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MSK > metabolic bone disease > Flashcards

metabolic bone disease Flashcards

1
Q

what cell forms bone

A

osteoblasts

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2
Q

what cell breaks down bone

A

osteoclasts

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3
Q

what is the test for vitamin D

A

25OH vit D

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4
Q

what is pagets disease of bone

A

localised disorder of bone turnover
increased bone resorption followed by increased bone formation
bigger, less compact, more vascular and more susceptible to deformity and fracture. not organised so some areas high density (sclerosis) some area lows ( lysis)

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5
Q

epidemiology of pagets

A

relatively common
strong genetic
UK and east coast of US and australia and NZ
possibility of chronic viral infection within osteoclast

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6
Q

investigations pagets

A

xray- bone enlargement and deformity, cotton wool appearance of skull, V shaped defects in long bones
isotope bone scan
raised alkaline phosphotase
normal calcium
normal phosphate

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7
Q

pagets disease signs

A

always patient >40years
constant bone pain sometimes worse at night

elevated serum alkaline phosphotase (LFT)
bone pain and local heat
bone deformity and local heat
hearing loss
osteosarcoma in affected bone RARE but lethal
can have no symptoms
particularly affects axial skeleton

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8
Q

treatment of pagets

A

asymptomatic dont treat unless in skull
do not treat based on alkaline phosphotase alone

IV bisphosphonate therapy- one off zoledronic acid infusion
monitor ALP levels

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9
Q

what is rickets and osteomalacia

A

severe nutritional vit D or calcium deficiency
rickets in growing child
osteomalacia in adult (when epiphyseal lines are closed)

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10
Q

rickets signs and symptoms

A

large forehead
odd shaped ribs and breast bones
large abdomen
stunted growth
wide joints at elbow and wrists
odd shaped legs
failure to thrive

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11
Q

osteomalacia signs and symptoms

A

bone pain
muscle weakness
increased falls risk
holes in skull- pepper box skull

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12
Q

treatment for rickets and osteomalacia

A

calcium and vit D supplements

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13
Q

what is osteogenesis imperfecta

A

genetic disorder of connective tissue. broad clinical age range
brittle bone disease

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14
Q

signs of osteogenesis imperfecta

A

fragile bones from mild trauma and even acts of daily life

growth deficiency
hearing loss
blue whites of eyes
scoliosis
barrel chest
hypermobility
easy bruising

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15
Q

types of OI

A

8 types. 4 most common
1- milder form child starts to walk and can present in adults
2- lethal by age 1
3- progressive deforming with severe bone dysplasia and poor growth
4- more severe type 1

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16
Q

managment of OI

A

surgery to treat fractures
IV bisphosphonates to prevent fractures
no team sports or PE for children
genetic counselling

17
Q

what is osteoporosis

A

reduction in the density of the bones leading to enhanced bone fragility and fracture risk

18
Q

DXA bone scan osteoporosis result

A

less than -2.5 SDs below the young adult mean in post menopausal woman (want z score to be 0)

19
Q

investigations

A

fracture risk calculators-
WHO fracture risk assessment tool FRAX
Q fracture
prodigy scanner
DXA scan of spine - want z score to be 0

20
Q

management of osteoporosis

A

fracture risk assessment tool to find if at risk of osteoporosis
then if significant risk (>10% risk of fracture over 10 years) then refer for DXA scan
all on oral steroids or suffer a low trauma fracture should be referred anyway

21
Q

endocrine causes of osteoporosis

A

thyrotoxicosis
hyper and hypoparathyroidism
cushings
hyperprolactinoma
hypopituitarism
low sex hormone levels

22
Q

rheumatic causes of osteoporosis

A

rheumatoid arthritis
ankylosing spondylitis
polymyalgia rheumatica

23
Q

GI causes of osteoporosis

A

UC and crohns
PBC, CAH, alcoholic cirrhosis, viral cirrhosis
CF
coeliac
chronic pancreatitis
whipples disease
ischemaic bowel

24
Q

meds that cause osteoporosis

A

steroids
PPI
enzyme inducting antiepileptic meds
aromatase inhibitors
GnRH inhibitors
warfarin

25
Q

risk factors

A

old age
female
previous fractures
low BMI
RA
alcohol and smoking
long term steroids

26
Q

management of osteoporosis

A

reduce fracture risk
good calcium and vit d
bisphosphonates- ate
HRT
SERM - raloxifene

27
Q

what is a low bone density but not osteoporosis yet called

A

osteopenia

27
Q

side effects of bisphosponates

A

all rare
reflux and oesophageal erosions
atypical fractures
osteonecrosis of jaw or ear
need good renal function
need drug holiday for 1-2 years after 10 years therapy

28
Q

examples of bisphosphonates

A

alendronate
risedronate
zoledronic acid (IV)

MSK (33 decks)

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