General Flashcards
reduced bone mass normal mineralisation
osteoporosis
risk factors osteoporosis
female oestrogen deficiency (early menopause) FH hip fracture low dietary calcium when young reduced mobility
causes of osteoporosis? mnemonic?
RACISM Rheumatoid arthritis Alcohol Corticosteroids Immobility Smoking Multiple myeloma
features of osteoporosis
asymptomatic until low trauma fracture
investigations osteoporosis
bone profile - all normal
x ray - normal until >30% bone mass lost
BMD via DEXA - gold
treatment osteoporosis
vitamin D3 + Calcium 1g
bisphosphonates - alendronic acid + risedronate once weekly (reduce resorption)
teriparatide (increase bone mass)
low mineralisation normal bone mass
osteomalacia
cause of osteomalacia
vitamin D deficiency
3 causes of osteomalacia
lack of dietary vitamin D3 / malabsorption (after gastrectomy)
lack of sunlight exposure (isolation, immobility)
chronic renal failure
osteomalacia investigations
bone profile - low Ca, PO4. raised ++ ALP. low urinary Ca
x ray - rarefaction, pseudo fractures, transverse lucencies
bone biopsy - diagnostic. wide osteoid seams
treatment osteomalacia
vitamin D3 + calcium supplements
wide osteoid seams on bone biopsy
osteomalacia
increased multinucleate osteoclasts
increased osteoblasts
increased fibrosis
disorganised bone matrix
pagets disease
presentation pagets disease
asymptomatic
deformity, throbbing, fracture, deafness due to CNVIII compression
investigations pagets disease
bone profile - Ca, PO4 normal. ALP raised
x ray - cortical thickening + thickened trabecular pattern
BONY EXPANSION ON X RAY!!!!! PATHOGNOMIC
bony expansion on xray
pagets disease
treatment pagets disease
bisphosphonates
PO risedronate OD 2 months
IV zoledronic acid 5mg single dose
polymyalgia rheumatica symptoms
inflammation of blood vessels
stiffness arms, shoulder, hips, neck
risk factors poly myalgia rheumatic
FHx
female
viral / bacterial illness
>65yo
investigations polymyalgia rheumatica
bloods - increased ESR, CRP
temporal artery biopsy - giant cells
treatment polymyalgia rheumatica
40mg PO steroids 1 week
maintain low dose steroids 12-18m
osteoarthritis presentation
older people gradual onset large joints MCP, DIP herbedens and Bouchard nodes bony swelling morning stiffness <1h pain ++ in evening if painful, improves with rest
IMPROVES WITH REST
investigations osteoarthritis
x ray hands - LOSS loss of joint space osteophytes subchondral cysts subarticular sclerosis
osteoarthritis management
no cure
analgesia and anti inflammatory
don’t give NSAID if renal impairment or on diuretics
steroid injections. NOT systemic steroids
rheumatoid arthritis features
younger patient bilateral and symmetrical quicker onset eg weeks, months smaller joints eg PIP, DIP systemic symptoms!!! and extra articular features stiffness improves with use stiffness >30mins pain >6 weeks
IMPROVES WITH USE
