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Endocrine > Disorders of Bone > Flashcards

Disorders of Bone Flashcards

1
Q

What characterises osteoporosis?

A

Low bone mass and micro-architectural destruction, producing an increased risk of fracture.

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2
Q

What is the role of osteoclasts?

A

Bone resorption

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3
Q

What is the role of osteoblasts?

A

Bone formation

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4
Q

What factors influence bone mass density?

A

Weight
Sex hormones
Diet
Exercise levels

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5
Q

What are the most common sites for an osteoporotic bone fracture?

A

Neck of femur
Distal radius
Vertebral body
Humeral neck

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6
Q

What is an example of a fracture common in young people?

A

Colles’ fracture (caused by FOOSH)

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7
Q

What is an example of a fracture common in the elderly?

A

Vertebral fracture (often with minimal trauma)

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8
Q

What is a potential complication of a vertebral fracture?

A

Thoracic kyphosis - this will result in height loss.

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9
Q

What is osteopenia?

A

A bone mineral density that is > 1 and <2.5 standard deviations below the young adult mean.

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10
Q

What is osteoporosis?

A

A bone mineral density that is >2.5 standard deviations below the young adult average.

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11
Q

In which patients is a DEXA scan indicated?

A

Those over 50, with a low-trauma fracture/deemed to be high-risk.

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12
Q

What are causes of secondary osteoporosis?

A

Cushing’s disease
Coeliac disease
COPD
CKD

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13
Q

What lifestyle changes can improve outcomes for those with osteoporosis?

A

High-intensity strength training
Low-impact weight-bearing exercise
Avoidance of smoking/alcohol excess
Falls prevention
Increased calcium intake

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14
Q

What pharmacological management options exist for osteoporosis?

A

HRT
Selective oestrogen modulators
Testosterone replacement (for young men)
Bisphosphonates

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15
Q

What is the first-line therapy in osteoporosis?

A

Bisphosphonates

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16
Q

If bisphosphonates are contraindicated, what can be given?

A

Zoledronic acid
Denosumab

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17
Q

What is a rare complication of Paget’s disease?

A

Osteosarcoma

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18
Q

What genetic bone condition also causes blue sclera?

A

Osteogenesis imperfecta

It is a disorder of type 1 collagen, and follows an autosomal dominant inheritance pattern.

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19
Q

What should always be considered as a potential cause of repeated fractures during childhood?

A

Non-accidental injury

20
Q

What is calcium metabolism dependent on?

A

Vitamin D

21
Q

What symptoms are associated with hypercalcaemia?

A

Bone pain
Kidney stones
Abdominal pain
Psychological disturbances

22
Q

What are the 2 most common causes of hypercalcaemia?

A

Primary hyperparathyroidism
Malignancy

23
Q

How may primary hyperparathyroidism present?

A

Raised serum calcium
Raised/Normal serum PTH
Raised urinary calcium

24
Q

Why can malignancy cause hypercalcaemia?

A

Metastatic bone destruction
Release of PTH-related peptide from a solid tumor

25
Q

How is hypercalcaemia treated?

A

Give 4-6L of 0.9% saline, within 24 hours.

May also give a loop diuretic/bisphosphonates (will lower calcium levels in a few days).

26
Q

What type of scan can be performed to locate a parathyroid adenoma?

A

Sestamibi scan

27
Q

When is a parathyroidectomy performed?

A

End organ damage (e.g. osteoporosis, or gastric ulcer)
Very high calcium levels
Those under 50
eGFR <60ml/min

28
Q

What is primary hyperparathyroidism?

A

A primary overactivity of the parathyroid gland, caused by high calcium, and high PTH levels.

29
Q

What is secondary hyperparathyroidism?

A

A physiological response to low calcium/vitamin D levels (causing high PTH).

30
Q

What is tertiary hyperparathyroidism?

A

When the parathyroid gland becomes autonomous due to years of overactivity (causes very high levels of PTH and calcium).

31
Q

What condition is almost always seen in those with a MEN1/MEN2 syndrome?

A

Parathyroid adenoma

32
Q

What is familial hypocalciuric hypercalcaemia (FHH)?

A

A condition where serum calcium levels are high, although levels within the urine are low.

It is the result of calcium-sensing receptors becoming insensitive, leading to continuously high PTH levels.

Usually this is asymptomatic, and will follow an autosomal dominant pattern of inheritance.

33
Q

What are symptoms of hypocalcaemia?

A

Paraesthesia
Muscle cramps/tetany
Muscle weakness
Fits
Bronchospasm
Chovstek’s sign
Prolonged QT

34
Q

How is acute hypocalcaemia treated?

A

Give IV calcium gluconate, 10ml 10% over 10 mins - this will prevent cardiac/respiratory arrest.

35
Q

What are causes of hyperparathyroidism?

A

Congenital abnormalities (e.g. DiGeorge Syndrome)
Destruction
Autoimmune disease
Hypomagnesemia
Iron overload
Idiopathic

36
Q

What are causes of hypomagnesemia?

A

Alcohol
Thiazide-like diuretics
PPIs
GI upset
Pancreatitis
Malabsorption

37
Q

Why does hypomagnesemia cause low serum calcium?

A

As magnesium is required to release calcium from the intracellular compartment.

38
Q

How does pseudohypoparathyroidism present?

A

Low calcium
Raised PTH

Due to the development of PTH resistance (a genetic defect of GNAS1).

39
Q

How does pseudo-pseudohypoparathyroidism present?

A

Normal calcium levels

Patient will only have symptoms of pseudohypoparathyroidism - no deranged bloods to match clinical picture.

40
Q

What symptoms are associated with pseudohypoparathyroidism?

A

Bone abnormalities
Obesity
Subcutaneous calcification
Learning difficulties
Brachdactyly

41
Q

What is vitamin D deficiency known as in children?

A

Rickett’s

42
Q

What is vitamin D deficiency known as in adults?

A

Osteomalacia

43
Q

How does osteomalacia present?

A

Low calcium
Muscle wasting
Dental defects
Tender bones

44
Q

How can chronic renal disease cause vitamin D deficiency?

A

As 1-hydroxylase enzymes will not be able to carry out their function.

45
Q
A

Endocrine (11 decks)

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