CORTEXT Biochemistry week 1

Question 1

What is Osteoporosis?

Answer 1

Quantitative defect of bone characterised by reduced bone density and increased porosity

Question 2

What does osteoporosis lead to?

Answer 2

Increased fragility of bone

Increased fracture risk

Question 3

What happens to bone mineral density as age increases?

Answer 3

Decreases over time past age of 30

Females lose more after menopause

Question 4

What are the two types of osteoporosis and when do they occur?

Answer 4

Type 1 - Post menopause

Type 2 - Old age

Question 5

How is osteoporosis diagnosed?

Answer 5

DEXA bone scan

Question 6

What are the treatments for osteoporosis?

Answer 6

Can’t build up bone density
Can stop further deterioration
Exercise, good diet and sunlight can maintain peak bone density

Question 7

What is osteomalacia?

Answer 7

Qualitative defect of bone with abnormal softening of the bone due to the deficient mineralization of osteoid secondary to inadequate amounts of calcium and phosphorus
AKA rickets

Question 8

What are the principle causes of osteomalacia?

Answer 8

Insufficient calcium absorption from the intestine
Phosphate deficiency
Malnutrition
Malabsorption
Lack of sunlight exposure
CKD

Question 9

What are the symptoms of osteomalacia?

Answer 9

Bone pain
Soft bone deformities
Pathological fractures
Hypocalcaemia
Psuedofractures

Question 10

What is the treatment for osteomalacia?

Answer 10

Vitamin D therapy

Calcium and phosphate supplementation

Question 11

What is Hyperparathyroidism/

Answer 11

Overactivity of parathyroid glands with high levels of PTH

Question 12

What is primary Hyperparathyroidism due to?

Answer 12

Benign adenoma
Hyperplasia
Malignant neoplasia

Question 13

What does overproduction of PTH result in?

Answer 13

Hypercalcaemia
Fatigue
Depression
Bone pain
Myalgia
Nausea
Thirst
Polyuria
Renal stones
Osteoporosis

Question 14

What is secondary Hyperparathyroidism?

Answer 14

A Physiological overproduction of PTH secondary to hypocalcaemia caused by lack of vitamin D or CKD

Question 15

When is tertiary Hyperparathyroidism seen?

Answer 15

Patients with chronic scondary Hyperparathyroidism (usually CKD) who develop an adenoma which will continure to produce PTH despite biochemical correction

Question 16

What can Hyperparathyroidism result in?

Answer 16

Fragility fractures

Lytic lesions in bone

Question 17

What is the treatment of Hyperparathyroidism?

Answer 17

Removal of adenomatous gland
Treatment of underlying cause
High serum calcium levels need emergency treatment
-Iv fluids, bisphosphonates, calcitonin

Question 18

What is renal dystrophy?

Answer 18

Typical bone changes due to CKD

Question 19

What are the typical bone changes as a result of CKD?

Answer 19

Reduced phosphate exretion
Inactive activation of vitamin D resulting in secondary Hyperparathyroidism
Osteomalacia
Sclerosis of bone
Calcification of soft tissues

Question 20

What is Paget’s disease?

Answer 20

Chronic disorder

Thickened, brittle and mis-shapen bones

Question 21

What may cause paget’s disease?

Answer 21

Viral infections

Genetic defects

Question 22

What is the pathogenesis of paget’s disease?

Answer 22

Increased osteoclast activity results in increased bone turnover
Osteoblasts become more active to try and correct bone resorption
The osteoblasts form new bone but this fails to remodel sufficiently and the new bone is thick but brittle and easily fractures

Question 23

What are the commonly affected bones in paget’s?

Answer 23

Pelvis
Femur
Skull
Tibia
Ear

Question 24

What are the symptoms of pagets?

Answer 24

Can be asymptomatic
Arthritis
Pathological fractures
Deformity
Pain 
Cardiac failure

Question 25

What is the treatment for paget’s disease/

Answer 25

Bisphosphonates
Calcitonic
Joint replacement
Stabilization