Bone Disorders Flashcards
what destroys bone?
osteoclasts
what rebuilds bone?
osteoblasts
female bone mass significantly reduces at what age/stage?
menopause
50s/60
what 2 classes of drug results in bone loss?
glucocorticoids and aromatase inhibitors
name the 4 common fracture sites
neck of femur
vertebral body
distal radius
humeral neck
those with osteoporosis often have thoracic ______sis
those with osteoporosis often have thoracic KYPHOSIS
what scan is performed to measure bone mass?
DEXA scan
normal
osteopenia
osteoporosis
severe osteoporosis
BMD ≥ 2.5 SD below the young adult mean
osteoporosis
normal
osteopenia
osteoporosis
severe osteoporosis
BMD within 1 SD of the young adult reference mean
normal
normal
osteopenia
osteoporosis
severe osteoporosis
BMD >1 SD below the young adult mean but <2.5 SD below this value
osteopenia
normal
osteopenia
osteoporosis
severe osteoporosis
BMD ≥2.5 SD below the young adult mean with fragility fracture
severe osteoporosis
if younger than 20, what is the only thing reported?
z score
who should be referred for DEXA?
patients over 50
low trauma fracture
10 year risk assessment for any OP fracture of at least 10%
name the risk assessment tool for increased risk of fracture
FRAX or Qfracture
WHO fracture risk calculator allows prediction of __ year fracture risk of major osteoporotic fracture or hip fracture
WHO fracture risk calculator allows prediction of 10 year fracture risk of major osteoporotic fracture or hip fracture
those under the age of 50 that have undergone early ________ or on _______________ should be assessed
those under the age of 50 that have undergone early MENOPAUSE or on GLUCOCORTICOIDS should be assessed
lifestyle advice for management of osteoporosis?
strength training
avoidance of alcohol
avoidance of smoking
fall prevention
how much calcium in those with osteoporosis should they get?
700mg calcium (2-3 portions)
postmenopausal women - 1000mg calcium
what 2 supplements should those with osteoporosis receive?
calcium and vitamin D
name the drug class prescribed in osteoporosis that prevent bone loss at all sites vulnerable to osteoporosis
biphosphonates - alendronate and risedronate
target osteoclast activity
reduce risk of hip and spine fractures
long term concern of biphosphonate therapy?
osteonecrosis of the jaw
GI upset
what is an alternative to biphosphonates due to GI upset?
zoledronic acid
once yearly IV infusion for 3 years
name the monoclonal antibody that inhibits development and activity of osteoclasts
denosumab
SC injection 6 monthly
adverse effects of densomab?
hypocalcaemia
eczema
cellulitis
name the recombinant hormone that stimulates bone growth rather than reduce bone loss
teriparatide
used in those who can’t tolerate oral treatment
corticosteroids ______ osteoblast activity and calcium absorption
corticosteroids REDUCE osteoblast activity and calcium absorption
also inhibit gonadal and adrenal steroid production
name the following disease:
abnormal osteoclastic activity followed by increased osteoblastic activity
paget’s disease
abnormal bone structure with reduced strength and increased fracture risk
what type of bones does pagets affect?
long bones
also pelvis, lumbar spine and skull
what causes pagets?
viral/environmental/biochemical trigger in genetically predisposed individuals
what does pagets present with?
bone pain, deformity, deafness, compression neuropathies
biochemistry of pagets:
high what?
ALP - alkaline phosphatase
how do you diagnose pagets?
high ALP and XR
pagets treatment?
biphosphonates
rare children fracture blue sclera dentinogenesis imperfecta
diagnosis?
Osteogenesis Imperfecta
autosomal dominant
mutations in collagen genes
Osteogenesis Imperfecta cure?
no cure
fracture fixation, surgery and biphosphonates
DHx for suspected non-accidental injury
