Metabolic bone disease Flashcards
What type of cells are osteoclasts>
Macrophages
Where is vit d stored?
liver, bones and fat
What food sources contain vitamin d?
Fortified foods, oily fisha nd egg yolks
In pagets disease: Does it cross over joints? Are the bones hot? What do we expect to be elevated? When would we treat?
No, doesnt cross joints (localised), hot bones, ALP will be elevated. If seen with Gamma GGT then think liver, btut only ALP then think Pagets. We only treat if it is in the skull (threatening hearing loss) or ithere is about to be surgery in the area of paget eg hip replacemetn.
What is the treatment for pagets?
IV bisphosphonates
What is rickets and osteomalacia caused by? WHat is the effect on muscles
Low vitamin d. Will also get floppy muscles
UK child with rickets, think abuse.
In 3rd world -> think malnutrition.
What is the role of Chipatti flour and clacium balance?
It absorbs and collates Ca in gut and so can’t be absorbed
What is rachitic rosaryy? What can you see this in? What othe symptoms may there be?
Lumpy rib cartilage attachments. Rickets. In children you can get big heads as the sutures don’t fuse.
In adults you can get a waddling gate, aches and microfractures
Thinking about osteoporosis:
-Dex scan, where do you want (remember these bone scans are 1/100 of cxr!
-What is the diagnosis cut off?
-If you are on oral steroids do you get a dexa scan if you are over 50?
-L1-L4 vertebra
- minus2.5 off the normal young person of roughly same build bone density
-yes
If you start HRT at 40 are you more likely to get breast cancer?
No! Becasause you usually would have ahad the horomones then anyway!! So is a great opetion for women who are experiencing tan early menopause
What are the side effects of bisphosphonates?
Oesophagitis
Iritis/uveitis
ONJ?
Atypical femoral shaft fractures?
Drug Holiday for 1-2 years
Usually after 10 years Oral Bisphosphonates
wHAT ARE THE treatment options for osteoporosis
1)Antiresorptive therapies( HRT, SERMs, Bisphosphonates and Denosumab
2)Anabolic therapies: Teriparatide and Romosuzumab
IV bisphosphonates are 1st line usually
How do bisphosphonates work?
Bisphosphonates -> causes starfish cell -> apoptosis -> spits out old stuff -> kills new osteoclasts too
How do bisphosphonates work?
Bisphosphonates -> causes starfish cell -> apoptosis -> spits out old stuff -> kills new osteoclasts too
What drug causes medication related osteoporosis of the jaw?
Bisphosphonates, so you need great oral hygine, as otherwise the jaw can become exposed and rot
