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Y2 ENDOCRINOLOGY > Bone Disorders > Flashcards

Bone Disorders Flashcards

1
Q

Define osteoporosis

A

Progressive decrease in bone mass and deterioration of bone tissue, causing increased fragility and susceptibility of fracture

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2
Q

Osteoporosis is more common in men than women. True/False?

A

False

Women

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3
Q

List common fracture sites due to osteoporosis

A

Neck of femur
Vertebral body
Distal radius
Humeral neck

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4
Q

Describe the bone remodelling cycle that occurs in bone remodelling units

A

Osteoclasts act on an inactive surface and resorbs bone; these are then replaced by osteoblasts that fill the cavity by laying osteoid; osteoid is then mineralised to form new bone

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5
Q

What is the abnormal process occurring in osteoporosis?

A

Relative/absolute increase in bone resorption compared to formation

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6
Q

In women, what is the major determinant of bone loss following menopause?

A

Oestrogen deficiency

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7
Q

What is the most widely used method of assessing bone mineral density and fracture risk respectively?

A

DEXA scan

Q fracture

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8
Q

Define normal BMD

A

Within 1 standard deviation of young adult reference mean

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9
Q

Define osteopenic BMD

A

BMD between 1 and 2.5 standard deviations below young adult reference

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10
Q

Define osteoporotic BMD

A

BMD of 2.5 or more standard deviations below young adult reference

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11
Q

Low BMD is proportional with increased risk of fracture. True/False?

A

True

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12
Q

List lifestyle advice for osteoporosis

A

High intensity strength training
Low impact weight-bearing exercise
Avoid smoking and alcohol
Diet management

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13
Q

List drug treatment for osteoporosis

A 
Calcium and vitamin D supplements
Biphosphonates
Denosumab
Teriparatide
Strontium ranelate
HRT
SERMs
Testosterone
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14
Q

How do bisphosphonates work?

A

Antiresorptive agents to prevent bone loss at vulnerable sites; absorb onto bone and ingested by osteoclasts, leading to cell death

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15
Q

Give examples of biphosphonates

A

Alendronate

Risedronate

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16
Q

When would antiresorptive therapy be started in patients?

A

T score less than -2.5

17
Q

List some long term concerns/complications of biphosphonates

A

Osteonecrosis of jaw
Oesophageal cancer
Atypical fractures

18
Q

Which complication of osteoporosis is zoledronic acid particularly useful for?

A

Reduces risk + incidence of fractures

19
Q

What is denosumab and why is it useful for osteoporosis?

A

Monoclonal antibody treatment that antagonises RANK to inhibit development of osteoclasts, resulting in increased bone density

20
Q

Strontium renelate is the 3rd line treatment for osteoporosis - why?

A

Antiresorptive capacity is lower than bisphosphonate

Has more contraindications

21
Q

What is teriparatide?

A

Recombinant PTH that helps stimulate bone growth

22
Q

What is Paget’s disease? What are the two types?

A

Abnormal osteoclast activity resulting in increased osteoblast activity
Mono- or polystatic

23
Q

Which bones does Paget’s disease typically affect?

A

Long bones
Pelvis
Lumbar spine
Skull

24
Q

List clinical features of Paget’s disease

A

Bone pain
Deformity
Deafness
Compression neuropathy

25
Q

What is the main treatment for Paget’s disease?

A

Analgesia

Biphosphonates if pain not responding

26
Q

List investigations used to diagnose osteoporosis

A 
U+Es/LFTs/FBC/PV/TSH
Bone biochemistry
Protein electrophoresis/ Bence Jones proteins
Coeliac Igs
Testosterone
Vitamin D
PTH
27
Q

List some secondary causes of osteoporosis

A

Endocrine (hyperthyroidism, hyperparathyroidism, cushings disease)
GI (coeliac disease, IBD, CLD, chronic pancreatitis)
Respiratory (CF, COPD)
CKD

28
Q

What type of malignancy is associated with Paget’s disease?

A

Osteosarcoma

29
Q

List investigations for Paget’s disease

A

XR (incidental)

Isotope bone scan

30
Q

What bone biochemistry would you expect in Paget’s disease?

A

Increased Alk Phos with normal LFTs

31
Q

Osteogenesis imperfecta affects type __ collagen

A

1

32
Q

List clinical features of osteogenesis imperfecta

A

Blue sclerae
Dentinogenesis imperfecta
Severe fracture in childhood

33
Q

Name a differential diagnosis for osteogenesis imperfecta

A

NAI

34
Q

Outline management of osteogenesis imperfecta

A

Fracture fixation
Surgery to correct deformity
Biphosphonates

Y2 ENDOCRINOLOGY (19 decks)

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