Disorders of Bone Flashcards
(92 cards)
1
Q
is bone loss normal
A
Yes, but it can be lost to a level where is causes problems
2
Q
when do you lose bone
A
before pubertal growth spurt
after menopause
3
Q
what are the two types of primary osteoporosis
A
postmenopausal senile (age related)- if you live long enough bone will suck
4
Q
bone loss secondary to diseases (malignancy, corticosteroid use, GI disorders, endocrine)
A
Secondary osteoporosis
5
Q
when is the highest risk of falls?
A
age 80 or greater
6
Q
what type fracture is a collapse of a spinal vertebral bone?
A
compression fracture
7
Q
are most compression fractures noticed?
A
No, 2/3 are silent
8
Q
what is a physical sign of a compression fracture?
A
loss of height
kyphosis
9
Q
what grade of compression fracture is 20-25% reduction in vertebral height
A
grade 1
10
Q
what grade of compression fracture is >40% reduction in vertebral height
A
Grade 3
11
Q
what grade of compression fracture is 2 normal vertebral height
A
Grade 0
12
Q
what grade of compression fracture is 25-40% reduction in vertebral height
A
Grade 2
13
Q
what grade of vertebral compression fracture needs spinal surgery
A
Grade 2 (sometimes, if painful) Grade 3
14
Q
what disorders are associated with stress/ insufficiency fractures
A
osteoporosis RA osteomalacia Paget's Dz Radiotherapy Glucocorticoids
15
Q
what meds can cause stress/ insufficiency fractures
A
methotrexate
sodium fluoride
etidronate
16
Q
what causes bone loss
A
smoking excess alcohol consumption low calcium intake or urinary losses renal problems inadequate Vit D and sunshine low levels physical activity
17
Q
what type activity do people w/ osteoporosis
A
weight bearing activity
18
Q
once bone loss has occurred, can you reverse the loss?
A
No, once the bone is lost it is gone Vit D and calcium can’t reverse it
19
Q
what drugs can reverse or stop significant bone loss
A
Rx meds
20
Q
what lab test do you want for the Vit D level?
A
25-hydroxy Vitamin D
21
Q
when is the best time to take calcium
A
with meals
body can only absorb 500-600 mg at once
22
Q
what is the best type of Vit D to take
A
D3 (cholecalciferol)
23
Q
what is the only prescription dose of Vit D?
A
D2
24
Q
what is the most useful test for osteoporosis
A
called a Dual X-ray Absorptiometry or DXA.
25
what is is the reduction in bone density compared to what the person would have had as a young adult.
T score
26
reduction in bone density compared to what other adults of the same age would have
Z-score
27
A T-score of -1.0 to -2.4 indicates what?
Osteopenia
28
A T-score of -2.5 or less indicates .......
osteoporosis
29
A Z-score of -1.0 indicates a __ times normal risk of fracture.
2
30
A Z-score of -2.0 indicates a __ times normal risk of fracture.
4
31
A Z-score of -3.0 indicates an __ times normal risk of fracture.
8
32
what is an IVA or VFA
Intervertebral Assessment of Vertebral Fracture Assessment
33
What is VFA used for?
physician to see whole spine & identify Compression Fractures that may be silent or may have progressed
34
who gets a DXA scan?
65 and above for females
70 and older for males
women over 50 w/ risk factors
35
what are some other factors that indicate you need a DXA scan?
```
10 pack/ year
persons on seizure meds, steroids, DepoP
liver/ kidney dz
body weight <127
RA or immboility
cancers that destroy bone
family hx, early menopause
loss of height/ kyphosis
hyperthyroidism or fragility fracture
organ transplant
anorexia/ malabsorption
excessive alcohol
cancer/ spinal cord injury
```
36
if someone shows up w/ no risk factors and has osteoporosis what do you need to rule out
```
hypertyroidism
hyperparathyroidism
cushing's
hematologic disorders
malignancy
vitamin D deficiency
```
37
what is the first line of treatment for osteoporosis
bisphosphonates
38
what is a big risk with SERMs
DVT
39
how long can you use teriparatide for?
no more than 2 years
40
ROA of calcitonin
nasal spray or SubQ
41
what is an osteoporosis med that is an IV infusion
zoledronic acid
42
Softening of the bones due to impaired mineralization (with excess accumulation of osteoid), resulting from Vitamin D deficiency
osteomalacia
43
is the organic matrix of bone or is young bone that has not yet undergone calcification
osteoid
44
what type "fracture" does osteomalacia cause?
pseudofractures
45
what happens to the bone in osteomalacia
bowing
46
what are red flags associated w/ hypocalcemia
pancreatitis
| osteoblastic metastasis
47
what are some signs of hypocalcemia
```
paresthesias
tetany (cramping)
HPOTN
seizures
bradycardia
prolongation of QT interval
Chvostek's sign (tap facial muscle)
Trousseau's signs (hand held flexed after BP cuff on form 3 min at above systolic)
```
48
what other labs should you test if you suspect hyper/ hypocalcemia
serum creatinine, phos, mag, and (PTH) and Pregnancy (!)
49
with symptoms how do you treat hypocalcemia
IV calcium (not too fast)
50
what disease can cause hypercalcemia
```
paget's dz
malignancy
malignant lymphoma
pheochromocytoma
theophylline toxicity
```
51
complications of hypercalcemia
```
pancreatitis
short Q-T interval
corneal calcifications
muscle weakness
constipation
nephrolithiasis
```
52
Tx for hypercalcemia
```
increase urinary Ca excretion (Lasix)
bisphosphonates
steroids (if high Vit D)
chelation therapy w/ EDTA or IV phos
dialysis
```
53
Sx of excess parathyroid secretion
```
symptoms of hypercalcemia
bone disease
nephrolithiasis, proximal renal tubular acidosis
anemia
hyperuricemia and gout
```
54
what does the parathyroid hormone affect
bone
kidney
intestine
55
Meds for HyperPTH
```
estrogen plus progestin
bisphosphonates
raloxifene
calcimemtic
Vit D
```
56
bone infection usually due by s. aureus
osteomyelitis
57
what are the 2 descriptions for duration of osteomyelitis
acute vs. chronic
58
what are the descriptions for cause of osteomyelitis
hematogenous
exogenous
surgical
true continguous spread
59
what must you describe w/ osteomyelitis
```
duration
cause
site
extent (of defect)
type of patient (infant, child, immunocomprimised)
```
60
what are patient with sickle cell anemia at risk for
salmonella osteomyelitis
61
what causes exogenous osteomyelitis
open Fx. Or surgery
62
Acute hematogenous osteomyelitis most commonly affects _____ bones of children
long
63
Chronic is used when after the acute infection has had appropriate treatment viable colonies of bacteria harbored in necrotic and ischemic tissue cause a __________________
recurrence of infection
64
clinical features of acute hematogenous osteomyelitis
pain
loss of motion
soft tissue swelling
drainage rare (no open wound)
65
presentation of chronic hematgenous osteomyelitis
acute flare-ups of tender, warm, sometimes swollen area
patients complain of malaise, anorexia, fever, wt. loss, night sweats
pain and drainage from sinus tract (from bone out to skin)
66
what do you order for osteomyelitis
WBC, CRP, ESR (normal possible)
ID organism ASAP (blood culture, bone biopsy)
aspirate joint if concerned of involvement
67
are x-rays good for tracking osteomyelitis
sort of, but 7-10 days behind symptoms
68
what is good for early detection of osteomyelitis
Ultrasound
69
what shows bone changes before XR or bone scan?
MRI
70
what is the gold standard for osteomyelitis imgaging
MRI (as it affects the tissue of the bone)
71
Tx for acute osteomyelitis
antibiotics x 3-12 weeks IV then to PO drugs
72
tx for chronic osteo
```
4 week- 2 years of IV abx
and PO antibiotics depending on organism
surgical I and D may be indicated
removal of adjacent orthopedic hardware
multiple surgeries may be required
```
73
_____ tumors of bone and soft tissue are more common than primary malignant tumors
benign
74
what is the most common primary malignant bone tumor
multiple myeloma
75
the most common bone tumor in adults is what?
metastatic (breast, lung, prostate, kidney, thyroid) most common location is spine
76
where does lung CA often metastasize to?
distal phalanges (hand)
77
what work up do you need to get for neoplasms
```
XR
CBC
ESR
CRP
CMP
bone scan
CT
```
78
Proliferation of a single cell line in bone marrow
multiple myeloma
79
injection dye and take pictures at intervals, goes to increased areas of remodeling
bone scan
80
diagnostic tool for multiple myeloma
urine electrophoresis
81
presentation for multiple myeloma
sudden bone pain
fractures
ROS for constitutional sx
anemia
82
who is multiple myeloma more common in?
Males
| african americans
83
Can be a single entity in bone, part of soft tissue mass, or metastatic
All age groups
Pain, soft tissue swelling
lymphoma of bone
84
Constant bone pain – hallmark is night pain
| Highest in teen yrs.."growing pains that don't go away"
osteosarcoma
85
What does an x-ray of a bone w/ osteosarcoma show?
periosteal stripping
86
tx for osteosarcoma
chemo, surgery, chemo
87
common in 5-25 year olds
pain, fever, elevated ESR/ WBC, anemia
small round blue cells on histology
Ewing's sarcoma
88
like a mole of the bone
benign
cortex of bone is completely undisturbed
enchondroma
89
periostael stripping around destroyed cortex indicates what?
osteosarcoma
90
who should manage a benign orthopedic tumors?
general orthopedics
| if malignant tumors- refer to orthopedic oncologist
91
tumor of fatty tissue, may grow slowly
lipoma
92
outpouching of synovial sac and fills up with fluid. wrist most common
ganglion
