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

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2
Q

when do you lose bone

A

before pubertal growth spurt

after menopause

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3
Q

what are the two types of primary osteoporosis

A
postmenopausal
senile (age related)- if you live long enough bone will suck
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4
Q

bone loss secondary to diseases (malignancy, corticosteroid use, GI disorders, endocrine)

A

Secondary osteoporosis

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5
Q

when is the highest risk of falls?

A

age 80 or greater

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6
Q

what type fracture is a collapse of a spinal vertebral bone?

A

compression fracture

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7
Q

are most compression fractures noticed?

A

No, 2/3 are silent

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8
Q

what is a physical sign of a compression fracture?

A

loss of height

kyphosis

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9
Q

what grade of compression fracture is 20-25% reduction in vertebral height

A

grade 1

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10
Q

what grade of compression fracture is >40% reduction in vertebral height

A

Grade 3

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11
Q

what grade of compression fracture is 2 normal vertebral height

A

Grade 0

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12
Q

what grade of compression fracture is 25-40% reduction in vertebral height

A

Grade 2

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13
Q

what grade of vertebral compression fracture needs spinal surgery

A
Grade 2 (sometimes, if painful)
Grade 3
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14
Q

what disorders are associated with stress/ insufficiency fractures

A
osteoporosis
RA
osteomalacia
Paget's Dz
Radiotherapy
Glucocorticoids
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15
Q

what meds can cause stress/ insufficiency fractures

A

methotrexate
sodium fluoride
etidronate

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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
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17
Q

what type activity do people w/ osteoporosis

A

weight bearing activity

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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

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19
Q

what drugs can reverse or stop significant bone loss

A

Rx meds

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20
Q

what lab test do you want for the Vit D level?

A

25-hydroxy Vitamin D

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21
Q

when is the best time to take calcium

A

with meals

body can only absorb 500-600 mg at once

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22
Q

what is the best type of Vit D to take

A

D3 (cholecalciferol)

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23
Q

what is the only prescription dose of Vit D?

A

D2

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24
Q

what is the most useful test for osteoporosis

A

called a Dual X-ray Absorptiometry or DXA.

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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