Endocrine - Bone Disease

Question 1

what occurs in osteoporosis?

Answer 1

loss of bone density

Question 2

risk factors for osteoporosis?

Answer 2

age
low BMI
postmenopausal
steroids
malabsorption
hyperthyroid
hyperparathyroid
smoking 
alcohol 
amenorrhoea 
eating disorders

Question 3

features of osteoporosis?

Answer 3

ASYMPTOMATIC

stress #

Question 4

Ix for osteoporosis?

Answer 4

DEXA scan

T score
-1 to -2.5 = osteopenic
below -2.5 = osteoporotic

Question 5

what is done in a myeloma screen?

Answer 5

protein electrophoresis of urine and serum for bence jones proteins

Question 6

criteria for osteoporosis treatment being started?

Answer 6

T score -2.5
multiple vertebral #
3mnths at ≥5mg of steroids
on ≥5mg oral pred long term

Question 7

how do bisphosphonates work?

Answer 7

inhibit osteoclasts (stop resorption)

Question 8

how are the oral bisphosphonates taken?

Answer 8

1st thing on empty stomach
remain upright
once a week
dont eat for 30mins-hr after

Question 9

how else can bisphosphonates be given?

Answer 9

IV

Question 10

what is a risk with bisphosphonates? how to prevent?

Answer 10

osteonecrosis of the jaw
ensure all dental work completed

upper GI problems
low eGFR

Question 11

how to prevent osteoporosis?

Answer 11

ca rich diet
vit D
stop smoking 
reduce alcohol 
maximise before 35yrs by strength and weight bearing exercise

Question 12

how does hyperparathyroidism result?

Answer 12

inappropriate secretion of PTH

Question 13

how does primary hyperparathyroidism result?

Answer 13

high PTH
Ca does not suppress
increased bone resorption 
kidneys convert Vit D to active form 
Gut absorbs Ca
hypercalcaemia results

Question 14

how does secondary hyperparathyroidism result?

Answer 14

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

Question 15

risk factors for hyperparathyroidism?

Answer 15

post menopausal
Li 
Female
head and neck radiation 
CKD
malabsorption

Question 16

features of hyperparathyroidism?

Answer 16

abdo pain
constipation 
psychosis
kidney stones
poor sleep
fatigue
depression
muscle cramps
parasthesias

Question 17

causes of primary hyperparathyroidism?

Answer 17

parathyroid adenoma

MEN1/2 associations

Question 18

causes of secondary hyperparathyroidism?

Answer 18

CKD
inadequate sunlight exposure
crohns
celiac
pancreatitis
gastric bypass surgery

Question 19

Ix for hyperparathyroidism and results?

Answer 19

PTH (high)
Ca (high in primary, low in secondary)
Vit D (may be low)
P (low)
DXA
Tc 99 Sestimibi (for parathyroid adenomas)

Question 20

Tx for hyperparathyroidism?

Answer 20

asymptomatic -> monitor and give bisphosphonate

symptomatic > parathyroidectomy

optimise underlying disease management

Question 21

complications of hyperparathyroidism?

Answer 21

osteoporosis
#
hypocalcaemia post surgery
recurrent laryngeal nerve injury

Question 22

how does tertiary hyperparathyroidism result?

Answer 22

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

Question 23

what happens in hypoparathyroidism?

Answer 23

low PTH due to gland failure

Question 24

blood results for primary hypoparathyroidism?

Answer 24

low Ca
normal Phos
low PTH
normal Alk Phos

Question 25

blood results for secondary hypoparathyroidism?

Answer 25

high Ca
normal Phos
low PTH
raised Alk phos