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Calcium part 2 Flashcards

1
Q

Biochemistry in osteoporosis?

A

NORMAL

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2
Q

What bones are measured on a dexa scan?

A

Hip, spine and wrist

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3
Q

How is osteoporosis diagnosed?

A

DEXA scan

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4
Q

What is a T score?

A

Normal healthy young person

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5
Q

What is a Z score?

A

Compared to age-matched person

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6
Q

How is osteopenia defined?

A

T score of -1 to -2.5

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7
Q

What drugs can cause osteoporosis?

A

Prednisolone

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8
Q

What can cause rapid bone loss?

A

Sedentary, alcohol use, smoking, low BMI/poor nutrition, hyperprolactinaemia, thyrotoxicosis, Cushing’s disease, steroids, prolonged intercurrent illness

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9
Q

Treatment to prevent osteoporosis?

A

Vitamin D, bisphosphonate

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10
Q

What is the problem with oral bisphosphonates?

A

Irritate the stomach, must be taken on an empty stomach with plenty of water. If taken alongside calcium, will just be excreted out.

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11
Q

How often is zelendronate given?

A

Yearly

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12
Q

What is teriparatide?

A

PTH analogue/derivative

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13
Q

SERMS - example raloxifen - how does it affect bone?

A

Improves bone density, agonist on bone
Similar to tamoxifen

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14
Q

Normal calcium level?

A

2.2-2.6

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15
Q

Osteomalacia?

A

Same amount of bone but bone is not calcified (content is wrong)

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16
Q

Osteomalacia is caused by what?

A

Lack of vitamin D

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17
Q

Osteoporosis is caused by what?

A

Increasing age and sedentary lifestyle

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18
Q

Symptoms of high calcium?

A

Polydipsia/polyuria
Constipation
Neuro symptoms

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19
Q

In high calcium, what should the PTH be?

A

Suppressed

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20
Q

What is high calcium with suppressed PTH indicative of?

A

Malignancy

21
Q

Most common cause of hypercalcaemia in hospital?

A

Metastatic cancer invading bone

22
Q

What else could cause high calcium with suppressed PTH?

A

Sarcoidosis, vitamin D excess, thyrotoxicosis, milk alkali syndrome

23
Q

High calcium with normal PTH?

A

Primary hyperparathyroidism

24
Q

Commonest cause of hypercalcaemia in the community?

A

Primary hyperaparathyroidism

25
Q

Parathryroid hyperplasia is associated with what?

A

MEN 1, 2A?

26
Q

Which bone is affected first in primary hyperparathyroidism?

A

Wrist

27
Q

Primary hyperparathyroidism signs?

A

Bones, stones, moans and groans
PTH bone disease, renal calculi, constipation, pancreatitis, confusion

28
Q

Parathryroid adenoma is normally singular or multiple?

A

Singular

29
Q

What is familial benign hypercalcaemia?

A

High PTH and calcium
Body can’t see this
Leave them alone! Caused by a gene mutation

30
Q

How does malignancy cause hypercalcaemia?

A
  1. Humoural hypercalcaemia of malignancy (PTHrp)
  2. Bone metastasis (Local bone osteolysis)
    3.Haematological malignancy (cytokines)
31
Q

What is PTHrp?

A

Shouldn’t be expressed in adults. Can be expressed by cancer cells.

32
Q

What cancers can secrete PTHrp?

A

Small cell lung cancer

33
Q

How does sarcoidosis cause hypercalcaemia?

A

Non-renal production of 1 alpha hydroxylase

34
Q

How does thryotoxicosis cause hypercalcaemia?

A

Causes bone resorption

35
Q

How does hypoadrenalism cause hypercalcaemia?

A

Affects renal calcium transport

36
Q

Which drugs can cause hypercalcaemia?

A

Thiazide diurectics (wee out less calcium)

37
Q

How is hypercalcaemia treated?

A

0.9% saline !!!! (4L daily if they don’t have heart failure)

38
Q

How to treat hypercalcaemia known to be caused by malignancy?

A

Bisphosphonates

39
Q

When shouldn’t you give bisphosphonates?

A

If high calcium is caused by hyperparathyroidism

40
Q

Signs of low calcium?

A

Tetany
Chvtoken’s sign - tap the facial nerve
Trousseau’s sign - Carpal spasm when BP cuff is put on
Can also cause hyperreflexia, convulsions and stridor

41
Q

Treatment for hypocalcaemia?

A

IV calcium

42
Q

How to check if low calcium is a true hypocalcaemia?

A

check albumin and get adjusted calcium level
Then - what’s the PTH?

43
Q

Causes of hypocalcaemia?

A

Chronic kidney disease, post-parathyroidectomy, vitamin D deficiency, PTH resistance, DiGeorge syndrome, hypoparathyroidism

44
Q

Thyroid operation can cause what?

A

Can cut out parathryoid, need to take calcitrol for life

45
Q

What is paget’s disease

A

Thought to be a virus that causes increased bone turnover
Elevated ALP on biochemistry

46
Q

Treatment’s for paget’s disease?

A

Bisphosphonates for pain

47
Q

Signs of Paget’s disease?

A

Focal pain, warmth, deformity, fracture, SC compression, malignancy, cardiac failure

48
Q

What is renal osteodystrophy?

A

Secondary hyperaparathyroidism + retention of aluminium from dialysis fluid

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