Endocrine - Bone Disease Flashcards
what occurs in osteoporosis?
loss of bone density
risk factors for osteoporosis?
age low BMI postmenopausal steroids malabsorption hyperthyroid hyperparathyroid smoking alcohol amenorrhoea eating disorders
features of osteoporosis?
ASYMPTOMATIC
stress #
Ix for osteoporosis?
DEXA scan
T score
-1 to -2.5 = osteopenic
below -2.5 = osteoporotic
what is done in a myeloma screen?
protein electrophoresis of urine and serum for bence jones proteins
criteria for osteoporosis treatment being started?
T score -2.5
multiple vertebral #
3mnths at ≥5mg of steroids
on ≥5mg oral pred long term
how do bisphosphonates work?
inhibit osteoclasts (stop resorption)
how are the oral bisphosphonates taken?
1st thing on empty stomach
remain upright
once a week
dont eat for 30mins-hr after
how else can bisphosphonates be given?
IV
what is a risk with bisphosphonates? how to prevent?
osteonecrosis of the jaw
ensure all dental work completed
upper GI problems
low eGFR
how to prevent osteoporosis?
ca rich diet vit D stop smoking reduce alcohol maximise before 35yrs by strength and weight bearing exercise
how does hyperparathyroidism result?
inappropriate secretion of PTH
how does primary hyperparathyroidism result?
high PTH Ca does not suppress increased bone resorption kidneys convert Vit D to active form Gut absorbs Ca hypercalcaemia results
how does secondary hyperparathyroidism result?
low levels of Ca due to CKD/lack of Vit D
PTH increases to try compensate for this
renal failure causes reduced reabsorption of Ca from kidneys/gut/bones
risk factors for hyperparathyroidism?
post menopausal Li Female head and neck radiation CKD malabsorption
features of hyperparathyroidism?
abdo pain constipation psychosis kidney stones poor sleep fatigue depression muscle cramps parasthesias
causes of primary hyperparathyroidism?
parathyroid adenoma
MEN1/2 associations
causes of secondary hyperparathyroidism?
CKD inadequate sunlight exposure crohns celiac pancreatitis gastric bypass surgery
Ix for hyperparathyroidism and results?
PTH (high) Ca (high in primary, low in secondary) Vit D (may be low) P (low) DXA Tc 99 Sestimibi (for parathyroid adenomas)
Tx for hyperparathyroidism?
asymptomatic -> monitor and give bisphosphonate
symptomatic > parathyroidectomy
optimise underlying disease management
complications of hyperparathyroidism?
osteoporosis
#
hypocalcaemia post surgery
recurrent laryngeal nerve injury
how does tertiary hyperparathyroidism result?
due to chronic hypocalcaemia due to secondary hyperparathyroidism
gland becomes autonomous and secretes more PTH
Ca becomes high
Alk phos also high as bones are broken down
what happens in hypoparathyroidism?
low PTH due to gland failure
blood results for primary hypoparathyroidism?
low Ca
normal Phos
low PTH
normal Alk Phos
blood results for secondary hypoparathyroidism?
high Ca
normal Phos
low PTH
raised Alk phos
