Disorders of Bone Flashcards
is bone loss normal
Yes, but it can be lost to a level where is causes problems
when do you lose bone
before pubertal growth spurt
after menopause
what are the two types of primary osteoporosis
postmenopausal senile (age related)- if you live long enough bone will suck
bone loss secondary to diseases (malignancy, corticosteroid use, GI disorders, endocrine)
Secondary osteoporosis
when is the highest risk of falls?
age 80 or greater
what type fracture is a collapse of a spinal vertebral bone?
compression fracture
are most compression fractures noticed?
No, 2/3 are silent
what is a physical sign of a compression fracture?
loss of height
kyphosis
what grade of compression fracture is 20-25% reduction in vertebral height
grade 1
what grade of compression fracture is >40% reduction in vertebral height
Grade 3
what grade of compression fracture is 2 normal vertebral height
Grade 0
what grade of compression fracture is 25-40% reduction in vertebral height
Grade 2
what grade of vertebral compression fracture needs spinal surgery
Grade 2 (sometimes, if painful) Grade 3
what disorders are associated with stress/ insufficiency fractures
osteoporosis RA osteomalacia Paget's Dz Radiotherapy Glucocorticoids
what meds can cause stress/ insufficiency fractures
methotrexate
sodium fluoride
etidronate
what causes bone loss
smoking excess alcohol consumption low calcium intake or urinary losses renal problems inadequate Vit D and sunshine low levels physical activity
what type activity do people w/ osteoporosis
weight bearing activity
once bone loss has occurred, can you reverse the loss?
No, once the bone is lost it is gone Vit D and calcium can’t reverse it
what drugs can reverse or stop significant bone loss
Rx meds
what lab test do you want for the Vit D level?
25-hydroxy Vitamin D
when is the best time to take calcium
with meals
body can only absorb 500-600 mg at once
what is the best type of Vit D to take
D3 (cholecalciferol)
what is the only prescription dose of Vit D?
D2
what is the most useful test for osteoporosis
called a Dual X-ray Absorptiometry or DXA.
what is is the reduction in bone density compared to what the person would have had as a young adult.
T score
reduction in bone density compared to what other adults of the same age would have
Z-score
A T-score of -1.0 to -2.4 indicates what?
Osteopenia
A T-score of -2.5 or less indicates …….
osteoporosis
A Z-score of -1.0 indicates a __ times normal risk of fracture.
2
A Z-score of -2.0 indicates a __ times normal risk of fracture.
4
A Z-score of -3.0 indicates an __ times normal risk of fracture.
8
what is an IVA or VFA
Intervertebral Assessment of Vertebral Fracture Assessment
What is VFA used for?
physician to see whole spine & identify Compression Fractures that may be silent or may have progressed
who gets a DXA scan?
65 and above for females
70 and older for males
women over 50 w/ risk factors
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
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
what is the first line of treatment for osteoporosis
bisphosphonates
what is a big risk with SERMs
DVT
how long can you use teriparatide for?
no more than 2 years
ROA of calcitonin
nasal spray or SubQ
what is an osteoporosis med that is an IV infusion
zoledronic acid
Softening of the bones due to impaired mineralization (with excess accumulation of osteoid), resulting from Vitamin D deficiency
osteomalacia
is the organic matrix of bone or is young bone that has not yet undergone calcification
osteoid
what type “fracture” does osteomalacia cause?
pseudofractures
what happens to the bone in osteomalacia
bowing
what are red flags associated w/ hypocalcemia
pancreatitis
osteoblastic metastasis
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)
what other labs should you test if you suspect hyper/ hypocalcemia
serum creatinine, phos, mag, and (PTH) and Pregnancy (!)
with symptoms how do you treat hypocalcemia
IV calcium (not too fast)
what disease can cause hypercalcemia
paget's dz malignancy malignant lymphoma pheochromocytoma theophylline toxicity
complications of hypercalcemia
pancreatitis short Q-T interval corneal calcifications muscle weakness constipation nephrolithiasis
Tx for hypercalcemia
increase urinary Ca excretion (Lasix) bisphosphonates steroids (if high Vit D) chelation therapy w/ EDTA or IV phos dialysis
Sx of excess parathyroid secretion
symptoms of hypercalcemia bone disease nephrolithiasis, proximal renal tubular acidosis anemia hyperuricemia and gout
what does the parathyroid hormone affect
bone
kidney
intestine
Meds for HyperPTH
estrogen plus progestin bisphosphonates raloxifene calcimemtic Vit D
bone infection usually due by s. aureus
osteomyelitis
what are the 2 descriptions for duration of osteomyelitis
acute vs. chronic
what are the descriptions for cause of osteomyelitis
hematogenous
exogenous
surgical
true continguous spread
what must you describe w/ osteomyelitis
duration cause site extent (of defect) type of patient (infant, child, immunocomprimised)
what are patient with sickle cell anemia at risk for
salmonella osteomyelitis
what causes exogenous osteomyelitis
open Fx. Or surgery
Acute hematogenous osteomyelitis most commonly affects _____ bones of children
long
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
clinical features of acute hematogenous osteomyelitis
pain
loss of motion
soft tissue swelling
drainage rare (no open wound)
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)
what do you order for osteomyelitis
WBC, CRP, ESR (normal possible)
ID organism ASAP (blood culture, bone biopsy)
aspirate joint if concerned of involvement
are x-rays good for tracking osteomyelitis
sort of, but 7-10 days behind symptoms
what is good for early detection of osteomyelitis
Ultrasound
what shows bone changes before XR or bone scan?
MRI
what is the gold standard for osteomyelitis imgaging
MRI (as it affects the tissue of the bone)
Tx for acute osteomyelitis
antibiotics x 3-12 weeks IV then to PO drugs
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
_____ tumors of bone and soft tissue are more common than primary malignant tumors
benign
what is the most common primary malignant bone tumor
multiple myeloma
the most common bone tumor in adults is what?
metastatic (breast, lung, prostate, kidney, thyroid) most common location is spine
where does lung CA often metastasize to?
distal phalanges (hand)
what work up do you need to get for neoplasms
XR CBC ESR CRP CMP bone scan CT
Proliferation of a single cell line in bone marrow
multiple myeloma
injection dye and take pictures at intervals, goes to increased areas of remodeling
bone scan
diagnostic tool for multiple myeloma
urine electrophoresis
presentation for multiple myeloma
sudden bone pain
fractures
ROS for constitutional sx
anemia
who is multiple myeloma more common in?
Males
african americans
Can be a single entity in bone, part of soft tissue mass, or metastatic
All age groups
Pain, soft tissue swelling
lymphoma of bone
Constant bone pain – hallmark is night pain
Highest in teen yrs..”growing pains that don’t go away”
osteosarcoma
What does an x-ray of a bone w/ osteosarcoma show?
periosteal stripping
tx for osteosarcoma
chemo, surgery, chemo
common in 5-25 year olds
pain, fever, elevated ESR/ WBC, anemia
small round blue cells on histology
Ewing’s sarcoma
like a mole of the bone
benign
cortex of bone is completely undisturbed
enchondroma
periostael stripping around destroyed cortex indicates what?
osteosarcoma
who should manage a benign orthopedic tumors?
general orthopedics
if malignant tumors- refer to orthopedic oncologist
tumor of fatty tissue, may grow slowly
lipoma
outpouching of synovial sac and fills up with fluid. wrist most common
ganglion
