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Endocrinology > Metabolic Bone Disease > Flashcards

Metabolic Bone Disease Flashcards

1
Q

Osteoporosis two types:

A

Primary (type 1 and type 2) and secondary

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2
Q

Primary osteoporosis includes

A

type 1 - postmenopausal most prevalent form (females 50-70yo)
type 2 - senile (age related, men and women > 70yo)

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3
Q

Secondary osteoporosis includes

A

malignancies, long term corticosteroid use, GI disorders, hormonal imbalances

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4
Q

Osteoporosis and osteopenia is

A

bone becomes weak and brittle, increased osteoclast or decreased osteoblast activity
end result = impaired bone structure, disorder skeletal architecture

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5
Q

Osteoporosis and osteopenia risk factors

A

EtOH, smoking, low body wt, sedentary lifestyle, low Ca, low Vit D, corticosteroid use

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6
Q

Osteopenia and osteoporosis presentation

A

usual presentation is via screening or fragility fractures - vertebrae > hip > pelvis > others
might see hyperkyphosis and/or ht loss (can be related to compression fractures)

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7
Q

What are fragility fractures?

A

any fracture that results from low-energy that wouldn’t otherwise produce a fracture in an otherwise healthy adult
fall from standing ht or less or no identifiable trauma

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8
Q

Screening for osteoporosis and osteopenia

A

Gold standard for screening is dual-energy x-ray absorption (DEXA) - reported as T-scores

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9
Q

Bone Density testing indications

A

ALL women (post menopausal) > 65, men > 70
Post/Perimenopausal women with clinical risk factors, hx of prior fracture
Anyone with a fragility fx
Pts with RA
Anyone with risk factors

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10
Q

DEXA measurement measures

A

bone density measurement - lumbar spine L1-4, femoral neck, total femur (hip)

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11
Q

T or Z score of -1 to -2.5 =

A

osteopenia

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12
Q

T or Z score of less than -2.5 =

A

Osteoporosis

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13
Q

T-score less than -2.5 with fracture =

A

severe osteoporosis

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14
Q

Repeat DEXA scan based on T score:
T score of -1 - -1.5 =
T score of -1.5 - 02.0 =
T score of -2.0 =

A

every 5 years
every 3-5 years
every 1-2 years

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15
Q

What tests do you ALWAYS want to check for osteomalacia?

A

Vit D
Co-occuring Vit D deficiency common

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16
Q

What is the BEST treatment for osteoporosis?

A

PREVENTION (first line)

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17
Q

What are some preventative strategies?

A

Wt bearing/ resistance exercise
Fall prevention strategies
Adequate dietary Ca or Ca supplementation and dietary Vit D or Vit D supplementation
Reduce Corticosteroids if possible, smoking cessation, ETOH reduction
fall prevention

18
Q

Osteoporosis/ osteopenia replacement/ supplementation that is recommended

A

Calcium replacement/ supplementation
Recommended: 1200 mg daily
Vit D - 1000-2000 units daily

19
Q

Who gets Osteoporosis/osteopenia treatment based on T score

A

T score of less than or equal to -2.5
Osteopenia and 10 year hip fracture risk > 3%
10 year major fracture risk of > 10%
Any patient with a fragility fracture

20
Q

Osteopenia/ Osteoporosis Pharmacologic treatment Options

A

Cal + Vit D
Bisphosphonates (outside of Vit supplementation this is first line) = usually Alendronate or risedronate

21
Q

Bisphosphonate Side effects

A

abdominal pain, heartburn, esophageal irritation, ulcers, osteonecrosis of the jaw

22
Q

Osteomalacia is a

A

disorder of the bone, characterized by decreased mineralization of newly formed osteoid at sites of bone turnover
secondary to increasing Vit D deficiency in adults - affects bones only

23
Q

Rickets is

A

Vit D deficiency or defect in Vit D metabolism in children - affects bones and cartilages

24
Q

Other vit that might be causing Osteomalacia or Rickets besides Vit D

A

calcium
phosphate deficiency or aluminum toxicity

25
Q

Medications that might cause osteomalacia

A

Phenytoin
carbamazepine
valproate
barbiturates

26
Q

Vit D deficiency Etiology

A

lack of sunlight
lack of fortified foods
absorption problems

27
Q

Osteomalacia/ Rickets presentation

A

diffuse muscle weakness, esp pelvic girdle
bone pain
waddling gait
fractures following minor or no trauma

Rickets - children develop permanent skeletal deformities

28
Q

Osteomalacia workup

A

bone density measurement - generalized decreased
bone bx
bloodwork - vit d low, calcium phosphate low, alkaline phosphatase high, secondary hyperparathyroidism

29
Q

Osteomalacia on xray

A

Milkman lines or Looser zones (Looser-Milkman pseudofractures) are dx but not always present

30
Q

Osteomalacia treatment

A

High dose Vit D
Phosphate supplementation and Vit D in renal phosphate wasting
Ca supplementation
Discontinue aluminum-containing antacids
Prophylactic treatment for pts on phenytoin

31
Q

Paget’s Disease of Bone is

A

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

32
Q

Paget’s Disease of Bone presentation

A

Often asymptomatic - may be incidental finding on Xray
enlarged, misshapen bones, bowed tibia, kyphosis

sx - bone and joint pain, HA, hearing loss, nerve root impingement, cauda equina (Neuro complications involving skill/spine compression)

33
Q

Diagnosis of Paget Disease of the Bone

A

calcium and phosphate - normal
PTH - usually elevated
Alkaline phosphatase - high (liver enzyme, marker of high bone turnover)
Hypercalciuria common

34
Q

Paget’s disease of bone dx is made primarily via

A

radiographs (xray and bone scans usually dx)

35
Q

Skeletal findings of Paget’s Disease of Bone

A

curved long bones (bowed)
Cotton ball appearance of skull
picture frame appearance in spine
if lesions suspicious for malignancy –> bone bx

36
Q

Paget’s disease of the bone treatment

A

Mainstay of treatment is bisphosphonates –> inhibits osteoclasts - IV zolendronic acid (Reclast) most effective
ensure adequate Ca and Vit D - all don’t need supplementation

37
Q

Osteogenesis Imperfecta is a

A

rare bone disorder - ‘brittle bone disease’
Genetic disorder - decreased or impaired type 1 collagen –> insufficient osteoid –> impaired remodeling

38
Q

Osteogenesis Imperfecta presentation

A

MSK manifestations:
fragile bones (multiple fx minimal trauma, reduces as pt gets older stops after puberty)
deformities (fx heal initially but can’t remodel)
bowing of long bones
scoliosis
short stature
ligamentous laxity

39
Q

Osteogenesis Imperfecta non-MSK manifestations:

A

Blue sclera
hearing loss
brownish opalescent teeth (teeth)
think skin
hypermetabolism

40
Q

Osteogenesis Imperfecta dx

A

skin bx - abnormal collagen
genetic testing (before/after birth)

41
Q

Osteogenesis Imperfecta treatment

A

best treatment is prevention of fractures
exercise & PT to strengthen muscles/bones
Prophylactic rods to prevent long bone fractures
bracing for fracture prevention

Endocrinology (5 decks)

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