consequent nerve impingement may include hearing loss, chronic facial pain, hydrocephalus, peripheral nerve entrapment, and spinal stenosis.

long-bone or back pain
pathological fracture
bony deformities (e.g., frontal bossing, prognathism, bone bowing)

Question 17

What is the diagnosis of Paget disease

Answer 17

incidental in the majority of patients, with an

isolated elevated serum alkaline phosphatase raising suspicion for disease.

Plain radiographs are diagnostic; in less clear cases, a computed tomography scan is indicated.

Bone biopsy is the ultimate confirmatory test, but it is rarely necessary.

Question 18

What are the treatment options for paget disease

Answer 18

bisphosphonates are the first-line therapy to retard excessive osteoclastic activity.
Or Calcitonin

Adjunctive therapy includes physiotherapy, orthoses, and walking and hearing aids. Analgesics are indicated for pain control.

Question 19

What are the increased risk factors for paget disease

Answer 19

More than 50
Family history
Make sex