Lecture 2 - finished Flashcards
What is the main complication of osteoporosis?
Fracture
How is bone lost in osteoporosis?
Resorption of bone is greater than formation of bone
Causes of generalised osteoporosis
GDNEIM
Genetic (congenital)
Deficiency states
- scurvy
- malnutrition
- protein deficiency
- alcoholism
Neoplastic
- myeloma
- lymphoma
- leukaemia
Iatrogenic
- Heparin induced
- Dilantin induced
Miscellaneous
- involutional
- postmenopausal
- Amyloidosis
- paraplegia
Risk factors for osteoporosis type 1
Female Premature menopause/postmenopausal Caucasian >65 Thin/small bone structure Family history of osteoporosis Sedentary lifestyle Cigarette smoking Alcohol abuse Low calcium intake High caffeine consumption
Is osteoporosis the most common metabolic disease of bone? If not, what is?
Yes it is.
What is the histology of osteoporosis?
Reduced cortical thickness Reduced number of trabeculae Reduced size of trabeculae Normal chemical composition Normal mineralisation
What are the main manifestations of type 2 osteoporosis?
Femoral neck # Proximal humerus # Proximal tibial # Pelvic # Vertebral #
What serum results would you find in osteomalacia/rickets?
25(OH)D3 = extremely low 1,25(OH)sD3 = extremely low Phosphate = low Alkaline phosphatase = increased Ca2+= decreased/normal PTH = increased Urinary Ca2+ = Decreased
In terms of patterns of bone loss, what does:
- normal matrix
- deficient mineralisation
usually mean?
Osteomalacia
What radiological findings can be expected with osteoporotic bone?
Decreased radiodensity (needs more that 30% bone loss)
Prominence of cortical end plates
Loss of horizontally oriented trabeculae
Wedge fractures
What radiological findings would you expect to see with osteomalacia?
Demineralisation especially in the spine, pelvis and lower extremities
Incomplete ribbon-like demineralisation of the cortex (pseudofractures)
Bone softening manifesting as:
- bowing of long bones
- vertical shortening of vertebrae
- flattening of pelvic bones
In terms of patterns of bone loss, what does:
- normal matrix and normal mineralisation
- increased resorption
usually mean?
Hyperparathyroidism
What are the ssx of osteoporosis?
Usually asymptomatic, may manifest as aching bone pain esp in the back.
What radiological findings would you expect with a patient with rickets?
Cup shaped diaphyseal ends
Spotty rarefaction at diaphyseal ends
Distance between the end of the radius and the metacarpal bones seems increased because the bone ends are not mineralised
Bending of bones
How would you diagnose rickets/osteomalacia?
Hx of inadequate vit D intake
Xray
Clinical picture
What are some DD’s for rickets/ostemalacia?
Hyperparathyroidism
Hyperthyroidism
Postmenopausal osteoporosis
Cushing syndrome
What are some causes of Vit D deficiency?
Dietary lack Increased intake of phytates Increased phosphate intake Decreased exposure to sunlight Malabsorption syndromes