Chronic Orthopaedic Conditions

Question 1

Role of PTH?

Answer 1

Increase Ca and lower PO4
- INCREASES bone resorption so as to release Ca and PO4
- Activates Vit D in the kidney by 1AH
- Increases renal reabsorption of Ca but excretion of PO4

Question 2

Role of Vit D?

Answer 2

Increases Ca AND PO4
- Increases bone resorption to release Ca and PO4
- Increase Ca and PO4 uptake through GIT
- Increase renal resorption of Ca PO4

Question 3

Calcitonin does what

Answer 3

INHIBITS BONE RESORPTION
Also inhibits renal resorption of Ca

Question 4

Oestrogen role in bone health and Ca?

Answer 4

Same as calcitonin -
INHIBITS BONE RESORPTION
Also inhibits renal resorption of Ca

Question 5

How may glucocorticoids cause Osteoporosis?

Answer 5

Decreases the replication, migration, differentiation, lifespan of osteoblasts

Question 6

Types of osteoporosis?

Answer 6

Primary (Type I and II) vs Secondary (congenital vs acquired)

Primary OP - Mayo Clinic classification:
Type I: Post-menopausal women with wrist or vertebral crush #
Type II: Age-related, with hip or vertebral wedge #

Secondary OP -
Congenital: Osteogenesis imperfecta, EHLER-DANLOS syndrome, Marfan’s, Glycogen storage disorders, hypophosphatasia

Acquired: DM, Cushing’s, Hyperparathyroidism, Hyperthyroidism, Hypercalciurea / Steroids, Aromatase inhibitors, Immunosuppressants, Anticonvulsants, Heparin and Warfarin, PPIs / Ca deficiency (<500mg/d), Vit D or B12 deficiency, Following a gastric or bariatric surgery, IBD or other malabsorption diseases, Alcoholism, CLD, Anorexia

Question 7

Name common sites of fragility fractures (be systematic!)

Answer 7

UL - Humeral head, Colles’ #
Spine - Compression, wedge fracture
LL - NOF, Intertrochanteric, subtrochanteric

Question 8

Fragility fractures are…

Answer 8

from minimal trauma like a fall from standing height OR less with no identifiable trauma

Question 9

What is a common complaint of compression / wedge fractures in the spine?

Answer 9

Pt may complain of getting shorter! 4cm shorter relative to the previous maximum height (of all time), OR 2cm loss in 2 years

Question 10

What questions can be asked to elicit that the pt is at risk for OP?

Answer 10

Primary OP - Weight, Loss of height over what timespan, Lifestyle (activity, smoking, alcohol