metabolic bone disease

Question 1

What is the cause of Type 1 primary osteoporosis

Answer 1

postmenopausal

Question 2

What is the cause of type 2 primary diabetes

Answer 2

age (>70)

Question 3

What is secondary osteoporosis

Answer 3

bone loss associated with other conditions

Question 4

What hormone deficiency can expedite bone loss

Answer 4

estrogen

Question 5

What medications can expedite bone loss

Answer 5

corticosteroids

Question 6

Is osteoporosis quantitative or qualitative

Answer 6

quantitative

Question 7

When does osteoporosis generally present and why

Answer 7

older age because after 30 bone remodeling becomes unbalanced
Bone resorption>bone formation

Question 8

What are some modifiable factors with osteoporosis

Answer 8

ETOH, smoking, low body weight
sedentary life style
low ca, low vitamin D, corticosteroids

Question 9

What are non-modifiable facts for osteoporosis

Answer 9

advanced age
caucasian or asian
female sex

Question 10

What is the most common presentation for osteoporosis

Answer 10

asymptomatic
*generally a fragility fx (vertebral>hip>pelvis)

Question 11

What is generally the source for a fragility fracture

Answer 11

typically, fall from standing height or less/ no identifiable trauma

Question 12

What is the gold standard for diagnosis osteoporosis

Answer 12

DEXA

Question 13

What are the indications for bone density testing

Answer 13

All postmenopausal women >65
Men >75
clinical risk fx/ hx prior fx

Question 14

What is the DEXA score for someone with osteoporosis

Answer 14

-2.6 to -4

Question 15

What is the DEXA score for osteopenia

Answer 15

-1 TO -2.5

Question 16

if the T score is -1 to -1.5, when does the next DEXA need to be

Answer 16

Q 5 years

Question 17

What is the T score range in those who need DEXA scans every 3-5 years

Answer 17

T score -1.5 to -2

Question 18

When is a DEXA every 1-2 years required

Answer 18

t score <-2

Question 19

What tests should be run to check for osteomalacia

Answer 19

Vitamin D level

Question 20

What is the best measurement for vitamin D levels

Answer 20

25- hydroxyvitamin D

Question 21

What is the best treatment for osteoporosis

Answer 21

Prevention 1st line

Question 22

What are some preventative measures for osteoporosis

Answer 22

weight bearing exercise
fall prevention strategies
adequate Ca
Adequate vitamin D
ETOH reduction

Question 23

What is the recommended daily amount of Ca

Answer 23

1200mg

Question 24

What are the requirements for pharmacological treatment of osteoporosis

Answer 24

Tscore < -2.5 (w/o secondary cause)

Osteopenia & 10yr hip fx risk >3%

10yr major hip fracture risk >10%

Any patient with fragility fracture

Question 25

What is the first line pharmacologic agent for osteoporosis

Answer 25

bisphosphonates (Alendronate)

Question 26

What are some side effects to watch for with bisphosphonates

Answer 26

Heart burn acute inflammation Osteonecrosis of the jaw

Question 27

How is Danuzomab administered as a pharmacological treatment for osteoporosis and when is it utilized

Answer 27

IV 2x a year When pt. cannot tolerate / are unresponsive to bisphosphonates

Question 28

What is osteomalacia

Answer 28

Disorder of bone characterized by decrease in mineralization of newly formed osteoid at sites of bone turnover

Question 29

What is the cause of osteomalacia

Answer 29

Vitamin D deficiency *effects only bones

Question 30

What is the cause of rickets

Answer 30

Vitamin D deficiency in children *effects bone and cartilage

Question 31

What pharmacological agents may cause osteomalacia

Answer 31

phenytoin carbamazepine Valproate Barbituates

Question 32

What can cause a vitamin D deficiency

Answer 32

Lack of sunlight lack of fortified food absorption problems renal disease

Question 33

How much exercise is recommended for preventing osteoporosis

Answer 33

30 min, 3x/week

Question 34

What is the presentation of osteomalacia

Answer 34

diffuse muscle weakness waddling gait bone pain **Children with rickets develop permanent skeletal deformities

Question 35

What is seen on XR that are diagnostic for osteomalacia

Answer 35

milkman lines (psuedofractures)

Question 36

how do you treat osteomalacia

Answer 36

high dose vitamin D Phosphate supplement Calcium supplementation

Question 37

Which gender is at higher risk of pagets

Answer 37

men (>55y/o) caucasian

Question 38

What is Paget's disease

Answer 38

inflammatory disorder of the bone -accelerated rate of bone remodeling resulting in overgrowth of bone in aging skeleton

Question 39

What area of the body is typically effected by Paget's disease

Answer 39

Skull spine pelvis (m/c) long bones ribs

Question 40

What will be seen on labs in someone with pagets disease

Answer 40

alkaline phosphatase is high (marker of high bone turnover)

Question 41

How is Pagets disease typically diagnosed

Answer 41

via radiographs -thickened corticles -lytic/blastic lesions -cotton ball skull appearance -picture frame spine appearance

Question 42

What is the mainstay treatment for Pagets disease

Answer 42

bisphonsphonates

Question 43

What is osteogenesis imperfecta

Answer 43

Brittle bone disease *genetic bone disorder

Question 44

What are the MSK presentations of Osteogenesis imperfecta

Answer 44

Fragile bones deformities (bowing legs) ligamentous laxity short stature scoliosis

Question 45

What are general presentations of osteogenesis imperfecta

Answer 45

Blue sclera brownish teeth Aortic regurge triangle facies

Question 46

What is the beast treatment for osteogenesis imperfecta

Answer 46

Prevention of fractures

Question 47

What is fibrodysplasia ossificans progressiva

Answer 47

Rare disorder characterized by progressive extra-skeletal ossification of soft tissues = the original skeleton being encased in unyielding new bone

Question 48

What do those with fibrodysplasia ossificans progressiva die from

Answer 48

cardiorespiratory failure