context W1 Flashcards
define osteoporosis
reduction in bone but same quality causing increased fragility
risk factors for osteoporosis
age, alcohol, smoking, corticosteroids, endocrine disorders
two types of osteoporosis and what fractures they commonly cause.
type 1 = post-menopause, causes colles’ (fracture distal forearm) and vertebral insufficiency fractures.
Type 2 = old age with risk factors (chronic illness, low Vit D, reduced activity) causing femoral and vertebral fractures
treatment for osteoporosis
calcium and Vit D supplements (all patients on steroids on these anyways), biphosphonates (end in -dionate), desunomab, strontium.
for type 1 HRT is not first line but is occasionally considered.
osteomalacia definition
abnormal softening of bone due to poor mineralisation of osteoid (immature bone). called Ricket’s in children with subsequent effect on growing skeleton.
causes of osteomalacia
calcium and Vit D insufficency. Due to lack in diet, resistance to Vit D action or increase renal losses causing phosphate deficiency.
symptoms of osteomalacia
bone pain, easy fracture, hypercalcimia symptoms (muscle cramps, fatigue…).
what may be seen on radiography for a patient with osteomalacia
pseudo fractures and looser zones
what would results of bone biochemistry be in a patient with osteomalacia
low calcium, and serum phosphate.
high serum alk phos. (opposite to osteoporosis)
treatment for osteomalacia
vit D therapy with calcium+phosphate supplementation
define hyperparathyroidism
overactive parathyroid glands with inc PTH (parathyroid hormone)
causes of primary Hyperparathyroidism
benign adenoma, hyperplasia, malignant neoplasia
signs of primary hyperparathyroidism
hypercalcaemia symptoms, inc serum PTH, inc Calcium. phosphate low or normal
hypercalcaemia symptoms
fatigue, depression, bone pain, myalgia, thirst, nausea, polyuria, renal stones, osteoporosis
what is secondary hyperparathyroidism
a physiological overproduction of PTH due to Vit D deficiency or CKD (chronic kidney disease)
what is tertiary hyperparathyroidism
chronic secondary which develop adenoma and continues continuous increased PTH production despite biochemical correction
treatment of hyperparathyroidism
treat underlying factors, check and treat fractures.
If very high serum calcium then is medical EMERGENCY - IV fluids, biphosphonates, calcitonin)
what is Renal (osteo)dystrophy
bone disease that occurs when your kidneys fail to maintain proper levels of calcium and phosphorus in the blood. Common in CKD and dialysis patients.
what does Renal (osteo)dystrophy cause?
sclerosis of bone, osteomalacia, calcification of soft tissues.
what is Paget’s disease and where is it commonly found?
Paget’s disease of bone is a chronic disorder causing thickened, brittle and mis-shapen bones.
commonly affects pelvis, femur, skull, tibia and ear bones (causing deafness)
risk factors for Paget’s disease
paramyxoviruses and genetics
disease process in paget’s disease
inc osteoclast activity causes osteoblasts to compensate to try replenish bone. however, this is not sufficient and causes brittle and mis-shapen bones.
complications of Paget’s
athritis, deformity, fractures, pain, inc CO and inc Arctic stenosis leading to HF.
[ due to arteriovenous connections can often form in the bone, and so the heart has to work harder (pump more blood) to ensure adequate oxygen supply to the tissues.]
treatment of paget’s
stabilise bones via plating/nails,
biphosphates (to reduce osteoclast activity),
replace joints
osteocondroma
commonest, bony outgrowth on external surface of bone.
covered by cartilaginous cap. Benign, usually unproblematic (maybe localised pain).
mutliple = genetic disorder. low malignancy chance.
If fast growing then exisional biopsy.
enchondroma
cartilageous tumour, incidentally finding as often asymptomatic. May weaken bone causing pathological fracture. BT, malignancy rare. easy to curettage.
simple bone cyst
BT. asymptomatic, may cause pathological fracture.
found in long bones (also talus and calcaneus, solid unicystic fluid-filled neoplasm. curettage to treat.
aneurysmal bone cyst
BT. lots of chambers filled with blood or serum. affects long bones, flat bones and vertebrae. locally aggressive (causes cortical destruction) and usually painful, risk pathological fracture. curettage.
giant cell tumour
can be local aggressive (cortical destruction), affects knee, long bones, digits, pelvis and spine. Painful and causes pathological fracture. considered BT but may metastasis to LUNG. excision with phenol, bone cement or liquid nitrogen to kill rest of tumour.
fiberous dysplasia
BT, genetic condition, adolescents, one or many bones affected, stress fractures may occur.
Treatment = biphospahtes to reduce pain, stablise fracture with internal fixation/corticol bone graft.
osteoid osteoma
BT, proximal femur, diaphysis of long bone and vertebrae. immature bone surrounded by intense sclerotic halo.
intense constant pain (esp at night), mediated by prostaglandin production so relieved by NSAID’s.
Xray/CT confirm diagnosis, may resolve over time or need CT guided radio frequency ablation.
which is commoner for malignant bone cancer: primary or secondary
secondary. primary rare and in younger patients.
red flags for malignant bone cancer
weight loss, pain at night (constant), reduced appetite, fatigue.
Osteosarcoma
commonest malignant tumour producing bone.
genetic with retinoblastoma tumour suppressor link.
adolscents, most around knee, femur, humerus and pelvis.
Lymph involvement rare, blood metastasis not uncommon
10% have lung mets at time of diagnosis, chemo helps not radio.
chondrosarcoma
cartilage producing primary tumour, older age, less common/aggressive as osteosarcoma.
large, slow to metastasise, pelvis and proximal femur common.
surgery to treat (not radio/chemo)
fibrosarcoma
many types of tumour, uncertain histogenesis.
Ewing’s sarcoma
teens, fever + inc inflammaroy markers + warm swelling.
misdignosed for osteomyelitis.
Chemo/Radio effective.
how to investigate/treat primary tumours in bone
MRI/CT to see stage.
Biopsy for histology.
surgery is main treatment (plus add ons).
lymphoma
cancer of lymphocyte system round cells/macrophages.
can occur as primary tumour (non-hogkins) or metastasis (any type.)
treatment = chemo, radio. good 5YSR.
how to tell difference between lymphomas
reed-steinberg cell is present in biopsy for hogkins.
myeloma
cancer of the plasma cells.
myeloma Presentation and treatment.
PC: weight loss, back pain, weakness, fatigue, bone pain.
soltiary myeloma = radio, multiple myeloma = chemo (poor 5YSR)
common secondary bone cancer sources
breast, prostate, lung, renal, thyroid.
what is osteochonditis and give an example
inc excerise (in adolesecnts commonly) causes impact/traction injuries. This causes bleeding and oedema in bone causing capillary compression.
Osgood-schlatter.
what is AVN
esteem of the bone
causes of AVN
fracture, ideopathic, alcohol, steroids.
AVN course of action
initially none, the joint stiffness and pain. Joint may need replaced if ruined. Bone compression leads to healing. May lead to OA in future
name the 2 types of soft tissue tumours
diffuse (synovitis or oedema)
local (inflammatory swellings, infection, cystic lesions, neoplasms (BT + MT))
History taking for suspected soft tissue tumour
size, site, definition, consistency, surface, mobility, temperature, fluid-filled?, pulsating? lymphadenopathy?
what is most common Benign soft tissue tumour
lipoma.
what is a DEXA scan used for?
Dual-energy X-ray absorptiometry
measures bone density (good for osteoporosis )
what is a T-score used for and what are the ranges?
T-score is used to classify bone density
> -1 = normal; -1 to -2.5 = osteopenia
