Metabolic Bone Disease

Question 1

What bone disease has normal calcium, phosphate and ALP?

Answer 1

Osteoporosis

+ osteogenesis imperfecta

Question 2

When should osteoporosis be treated?

What is the treatment of osteoperosis?

Answer 2

When DEXA scan is worse than -2.5 (scan not necessarily needed in >75s)

Vitamin D and Ca2+ supplementation offered, unless certain there is no deficiency.
Alendronate is first line - if not tolerated (GI side affects), offer risedronate or etidronate.

Strontium renelate and Raloxifene are reserved for those who cannot tolerate bisphosphonates.

Question 3

What bone disease has low calcium, low vitamin D; but increased ALP?

Answer 3

Osteomalacia

Question 4

How do you treat osteomalacia?

Answer 4

Vitamin D and Ca2+ supplementation

Question 5

What bone disease presents with normal calcium and phosphate, but raised ALP?

Answer 5

Paget’s disease

Question 6

What are the (4) indications for management of Paget’s?

Answer 6

Bone pain

Bone deformity (skull or long bones)

Pathological fracture

Peri-articular disease

Question 7

What is the management of Paget’s?

Answer 7

Oral risondrenate or IV zoledronate

IV calcitonin rarely used

Question 8

What are some of the complications of Paget’s disease?

Answer 8

Deafness (CN8 compression)
Bone sarcoma development (fibrosarcoma and osteosarcoma)
Pathological fractures
Skull thickening
High output HF (HF PEF)