Metabolic Bone Disease Flashcards
Paget's, et al
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Is loss of bone r/t a vitamin D deficiency
- Is the adult equivalency to Rickets (a vitamin D deficiency in children)
- May occur from lack of sunlight, lack of Vit D in the diet, or may be from malabsorption issues, liver or pancreatic disorders, drug s/e, etc.
- Often confused w/osteoporosis b/c of similarities shared by the 2; can occur together in some people
- Not very common in the US, but can be in countries prone to famine
Osteomalacia
The major treatment is ____ in an active form, such as ____
Vitamin D; ergocalciferol
Causes
- Vit D disturbance
- Inadequate production
- Lack of sunlight exposure
- Dietary deficiency
- Abn metabolism
- Drug therapy
> Phenytoin (Dilantin)
> Fluoride
> Barbiturates
- Liver, renal dz
- Inadequate absorption/malabsorption syndrome
- Post-gastrectomy
- IBD
- Kidney dz, CKD, acute tubular disorders
> Acidosis
> Hypophosphatemia - Familial metabolic error
Paget’s Disease (osteitis deformans)
- Primary lab findings for probable dx of Paget’s is increased ____
- xrays also used to dx
- Radionuclide bone scan most sensitive in detecting Paget’s as opposed to CT & MRI which are most useful in detection of cancerous tumors, changes in the skull, & spinal cord or nerve compression
- Rx’s - think osteoporosis rx’s/very similar
> Primary intervention is meds - relieve pain & dec bone resorption
> Bisphosphonates when ALP is 2x normal lvl; Mab therapy (Prolia [denosumab]), calcitonin
serum alkaline phosphatase (ALP)
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Is a chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) & re-formed (osteoblastic activity)
> The bone that’s rebuilt is weak & structurally disorganized
> In long bones it can cause a bowing
- Most common areas where this happens are the vertebrae, femur, skull, clavicle, humerus, & pelvis
Paget’s disease
- Is 2nd only to osteoporosis as 1 of the most common bone dz’s in the US
- Usually occurs in people over 50 & more frequently in those of European descent, but risk incr w/age, esp in those >80 y.o.
- Men affected 2x as often as women
Musculoskeletal Manifestations
- Bone & joint pain (may be in a single bone) that is aching, poorly described, & aggravated by walking
- Low back & sciatic nerve pain
- Bowing of long bones
- Loss of normal spinal curvature
- Enlarged, thick skull
- Pathologic fx’s
- Osteogenic sarcoma (bone cancer)
Skin Manifestations
- Flushed, warm skin
Other Manifestations
- Apathy, lethargy, fatigue
- Hyperparathyroidism
- Gout
- Urinary or renal stones
- Heart failure from fluid overload
Primary Problems in Metabolic Bone Disease
- Strength (loss)
- Risk for fracture
- Injury prevention
- Nutritional status
Take Action
- Safety precautions
- Medications
- Surgical management
- Pt teaching
- Collaborative health care team roles
- Community resources
Benign Bone Tumors vs Bone Cancer
Benign bone tumors
- chondrogenic (cartilage), osteogenic (bone), & fibrogenic (fibrous tissue)
- Most common is osteochondroma
> present in childhood & not dx’d until adulthood; in femur or tibia
- Often asymptomatic
- May be discovered on routine xray or as a cause of pathologic fx
Bone cancer
- Most common type of primary, malignant bone cancer is osteosarcoma
- More than 1/2 in the femur then proximal tibia & humerus; usually metastasizes & results in death
- Ewings sarcoma - not as common but is most malignant
> usually found in pelvis & lower extremities
> death from metastasis to lungs & other bones
> any age but most often in children & young adults; males more often than females
Interventions: Take Action
- Benign bone tumors
> Non-drug pain relief measures
> Drug therapy (analgesics, NSAIDs)
> Surgical therapy (curettage, joint replacement, arthrodesis)
- Bone cancer
> Surgical intervention
> Radiation, chemotherapy
> Psychosocial resources
