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LOCO2 > Metabolic Bone Conditions > Flashcards

Metabolic Bone Conditions Flashcards

1
Q

Which bone disease has normal serum Ca, PO4, alkaline phosphatase, PTH, and 1,25 OH2 vitamin D

A

Osteoporosis

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2
Q

Which bone disease has low serum Ca, low PO4, high alkaline phosphatase, high PTH, and low 1,25 OH2 vitamin D

A

Osteomalacia

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3
Q

Which bone disease has normal serum Ca, PO4,, PTH, and 1,25 OH2 vitamin D, and very high alkaline phosphatase

A

Pagets

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4
Q

Which bone disease has low serum Ca, high PO4, normal or high alkaline phosphatase, high PTH, and low 1,25 OH2 vitamin D

A

Renal failure

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5
Q

Which bone disease has high serum Ca, low PO4, normal or high alkaline phosphatase, high PTH, and normal 1,25 OH2 vitamin D

A

Primary hyperparathyroidism

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6
Q

Why is 25 vit d often measured instead of 1,25 vit d

A

More long lived

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7
Q

Why does renal failure cause low serum 1,25 vit d but normal serum 25 vit d

A

1,25 synthesised in kidney

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8
Q

How does osteoporosis affect bone amount and mineralisation

A

Decr amount
Normal mineralisation

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9
Q

How does osteomalacia affect bone amount and mineralisation

A

Normal amount
Decr mineralisation

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10
Q

Why are women more affected by osteoporosis than men

A

Men start with more bone
Women have faster bone mass decline
Decline speeds up at menopause

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11
Q

How can bone mineral density be expressed

A

T score
Z score

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12
Q

T score

A

Number of standards deviations from the mean bone density for 30 year old of same gender and ethnicity

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13
Q

Z score

A

Number of standards deviations from the mean bone density for same age, gender and ethnicity

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14
Q

When is z score used

A

Young people w osteoporosis

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15
Q

What t score indicates osteoporosis

A

<2.5

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16
Q

What t score indicates osteopenia

A

-1- -2.4

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17
Q

What type of bone is more susceptible to osteoporotic bone loss

A

Trabecular

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18
Q

Why are vertebral bodies and femoral neck susceptible to osteoporotic bone loss

A

High proportion of trabecular bone

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19
Q

Osteoporosis

A

Relative incr in bone resorption not matched by formation

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20
Q

Osteoporosis treatments

A

Bisphosphonates
Calcium
Vitamin D
HRT - oestrogen
Raloxifene - Selective oestrogen receptor modulator
Teriparatide
Denosumab
BCD TROD

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21
Q

What is raloxifene

A

Selective oestrogen receptor modulator

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22
Q

What is teriparatide

A

Recombinant PTH

23
Q

What is denosumab

A

Monoclonal antibody for RANKL that mimics OPG receptor

24
Q

When is a selective oestrogen receptor modulator used instead of HRT

A

Women at risk of breast or uterine cancer

25
Q

Primary osteoporosis treatment

A

Bisphosphonates

26
Q

How do Bisphosphonates inhibit bone resorption

A

Deposited into hydroxyapatite making clasts less likely to degrade
Causes apoptosis in clasts that uptake bisphosphonate containing hydroxyapatite bone
Decr RANKL expression and decr OPG production by blasts -> mod blast to Clast signalling

27
Q

Bisphosphonate complications

A

Less bone renewal leading to
Giant osteoclasts
Osteonecrosis of jaw
Atypical fractures

28
Q

How are Bisphosphonate complications managed

A

Give pt Bisphosphonate holiday to allow bone renewal

29
Q

What is osteopotegrin OPG

A

decoy receptor for RANKL

30
Q

Why does teriparatide treatment give intermittent PTH exposure rather than continual OTH exposure

A

Intermittent exposure causes blasts proliferation
Chronic exposure causes clast differentiation

31
Q

Romosozumab

A

Monoclonal antibody against sclerostin

32
Q

Why does bone resorption decrease during lutealphase of menstrual cycle

A

High progesterone

33
Q

Osteomalacia

A

Impaired mineralisation of bone matrix causing softening of bones

34
Q

What causes osteomalacia

A

Insufficient calcium and phosphate to mineralise new bone osteoid

35
Q

What is osteomalacia called in children

A

Rickets

36
Q

Why does osteomalacia cause more deformity in children

A

Epiphyseal growth plate still open
More woven bone

37
Q

How are serum calcium, phosphorus, and alkaline phosphatase levels in osteomalacia

A

calcium and phosphorus low
Alkaline phosphatase High

38
Q

Pseudofractures/loosers lines

A

Areas of unmineralised bone that look like fractures of x ray
Common in osteomalacia

39
Q

How much osteoid is unmineralised in normal bone

A

<20%

40
Q

Why are Clast numbers increased in osteomalacia

A

Incr ca reabsorbtion

41
Q

What subtpstance is used to label mineralising bone and asses bone mineralisation

A

Tetracycline

42
Q

Osteomalacia treatment

A

Vitamin d supp
Calcium supp

43
Q

Paget’s disease

A

Chronic Condition causing increased bone breakdown and growth

44
Q

Dysfunction in What cell causes Paget’s

A

Osteoclasts - genetic + viral infection

45
Q

3 phases of Paget’s

A

Incr rate of bone resorption
Compensatory/proliferative phase
Burnt out/sclerotic phase

46
Q

What happens in the compensatory phase of Paget’s

A

Incr woven bone formation with disorganised deposition
Blast proliferation

47
Q

Pagetic bone

A

Dense bone with little cellularity

48
Q

Features of bone in Paget’s burnt out phase

A

Irregular thickened Trabeculae
Prominent cement line
Bone marrow replaced by fibrovascukar CT
Pagetic bone

49
Q

Which bones are most commonly effected in Paget’s

A

Pelvis
Femur
Vertebrae
Skull
tibia

50
Q

How can Paget’s cause CN palsies

A

Bone growth closes foramena and compresses nerves

51
Q

What type of cancer is a rare complication of Paget’s

A

Osteosarcoma

52
Q

Which bones do osteosarcomas most commonly affect

A

Long bones
Often near knee

53
Q

Paget’s treatment

A

Bisphosphonates
Calcium
Vit d
Pain management
Surgery
Calcitonin (used less)

LOCO2 (26 decks)

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