bone disorders Flashcards
What are the risk factors for OA?
Female Obesity Fracture through a joint Congenital joint dysplasia Occupation (farmers) Repetitive injuries
What are the clinical features of OA?
Joint pain made worse by movement and relieved by rest Stiffness occurs after rest Transient <30 mins morning stiffness DIPJs, PMCJ, vertebrae, hips and knees Muscle wasting Deformity Crepitus Herbedens and bouchards
How is OA diagnosed?
FBC and ESR are normal
RA negative
X-rays: narrowing of joint space, osteophytes, subchondral sclerosis and cyst formation
What are the biochemistry results of Paget’s disease?
Normal calcium
Normal phosphate
High ALP
Normal PTH
What are the biochemistry results of osteomalacia?
Low calcium (can be N) Normal phosphate (can be L) PTH may be raised due to 2ndHP
What are the risk factors for osteoporosis?
Immobilization Chronic liver disease Chronic renal disease Chronic obstructive pulmonary disease Gastrointestinal disease Low dietary calcium intake Vitamin D insufficiency Drugs (heparin, ciclosporin, anticonvulsants) Endocrine disease (Cushing’s syndrome, hyperthyroidism, hyperparathyroidism) Low body mass index Smoking Alcohol abuse Glucocorticoid therapy High bone turnover Increased risk of falling Rheumatoid arthritis
What are the indications for a DEXA scan?
Radiographic osteopenia
Previous fragility fracture (in those aged less than 75 years) Glucocorticoid therapy (in those aged less than 65 years) Body mass index below 19kg/m2
Maternal history of hip fracture
What is Paget’s disease?
focal disorder of bone remodelling in which there is increased oste- oclastic bone resorption followed by formation of weaker new bone, increased local bone blood flow and fibrous tissue. The incidence increases with age; it is rare in the under 40s and affects up to 10% of adults by the age of 90 years.
What are the clinical features of Paget’s disease?
Pain in the bone or nearby joint (cartilage or adjacent bone is damaged)
• Deformities: enlargement of the skull, bowing of the tibia
• Complications: nerve compression (deafness, paraparesis), pathological fractures, rarely high-output cardiac failure (due to increased bone blood flow) and osteogenic sarcoma.
What are the risk factors for osteomalacia? (rickets vit d deficiency)
Pigmented skin Old age Malabsorption Short bowel Renal disease Cholestatic liver disease Anticonvulsants, rifampicin and antiretroviral
How can Paget’s disease present?
Bone aches Stiffness Frequent headaches and hearing loss Warm and deformed limbs Angoid steaks on fundoscopy Elevated ALP X-ray: increased bone sclerosis, abnormal architecture, bowing and bone enlargement
Which diseases commonly cause secondary osteoarthritis?
Acromegaly
Haemophilia A
RA
What does the T score indicate?
What are the risk factors for osteoporosis?
Overactive thyroid Crohns, coeliacs Chronic liver/kidney disease Early menopause, late menarche RA Smoking BMI <18 Steroids COPD Asian, Caucasian >4 units of alcohol per day
How is Paget’s disease treated?
Bisphosphonates
