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Endocrine > Bone physiology > Flashcards

Bone physiology Flashcards

1
Q

True or False

One vertebral fracture will lead to another

A

True

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2
Q

What do osteoclasts do?

A

Resorb bone

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3
Q

What do osteoblasts do?

A

Put down osteoid to form new bone

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4
Q

Who should be assessed using the risk factor assessment? (2)

A

Anyone over 50 with risk factors

Anyone under 50 with an early menopause or on steroids

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5
Q

When should a DEXA scan be requested?

A

10 year risk assessment of at least 10%

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6
Q

In a DEXA scan, which value is the most important?

A

T value

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7
Q

What does the T value have to be to be classified as osteoporosis?

A

More than -2.5

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8
Q

What is a Z score?

A

Age matched so compares with age and size

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9
Q

When are Z scores used?

A

If younger than 20

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10
Q

What class of drug is given if osteoporosis is diagnosed?

A

Bisphosphonate

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11
Q

What are examples of bisphosphonates?

A

Alendronic or risedronic acid

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12
Q

When is zolendronic acid given?

A

If DEXA intolerable

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13
Q

What is given in severe spinal osteoporosis?

A

Teriparatide

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14
Q

If osteopenia is diagnosed what is done?

A

Lifestyle advice e.g. smoking, alcohol, weight bearing exercise, falls advice
DEXA reassessment

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15
Q

True or False

Post-menopausal women should increase their dairy intake

A

True

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16
Q

How do bisphosphonates work?

A

Apoptosis of osteoclasts so inhibit bone resorption

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17
Q

What are long term potential side effects of bisphosphonates?

A

Osteonecrosis of jaw

Oesophageal Ca

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18
Q

How is zolendronic acid given?

A

Once yearly IV infusion

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19
Q

When is denosumab given?

A

If bisphosphonates intolerable.

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20
Q

How should alendeonic acid be given?

A

Tablet, 30 minutes before food and don’t lie down for half an hour after

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21
Q

When should alendronic acid be stopped?

A

Oesophagitis or ulcers

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22
Q

What are common side effects of alendronic acid?

A

Abdo pain
Nausea
dyspepsia
GI side effects

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23
Q

How does denosomuab work?

A

Monoclonal Ab that binds to RANKL

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24
Q

What is RANKL?

A

Receptor activator of nuclear factor kB ligand

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25
Q

How does activating RANKL prevent osteoporosis?

A

Inhibits osteoclasts and decreases bone resorption

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26
Q

How is denosomuab given?

A

Subcut injection 6 monthly

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27
Q

Why is strontium not recommended as 1st line?

A

Fracture reduction is slightly less and dangerous in heart disease

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28
Q

Where does Paget’s disease affect?

A

Long bones
Pelvis
Lumbar spine
Skull

29
Q

What is Paget’s disease?

A

Increased osteoclast activity with abnormalities. Reduced strength

30
Q

What is a complication of Paget’s disease?

A

Osteosarcoma

31
Q

What symptoms may present with Paget’s?

A

Often asymptomatic but bone pain or deformity and deafness

32
Q

How is Paget’s diagnosed?

A

XR

Increased alk phos

33
Q

How is Paget’s treated?

A

Bisphosphonates

34
Q

Which defect causes osteogenesis imperfecta?

A

COL1A1/2

Autosomal dominant

35
Q

What is associated with osteogenesis imperfecta?

A

Blue sclerae

Dentinogenesis imperfecta

36
Q

Which receptor on the parathyroid is for calcium?

A

Ca sensitive receptor

37
Q

What kind of receptor is CaSR?

A

G protein coupled

38
Q

How is vitamin D stored in the liver?

A

Cholecaliferol

39
Q

What does the liver convert it to?

A

25-hydroxycholecaliferol

40
Q

What does the kidney turn it into?

A

1,25-hydroxycholecaliferol

41
Q

What are symptoms of acute hypercalcaemia?

A

Thirst
Dehydration
Polyuria
Confusion

42
Q

What are symptoms of chronic hypercalcaemia?

A

Myopathy
Fractures
Depression
Abdo pain

43
Q

What are major causes of hypercalcaemia?

A

Primary hyperparathyroidism

Malignancy

44
Q

What drugs can cause hypercalcaemia?

A

Vitamin D

thiazides

45
Q

What will blood results be for 1o hyperparathyroidism?

A

Raised serum Ca
Raised serum PTH
Increased urine Ca excretion

46
Q

What other serum protein is important for diagnosing malignancy?

A

Alkaline phosphate (raised in malignancy)

47
Q

What is the treatment for acute hypercalcaemia?

A

Fluids
Loop diuretics once rehydrated
Bisphosphonates will lower Ca

48
Q

How is 1o primary hyperparathyroidism managed?

A

Surgery or nothing

49
Q

When should surgery for 1o hyperparathyroidism be indicated?

A

If end organ damage e.g. renal stones, osteoporosis, gastric ulcers or renal disease
Or if calcium is v high (>2.85)

50
Q

What is 2o hyperparathryoidism?

A

Physiological response to low Ca

PTH raised

51
Q

What is 3o hyperparathyroidism?

A

Overactive PTH after many years of 2o

52
Q

Which genetic syndromes are closely linked with hyperparathyroidism?

53
Q

What is FHH?

A

Familial hypocalciuric hypocalcaemia

54
Q

What signs will be present in FHH?

A

Low Ca urine

Hypercalcaemia

55
Q

How does PTH work on the gut?

A

Causes it to absorb Ca and therefore increased serum Ca levels

56
Q

In which fish is vitamin D high in?

57
Q

What are the symptoms of hypocalcaemia?

A

Paraesthesia in extremities and perioral
tetany and cramps
Fatigue and myopathy
Long QT on ECG

58
Q

What are the causes of hypocalcaemia?

A

Hypoparathyroidism
Vitamin D deficiency
renal failure
Pancreatitis

59
Q

What is the treatment for acute hypocalcaemia?

A

10ml 10% IV calcium gluconate over 10 mins

60
Q

In what congenital condition is the parathyroid gland underachieve?

A

DiGeorge syndrome

61
Q

What are the other features of DiGeorge syndrome?

A 
Cardiac abnormalities
Abnormal facies
Thymus aplasia
Cleft palate 
Hypoparathyroidism/hypocalcaemia
Chromosome 22
62
Q

What is the long term management of hypoparathyroidism?

A

Calcium supplement daily

Vitamin D tablet

63
Q

Why can hypomagnaeseamia cause low calcium?

A

Ca release is Mg+ dependent

64
Q

What causes hypomagnaeaemia ?

A

Alcohol
Thiazides
PPI

65
Q

What is pseudohypoparathyroidism?

A

Genetic defect of GNAS1 which means that PTH is resisted

66
Q

What are symptoms of pseudohypoparathyroidism?

A

Obesity
Learning disabilities
Brachdactyly of 4th metacarpal
Hypocalcaemia

67
Q

What is pseudo-pseudohypoparathyroidism?

A

Same but with normal Ca

68
Q

What can cause rickets?

A

Coeliac disease
Liver disease
Chronic renal failure

69
Q

True or False

Alk phos is raised in Osteomalacia

Endocrine (20 decks)

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