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T year baker and burns week > clinical aspects of bone disease > Flashcards

clinical aspects of bone disease Flashcards

1
Q

what is the definition of osteoporosis?

A

a systemic skeletal disease with low bone mass increasing fragility and susceptibility to fracture

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2
Q

what are the types of osteoporosis?

A

type 1: post menopausal
Type II: senile
secondary

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3
Q

who tends to get type I osteoporosis?

A

Post menopausal women around 10 years after

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4
Q

what causes type I osteoporosis?

A

Low levels of oestrogen after post menopause

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5
Q

what bone is affected in type I osteoporosis?

A

trabecular bone and there is accelerated loss

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6
Q

who tends to get type II osteoporosis?

A

equally men and women over 70

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7
Q

what are the causes of type II osteoporosis?

A

nutrition and delayed physical activity

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8
Q

what bone is lost in type II osteoporosis?

A

both trabeculae and corticol

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9
Q

what bone is lost in secondary osteoporosis?

A

both trabecular and cortical

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10
Q

what are the main ‘ACCESS’ risk factors for osteoporosis ?

A 
A- alcohol use
C- corticosteroid use
C- calcium low
E- estrogen low
S- smoking
S- sedentary lfiestyle
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11
Q

other than the ‘ACCESS’ risk factors for osteoporosis?

A
  • family history
  • rheumatoid arthritis
  • thyroid or liver disease
  • spinal cord injury
  • nutrition
  • thyroid replacement
  • ant acids
  • long term anti convulsant use
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12
Q

what is the normal presentation of osteoporosis?

A

often silent but get kyphosis and fractures

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13
Q

what are DEXA T scores?

A

SD is to the young normal mean bone density from a population of 20-30 year olds Caucasian women

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14
Q

what is Z score in DEXA?

A

the age matched mineral bone density

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15
Q

when is a patient referred for a DEXA scan?

A
  • low trauma fracture
  • osteopenia/ vertebral fracture seen on XRAY
  • steroid therapy
  • early menopause
  • secondary causes
  • strong family history
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16
Q

what is FRAX?

A

a calculator to work out 10 year fracture possibility

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17
Q

what does FRAX consider?

A 
T score
Alcohol
R.A
glucocorticoids
smoking
previous fractured hip
previous fracture
afe
BMI
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18
Q

what is the conservative management of osteoporosis?

A

weight bearing exercise
calcium rich diet
vitamin D supplements
avoid alcohol and smoking

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19
Q

what anti-resorptive medications is given for osteoporosis?

A
  • oestrogen
    – bisphosphonates (alendronate, risedronate, etidronate)
    selective oestrogen receptor modulators
    calcitonin
20
Q

what bone forming agents can be given for osteoporosis?

A
  • PTH (teriparatide fluoride)

anti rank ligand (denosumab)

21
Q

what are CI to bisphosphonates?

A

oesophagitis

22
Q

what is an alternative for bisphosphonates in osteoporosis?

A

strontium ranelate

23
Q

what is the definition of osteomalacia?

A
  • loss of bone mineralisation related to vitamin D deficiency
24
Q

what is the different in bone amount in osteoporosis vs osteomalacia?

A

reduced in osteoporosis

normal in osteomalacia

25
Q

what is the different in bone mineralisation in osteoporosis vs osteomalacia?

A

Normal is osteoporosis

reduced in osteomalacia

26
Q

what are causes of osteomalacia?

A
  • vitamin D deficiency
  • lose of vit D through the gut
  • defect in production of vit D
27
Q

what can cause Vitamin D loss in the gut contributing to osteomalacia?

A
  • coeliac disease
  • pancreatic insufficiency
  • cholestatic liver disease
  • chapattis
28
Q

what are causes of defective Vit D production?

A
  • familial hypophosphaetaemic rickets
    CKD
    fanconis syndrome
29
Q

what is the presentation of osteomalacia?

A
  • bone pain
  • proximal weakness
  • malaise
  • symptoms of hypocalcaemia
  • deformity
  • fractures
  • rickets (hypotonia, growth retardation, skeletal deformities)
30
Q

what blood results suggest osteomalacia?

A
  • low calcium
  • low phosphate
  • low vit D
  • raised PTH (due to low calcium)
  • increased serum alkaline phosphatase
31
Q

what can be seen in osteomalacia Xrays?

A
  • normal or osteopenia
  • looser zones
  • pseudo fractures often in ribs, scapula, pubic rami and upper femur
32
Q

what is seen in Xray of someone with rickets?

A

Cupping and fraying of metaphyses

widened epiphyseal plates

33
Q

what is a definition of pagets disease of the bone?

A
  • a condition of abnormal bone remodelling
34
Q

what genes are involved with pagets disease?

A

5q35 QTER

35
Q

what are the phases of pagets disease?

A
  1. lytic phase
  2. mixed phase
  3. sclerotic phase
36
Q

what is the lytic phase of pagets?

A

intense osteoclastic resorption

37
Q

what is the sclerotic phase of pagets disease?

A

osteoblast bone formation dominates

38
Q

what is the presentation of pagets disease?

A 
pain
deformity
osteoarthritis
fractures
neurological symptoms (deafness and conductive defects)
sarcomatous transformation
cardiac failure
39
Q

what are differentials of raised alkaline phosphatase?

A
  • metastatic bone disease
  • osteomalacia
  • pagets disease
  • lliver disease
  • hyperparathyroidism
40
Q

what is seen on XRay in pagets?

A

marked areas of sclerotic and lytic lesions

41
Q

what are complications of pagets disease?

A
  • stress fractures
  • increased OA
  • skull enlargement can cause deafness, hydrocephalus
  • high output cardiac failure
  • osteosarcoma
42
Q

what is osteopetrosis?

A

increased bone density due to decreased osteoclast action

43
Q

what is the treatment of osteopetrosis?

A

bone marrow transplant

calcitriol

44
Q

what is osteopoikilosis?

A
  • spotted bone disease

- islands of deep cortical bone appear within the medullary cavity and the cancellous bone of the long bones

45
Q

what is a bisphosphonate fracture?

A

An atypical femoral fracture is a diagnosis of exclusion:

  • not spiral or comminuted
  • not to the femoral neck or intertrochaneric
  • no evidence of malignant bone tumour
  • not periprosthetic

T year baker and burns week (4 decks)

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