bone problems

Question 1

describe osteomalacia

Answer 1

Vitamin D deficiency
Non-ossification of soft osteoid (bones too soft)
Bone deformity, pain and tendency to partial fractures
Poor cortico-medullary differentiation

Question 2

describe paget’s disease

Answer 2

increased bone turnover with unknown cause
single or multiple bones affected
initial lytic phase results in well defined lucency
latter sclerotic phase with
enlarged bone
increased density
coarse trabecular pattern

Question 3

describe rickets

Answer 3

Vitamin D deficiency
Non-ossification of soft osteoid (bones too soft)
Bone deformity, pain and growth abnormality
Widened growth plates
Irregular, flared metaphyses

Question 4

describe lytic bone destruction?

Answer 4

Medullary lucency and loss of trabeculae
Loss of inner cortex (endosteum)
Complete loss of cortex
Loss of both cortices
Potential for pathological fracture

Question 5

describe sclerotic bone lesion

Answer 5

Subtle medullary density and loss of trabeculae
Spreading zone of density which includes cortex
Featureless white bone
Expansion beyond normal bone limits, with cortical destruction and potential for pathological fracture

Question 6

what are the 3 bone cells that contribute to homeostasis?

Answer 6

osteoblasts are bone forming cells

osteoclasts are responsible for bone breakdown/resorption

osteocytes are mature bone cells within the bone matrix, help to maintain bone and act as mechanosensors

Question 7

what are the drug treatments for osteoporosis?

Answer 7

Calcium & vitamin D supplementation
Bisphosphonates
Denosumab
Teriparatide
Romosozumab
HRT
Testosterone

Question 8

when & how would you use zoledronic acid?

Answer 8

Once yearly IV infusion for 3 years

1 in 3 acute phase reaction with first infusion – paracetamol

~ 70% reduction in vertebral fracture, 40% reduction in hip fracture

Consider if intolerant of oral bisphosphonates or unable to comply with dosing regime

Question 9

what are the symptoms of paget’s disease?

Answer 9

bone pain, deformity, deafness, compression neuropathies

Question 10

how do you diagnose paget’s disease?

Answer 10

xray, isotope bone scan shows the distribution of the disease

Question 11

what is the bone cell activity in paget’s disease?

Answer 11

abnormal osteoclastic activity followed by increased osteoblastic activity

Question 12

what type of inheritance pattern does osetogenesis imperfecta follow?

Answer 12

autosomal dominant

Question 13

what can be associated with osteogenesis imperfecta?

Answer 13

blue sclera and dentinogenesis (tooth formation abnormality)