Clinical Management of osteoporosis and other metabolic bone diseases Flashcards

Question

what stimulates calcitonin release

Answer 1

elevated serum calcium

Answer 2

Inhibited by decreased serum calcium

Answer 3

Directly inhibits osteoclasts (have calcitonin receptors) causing transient decrease in serum calcium

Answer 4

Inhibits bone resorption (so prevents bone loss) | Also inhibits bone formation (so does not increase bone density)

Answer 5

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

Answer 6

Asymptomatic Fragility fractures Chronic pain Deformity (kyphosis) Impaired mobility

Answer 7

``` Non-modifiable Sex (female) Age Ethnicity Genetics Early menopause Small stature ``` ``` (Potentially )Modifiable Alcohol Vit D deficiency Smoking Malnutrition Inactivity Heavy metals PPIs ``` ``` Medical conditions Hypogonadal states Menopause, amenorrhoea, Turner syndrome… Endocrine disorders Cushing’s, ↑PTH, ↑T4, ↓T4 Malabsorption Coeliac, Crohn’s, UC, CF, short gut… Rheumatological conditions RA, Ank Spond, SLE… Renal insufficiency Haematological diseases MM, lymphoma, leukaemia… Inherited disorders Medications - Steroids, Phenytoin, Anticoagulants (warfarin, heparin) PPIs ```

Answer 8

``` Low peak bone mass Genetics (>20 genes) Oestrogen Environment factors Excessive bone resorption Inadequate bone formation ``` Bone formation < Bone resorption

Answer 9

Bone Mineral Density (BMD) The difference between your measurement and that of a young healthy adult is known as a T score The difference between your measurement and that of someone of the same age is known as a Z score N: T >-1.0 osteopenia -2.5

Answer 10

1: postmenopausal- loss of trabecular bone 2: senile- loss of corticol and trabecular bone 3: secondary- loss of corticol and trabecular bone

Answer 11

``` Intrinsic factors CVS Neuromuscular Visual acuity Locomotor Alcohol ``` Extrinsic factors Lighting Flooring

Answer 12

vertebra hip distal radius

Answer 13

Signs - Kyphosis - Loss of height - Tummy bulges due to loss of space under the ribs Symptoms - neck becomes weak and head falls forward - pain in whole or part of back - breathing difficulties - indigestion and GORD - stress incontinence - difficulty with mobility

Answer 14

Primary Post menopausal Idiopathic osteoporosis in men Osteoporosis in older people Secondary Disease e.g. rheumatoid arthritis, organ Tx Iatrogenic e.g. steroids

Answer 15

``` Full blood count Biochemistry Myeloma screen Gonadal function Vitamin D and PTH Bone density measurements ```

Answer 16

Low trauma fracture (defined as a fracture which is either spontaneous or following a fall from the upright position) ``` Osteopenia or vertebral fractures on X-ray Steroid therapy Early menopause Secondary causes of osteoporosis Strong family history of osteoporosis ```

Answer 17

``` Offer DEXA (rpt ~2 years) Bone-sparing drug tx if T-score ```

Answer 18

Lifestyle advice, review <5 years

Answer 19

Antiresorptive drugs - Hormone replacement therapy - Selective oestrogen receptor modulators - Bisphosphonates Bone formation drugs -Teriparatide Calcium & Vitamin D (All patients with osteoporosis)

Answer 20

‘A metabolic bone disease where defective mineralization results in a large amount or unmineralized osteoid’ Qualitative defect as opposed to a quantative defect like osteoporosis Rickets and osteomalacia are manifestations of the same pathologic process

Answer 21

Vitamin D deficiency - Lack of adequate sunlight - Low intake of vitamin D - GI diseases Calcium deficiency -Dietary Phosphate deficiency - TPN - Chronic phosphate binder therapy

Answer 22

``` vitamin-D deficient diets malabsorption e.g. celiac disease renal osteodystrophy hypophosphatemia chronic alcoholism tumors (tumor-induced osteomalacia) drugs ```

Answer 23

``` Bone pain Proximal weakness Symptoms from hypocalcaemia Deformity Fracture ```

Answer 24

``` Low Ca Low Phosphate Low vitamin D Raised PTH X-ray / bone scan abnormalties Investigation for underlying abnormalities ``` Radiograph findings Looser's zones (insufficiency fractures) medial femoral cortex pubic ramus scapula fractures (especially in the proximal femur/femoral neck) Bone scan: increased activity

Answer 25

Underlying cause Eg coeliacs disease Vitamin D supplements - Oral Vitamin D3 - Oral 1,25 Vitamin D - Intramuscular vitamin D3

Answer 26

A condition of abnormal bone remodelling excessive bone resorption and abnormal new bone formation Disease of osteoclasts Osteoclasts show abnormal morphology and are increased in number Focal areas of increased and disorganised bone turnover Focal bone is common

Answer 27

``` Frequently asymptomatic Orthopaedic manifestations Pain (e.g. stress #, increased vascularity) Deformity Osteoarthritis Fracture Neurological symptoms Sarcomatous transformation less than 1% will develop malignant Paget's sarcoma (secondary sarcoma) Cardiac failure ```

Answer 28

Markers of bone turnover - Alkaline phosphatase (serum) - Collagen cross-link (urine) ``` X-rays -coarsened trabeculae which give the bone a blastic appearance -remodeled cortices -Long bone bowing ``` Isotope bone scans Bone biopsy

Answer 29

``` Raised alkaline phosphatase Metastatic bone disease Osteomalacia Hyperparathyroidism Liver disease ``` ``` Similar radiographic appearance Metastatic disease Lymphoma Fibrous dysplasia Chronic osteomyelitis ```

Answer 30

Conservative physiotherapy, NSAIDS, oral analgesics ``` Medical Bisphosphonates -Drugs which promote osteoclast apoptosis -Reduce bone turnover -Reduce woven bone formation -Increase lamellar bone formation -Improves bone strength ``` Surgical E.g. arthroplasty