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Yr5 MSK > Bone Pathology > Flashcards

Bone Pathology Flashcards

1
Q

What is Osteoporosis?

A

Reduced bone mass/density & ↓quality

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2
Q

What are the causes of osteoporosis?

A 
PRIMARY: Age-related, Fhx, prolonged immobility
SECONDARY: SHATTERED-
S: Steroids
H: Hyper (para)thyroid
A: OH- & tobacco
T: Thin (BMI <22)
T: Testosterone
E: Early menopause
R: Renal/liver failure
E: Errosive/inflam bone disease
D: Diet (↓Ca2+)
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3
Q

How is osteoporosis investigated?

A

DEXA SCAN
Xray
FRAX score- Risk assess severity
Bloods: TFTs, Ca2+, PO4-, ALP

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4
Q

What do the DEXA scores refer to?

A

T > -1.0 = normal
T -1 - -2.5 = Osteopenia
T < -2.5 = Osteoporosis

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5
Q

How is Osteoporosis managed?

A

Lifestyle: Weight bearing & balance exercises

1) Bisphosphonates: 10mg OD OR 70mg weekly Alendronate
2) Ca + Vit D Supplements: Ergocalciferol + Calcium → Target >75

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6
Q

What are the complications of osteoporosis?

A

Fragility #
Vertebral crush #
Long bone #

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7
Q

What are the SE of Alendronic acid?

A

Take standing before breakfast

SE: Fever, myalgia, arthralgia, oesophagitis, GORD, osteonecrosis of the jaw, avascular femoral #

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8
Q

How can women in particular be protected against osteoporosis?

A

HRT in post-menopausal

ANY post-menopausal woman WITH # = Bisphosphonates + Calcium

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9
Q

What is Paget’s disease of bone?

A

AKA Osteitis Deformans

Chronic localised bone remodelling disorder which may lead to major long bone & skull deformities

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10
Q

What is the pathophysiology & phases of Paget’s?

A

1) LYTIC PHASE: ↑Osteoclast activity leads to rapid bone resorption
2) SCLEROTIC PHASE: ↑Osteoblast activity leads to rapid bone formation
Disorganised bone turnover & remodelling
↑vascularity & hypertrophy of bone = deformity & mechanically weak bone

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11
Q

Which bones does Paget’s commonly affect?

A

Lumbo-sacral spine
Pelvis
Skull
Tibia

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12
Q

What are the RFs for Paget’s?

A 
Anglo-Saxon heritage
SQSTM1 mutation
↑Age
Male
FHx
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13
Q

What are the Sx of Paget’s?

A 
70% Asymptomatic
Bone pain: Deep, boring 
Bone deformity: Bowed, kyphosis, frontal bossing/enlarged maxilla
Pathological #
↑Temperature: Over active bone
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14
Q

How is Paget’s investigated?

A

Xray: Localised enlarged bone, asymmetrical, patchy cortical thickening w/sclerosis & osteolysis & deformity
Bone Scan: Reveals hot spots & extent of severity
Bloods: ↑↑ALP, Ca2+, Phos, PTH (N)

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15
Q

What signs on Xray may indicate Paget’s disease?

A

Blade of grass: V-shaped pattern between healthy & diseased bone
Cotton wool: Skull- multifocal sclerotic patches

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16
Q

How is Paget’s managed?

A

1) Conservative: Orthotic devices
2) NSAID + Paracetamol
CORRECT Ca2+/Vit D then:
3) Alendronic Acid or Calcitonin

17
Q

How is Paget’s monitored?

A

Serial ALP

18
Q

What are the complications of Paget’s?

A

OA
Deafness & tinnitus: Compress CN8 by bone overgrowth = stapes fixation
Spinal stenosis
High output HF: If >40% skeletal involvement as ↑blood through bone
Osteosarcoma: AMPUTATION
HyperCa

19
Q

What is Osteomalacia?

A

Metabolic bone disease characterised by incomplete mineralisation of underlying mature bone

20
Q

What is Osteomalacia called in children?

A

Rickets

21
Q

What are the causes of Osteomalacia?

A 
Vit D Deficiency- MOST COMMON
Coeliac disease
CKD
Drugs: Anti-convulsants
Liver disease: Cirrhosis
Tumours
22
Q

What is the pathophysiology of Osteomalacia?

A

Vit D required to maintain Ca2+/Phos homeostasis
↓Ca2+/Phos leads to secondary hyperPTH
Poor mineralisation of bone matrix (excess uncalcified osteoid & cartilage)
Results in ↓skeletal mass

23
Q

What are the Sx of Osteomalacia?

A

Bone pain
Muscle tenderness
Proximal myopathy- Waddling gait
Fractures

24
Q

What are the Sx of Rickets?

A

Growth retardation
Hypotonia
Apathy
Genu Valgum/Varum

25
Q

How is osteomalacia investigated?

A

Xray: TRANSLUCENT BANDS, partial #
Bloods: ↓Ca2+, ↓PO4-, ↑ALP, ↑PTH
↓Vit D3 (1,25 (OH)2D) = renal disease <30-50 = Tx
Biopsy: Bone & Muscle

26
Q

When does osteomalacia require referral?

A 
Fragility #
Documented osteoporosis
↑PTH
Malabsorption: CD/UC
Pregnant
27
Q

What signs of Xray show Rickets?

A

Cupped, ragged metaphysical surfaces

28
Q

How is Osteomalacia managed?

A

Colecalciferol/ Ergocalciferol 50,000units PO 1-2 weekly
AND
Calcium Carbonate: 1-2g/d in 3doses

Yr5 MSK (9 decks)

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