metabolic bone disease Flashcards
What is the cause of Type 1 primary osteoporosis
postmenopausal
What is the cause of type 2 primary diabetes
age (>70)
What is secondary osteoporosis
bone loss associated with other conditions
What hormone deficiency can expedite bone loss
estrogen
What medications can expedite bone loss
corticosteroids
Is osteoporosis quantitative or qualitative
quantitative
When does osteoporosis generally present and why
older age because after 30 bone remodeling becomes unbalanced
Bone resorption>bone formation
What are some modifiable factors with osteoporosis
ETOH, smoking, low body weight
sedentary life style
low ca, low vitamin D, corticosteroids
What are non-modifiable facts for osteoporosis
advanced age
caucasian or asian
female sex
What is the most common presentation for osteoporosis
asymptomatic
*generally a fragility fx (vertebral>hip>pelvis)
What is generally the source for a fragility fracture
typically, fall from standing height or less/ no identifiable trauma
What is the gold standard for diagnosis osteoporosis
DEXA
What are the indications for bone density testing
All postmenopausal women >65
Men >75
clinical risk fx/ hx prior fx
What is the DEXA score for someone with osteoporosis
-2.6 to -4
What is the DEXA score for osteopenia
-1 TO -2.5
if the T score is -1 to -1.5, when does the next DEXA need to be
Q 5 years
What is the T score range in those who need DEXA scans every 3-5 years
T score -1.5 to -2
When is a DEXA every 1-2 years required
t score <-2
What tests should be run to check for osteomalacia
Vitamin D level
What is the best measurement for vitamin D levels
25- hydroxyvitamin D
What is the best treatment for osteoporosis
Prevention 1st line
What are some preventative measures for osteoporosis
weight bearing exercise
fall prevention strategies
adequate Ca
Adequate vitamin D
ETOH reduction
What is the recommended daily amount of Ca
1200mg
What are the requirements for pharmacological treatment of osteoporosis
Tscore < -2.5 (w/o secondary cause)
Osteopenia & 10yr hip fx risk >3%
10yr major hip fracture risk >10%
Any patient with fragility fracture
What is the first line pharmacologic agent for osteoporosis
bisphosphonates (Alendronate)
What are some side effects to watch for with bisphosphonates
Heart burn
acute inflammation
Osteonecrosis of the jaw
How is Danuzomab administered as a pharmacological treatment for osteoporosis and when is it utilized
IV 2x a year
When pt. cannot tolerate / are unresponsive to bisphosphonates
What is osteomalacia
Disorder of bone characterized by decrease in mineralization of newly formed osteoid at sites of bone turnover
What is the cause of osteomalacia
Vitamin D deficiency
*effects only bones
What is the cause of rickets
Vitamin D deficiency in children
*effects bone and cartilage
What pharmacological agents may cause osteomalacia
phenytoin
carbamazepine
Valproate
Barbituates
What can cause a vitamin D deficiency
Lack of sunlight
lack of fortified food
absorption problems
renal disease
How much exercise is recommended for preventing osteoporosis
30 min, 3x/week
What is the presentation of osteomalacia
diffuse muscle weakness
waddling gait
bone pain
**Children with rickets develop permanent skeletal deformities
What is seen on XR that are diagnostic for osteomalacia
milkman lines (psuedofractures)
how do you treat osteomalacia
high dose vitamin D
Phosphate supplement
Calcium supplementation
Which gender is at higher risk of pagets
men (>55y/o)
caucasian
What is Paget’s disease
inflammatory disorder of the bone
-accelerated rate of bone remodeling resulting in overgrowth of bone in aging skeleton
What area of the body is typically effected by Paget’s disease
Skull
spine
pelvis (m/c)
long bones
ribs
What will be seen on labs in someone with pagets disease
alkaline phosphatase is high (marker of high bone turnover)
How is Pagets disease typically diagnosed
via radiographs
-thickened corticles
-lytic/blastic lesions
-cotton ball skull appearance
-picture frame spine appearance
What is the mainstay treatment for Pagets disease
bisphonsphonates
What is osteogenesis imperfecta
Brittle bone disease
*genetic bone disorder
What are the MSK presentations of Osteogenesis imperfecta
Fragile bones
deformities (bowing legs)
ligamentous laxity
short stature
scoliosis
What are general presentations of osteogenesis imperfecta
Blue sclera
brownish teeth
Aortic regurge
triangle facies
What is the beast treatment for osteogenesis imperfecta
Prevention of fractures
What is fibrodysplasia ossificans progressiva
Rare disorder characterized by progressive extra-skeletal ossification of soft tissues = the original skeleton being encased in unyielding new bone
What do those with fibrodysplasia ossificans progressiva die from
cardiorespiratory failure
