Bones - Acquired Disorders Flashcards
Osteopenia
Decreased bone mass
With Osteopenia, how many SD’s below the mean must be present?
1-2.5 SD below mean
Osteoporosis
Very decreased bone mass with fracture risk
With Osteoporosis, how many SD’s below the mean must be present?
More than 2.5 SD below the mean
What are the signs of Osteoporosis?
Vertebral compression fractures or atraumatic fractures
Loss of height
What are the signs of Osteoporosis?
Vertebral compression fractures or atraumatic fractures
Loss of height
The magnitude of bone deficits that accumulate each year of life are determined by?
Hereditary factors
What treatment can often increase bone loss?
Breast cancer treatment (tamoxifen)
What are some risk factors for Osteoporosis?
Caucasian
Low calcium
High phosphorus
Smoke exposure
Age-related Osteoporosis
Decreased capacity to make bone (low turnover variant)
Decreased physical activity correlates with?
Increased rate of bone loss
Between load magnitude and load cycles, which physical activity is better for decreasing rate of bone loss?
Load magnitude – resistance exercises are better
Adolescent girls have insufficient ____ intake during growth that causes a decreased peak bone mass to be achieved
Insufficient calcium intake
Hormones can play a major role in the pathogenesis of Osteoporosis. Especially when?
Post-menopause = accelerated bone loss
_____ Estrogen can cause Osteoporosis
DECREASED
Decreased Estrogen causes _____ resorption»_space; formation
Increased resorption (high turnover variant)
Decreased Estrogen can also activate what things to cause bone resorption?
RANKL
Cytokines
==> (+) osteoclasts
How does Osteoporosis look on histo?
NORMAL – just decreased bone in quantity
Post-menopausal Osteoporosis involves increased Osteoclast activity. What changes can be seen on the bone?
Trabeculae thinned and loss of the horizontal trabeculae
– microfractures and vertebral collapse
Post-menopausal Osteoporosis involves thinned trabeculae. Senile Osteoporosis involves thinned ____
Thinned cortex = senile
What causes Rickets and Osteomalacia?
Vitamin D Deficiency –> impairs mineralization
What causes Rickets and Osteomalacia?
Vitamin D Deficiency –> impairs mineralization
Rickets occurs in ____ and interferes with bone deposition where?
Kids - interferes with deposition of bone at growth plate
What are the signs of Rickets?
Frontal bossing of head
Rachitic Rosary of ribs
Bowed legs
Pigeon breast deformity of chest
A kid presents with frontal bossing, bowed legs, rachitic rosary of the ribs and pigeon chest. What do they have?
Rickets
Osteomalacia occurs in?
Adults
– prone to fractures
Hyperparathyroidism involves Increased PTH which = ___
Increased PTH = Increased Calcium
Describe the cascade seen with Hyperparathyroidism
- PTH increases RANKL to (+) osteoclasts
- Calcium is resorbed by renal tubules
- Urinary excretion of phosphates
- Increased vitamin D synthesis increases RANKL
Hyperparathyroidism involves ___ bone mass along with fractures, deformities, etc.
Decreased bone mass
What 3 things can be seen morphologically with untreated Hyperparathyroidism?
- Osteoporosis
- Brown tumor - secondary hemorrhage mass lesion
- Von Recklinghausen - clasts tunnel to form “railroad tracks”
Renal Osteodystrophy
Skeletal changes that occur with chronic renal disease
What molecule is increased in the blood with Renal Osteodystrophy?
Hyperphosphatemia
Paget Disease
INCREASED bone mass – disorganized
With disease involves increased bone mass?
Paget Disease
Paget Disease usually affects 1 or multiple bones?
Multiple
What bones are usually involved with Paget Disease?
Axial skeleton
Femur
Some cases of Paget disease are asscociated with mutations in what gene?
SQSTM1
How does the bone look with Paget Disease?
Mosaic pattern of lamellar bone
== jigsaw appearance with prominent cement lines
How does the bone look with Paget Disease?
Mosaic pattern of lamellar bone
== jigsaw appearance with prominent cement lines
What are the 3 stages of Paget Disease?
- Osteolytic = Osteoclasts with 100 nuclei
- Mixed = clasts and blasts
- Burned out quiescent osteosclerotic = Osteoblasts
What are the 3 stages of Paget Disease?
- Osteolytic = Osteoclasts with 100 nuclei
- Mixed = clasts and blasts
- Burned out quiescent osteosclerotic = Osteoblasts
What types of fractures are seen with Paget Disease?
Chalk stick fractures of long bones
Spinal compression fractures
With Paget Disease, the leg bones will ____. What types of fractures are seen too?
Legs will bow
- Chalk stick fractures of long bones
- Spinal compression fractures
How will the skin feel over the affected bone and why with Paget Disease?
Warm due to hypervascularity
Hypervascularity of the affected bones with Paget Disease can result in?
AV shunt ==> High output Heart Failure
What will be elevated with Paget Disease?
Alk Phosphatase
What are 2 treatment options for Paget Disease
Calcitonin
Bisphosphonates
