Metabolic Bone Disease Flashcards
Learning outcomes for MCQ
What are the 2 classifications of bone?
Cortical and Trabecular bone
What dose cortical bone consist of?
Dense calcified tissue, providing structure and protection
What does trabecular bone consist of?
Horizontal and vertical interconnecting plates called trabeculae.
What does trabecular bone permit?
Bone marrow, blood vessels, connective tissue to be in contact with the endosteum
What are osteoblasts?
bone cells which produce bone matrix & initiate bone mineralisation
What are osteoblast function influenced by?
Parathyroid hormone, calcitonin, Vit D3, growth hormone, glucocorticoid hormones, gonadal steroids - oestrogen & testosterone
What are Osteoclasts?
Bones cells responsible for bone reabsorption
Name the 3 bone cells?
Osteoclasts, Osteoblasts, Osteocytes
What is the function of osteocytes?
Derive from osteoblasts, mature cells which transport calcium in the bone
How much of the body’s total calcium exists in bone?
98%
How is VitD synthesised in the body?
Via the skin during UV light exposure. Acting on bone, the intestine and kidneys
What hormone requires the presence of VitD and why?
Parathyroid hormone. It stimulates bone reabsorption enhances renal reabsorption of calcium and renal resynthesis of Vit D
What are the 6 functions of bone?
Provide vital function, 1. protection of internal organs, 2. storage and release of fat. 3. Production of blood cells. 4. storage and release of minerals e.g. Calcium. 5. Facilitates movement. 6. Supports the body
What is mechanotransduction?
The process whereby the skeleton responds to imposed demands and adjusts it’s structure accordingly.
Why does bone disease come under endocrinology?
Because of metabolism of bone being controlled by hormones
What is the bone turnover cycle?
A process where bone is removed by osteoclast cells then osteoblasts form new bone scaffold, calcium and other minerals finish the cycle. Continuous process
What is the percentage of our annual bone turnover cycle throughout our lives?
10%
In healthy adults what is the balance of the bone turnover cycle?
In healthy adults the amount of bone being removed is equal to the amount of new bone matrix being produced
What is osteopenia or osteoporosis?
Where the resorption/removal of bone is greater than bone formation
What is increased bone loss a risk factor for?
Fracture
Name a side effect of long term corticosteroid usage?
Osteoporosis
Is obesity a risk factor for osteoporosis?
no, low BMI is a greater risk factor for osteoporosis
Name secondary causes for osteoporosis…
Anorexia nervosa, male hypogonadism, chronic liver disease, renal disease, coeliac disease, RA, hyperthyroidism, IBD, Vit D deficiency
Who are at risk groups for osteoporosis?
People aged over 70
Osteocalstic activity is increased by Corticosteroids (7.5mg a day or more) causing osteoporosis over what time frame?
First 6 months
What is Type I primary osteoporosis?
females, hormonal related. post menopausal, in vertebra
What is Type II primary osteoporosis?
Male + Female gender, age related (O70yrs) decreased osteoblast activity, reduction in exposure to sunshine, reduction in calcium and VitD, reduced Vit D synthesis & an increase in parathyroid hormones and increased bone resorption.
What is Secondary Osteoporosis?
Predisposed reduced bone density - nutritional, hormonal, drugs, disease, Rheumatological conditions.
What investigations are used in diagnosing osteoporosis?
DEXA, Ultrasound, Bone scans, Blood Tests (to rule out other pathology, CA etc)
What T score is indicative of osteoporosis?
< -2.5 SD
What are clinical features of Osteoporosis?
Pain, Kyphosis, Mid-Thoracic #, Low Thoracic #, Upper Lumbar #, NOF # Distal radius/ulnar #
What are clinical features of osteoporosis?
Loss of height, long legs, kyphosis.
What are clinical features of osteoporosis?
Resp tract infection secondary to rib #
What are clinical features of osteoporosis?
Increased abdominal skin creases
What loss of height is indicative of osteoporosis?
A loss of 4-16cm in height
What are the risks of # in over 50 age catagory?
50% of women and 1/8th of men
Can osteoporosis be cured?
No
What is the aim of treatment for osteoporosis?
The slow the rate of bone loss, reduce fracture risks/falls
What are forms of osteoporosis prevention?
Education, smoking cessation, HRT, Ca/VitD diet, Medication & WB exercises
What medications are used to treat osteoporosis?
Fosamax, Bonviva, Actonel
What age does peak bone mass occur?
Late teens - early 20’s
By what age does bone consolidation complete?
at 30 years of age
After the age of 30, what percentage of bone loss occurs annually thereafter?
1% loss per year (accelerated post-menopause in women)
What medications are prescribed for osteoporosis?
Romosozumab, VitD & Calcium & HRT
What functional test is used in the physical examination of osteoporosis?
TUG
What measure of aerobic fitness is used in osteoporosis?
6 metre walk test & 2 minuet walk test
What are elements of physiotherapy management for osteoporosis?
Education, pain relief options, postural correction, WB exercise, Hydrotherapy, Mobility and Balance for falls prevention
Define WB exercise as treatment for osteoporosis?
Low impact WB activity, characterised by having 1 foot on the floor.
(high impact training is not suitable for patients with osteoporosis, e.g. jumping both feet on floor
Why is weight baring activity preferred over non WB exercise?
Because swimming, cycling do not stimulate bone adaptation as you need load to cause bone adaptation.
How often should people with osteoporosis perform resistance training exercsie?
Weights three times per week for 30 minuets
What precautions should be considered before commencing exercise?
GP sign-off & Screening questionnaire
What does BMD stand for?
bone mineral density
What physiotherapy interventions are contraindicated for osteoporosis?
Manual therapy techniques & Manual Chest clearance techniques (lung disease)
What exercise’s are to be avoided for osteoporotic patients?
Excessive spinal flexion e.g. dynamic abdominal exercises. Abrupt or explosive movements. High-impact loading. Twisting movements.
How are vertebral fractures managed during the initial 6-8 week healing phase?
Bed rest & pain relief, spinal brace mobilising.
How are vertebral fractures managed during the initial post 8 weeks?
Ax, posture/taylor brace, exercise & HEP
What is a fragility fracture?
A pathological fracture resulting from normal every day activities, such as a fall from standing height or less.
Hip fracture is one of the most serious consequences of falls in the elderly. What is the mortality rate associated with hip fractures?
10% at 1 month and 30% at 12 months
What complications do 20% of post op hip fracture patients experience?
9% contract chest infections & 5% suffer heart failure
What percentage of elderly people who sustain a hip fracture are unable to take care of themselves afterwards?
50%
What less common disease affects the pelvis, skull and lower limbs?
Paget’s Disease
What less common VitaminD deficiency related disease affects the bones & why?
Osteomalacia is a softening of the bones which occurs do to lack of uptake of Calcium do to a lack of Vitamin D in the bones
What is another name for osteomalacia?
Rickets / Soft Bones
How dose a deficiency in Vit D cause Osteomalacia?
Inadequate mineralisation of osteoid framework in the bone matrix.
What are clinical features of Osteomalacia? (Rickets)
Bone deformity, diffuse bone + muscle pain, fatigue, proximal myopathy (weakness) in the hips/spine region, observed “waddling gait”
How is osteomalacia diagnosed?
Bone biopsy / biochemistry / x-ray
How is osteomalacia treated?
Oral Vit D supplements & sunlight
How do you prevent osteomalacia?
Education, diet, vit d
How does Paget’s Disease affect bone?
it effects bone renewal by disrupting the normal cycle of bone renewal replacing hard bone with soft bone increasing the risk of fracture
How common is Paget’s?
2-3% of over 55’s and 10% of over 85’s - Aetiology is unknown
Where in the body is Paget’s disease most common?
Pelvis 71%, Lumbar Spine 50%, Femur49%, Humerus 40%, Skull 28%, Tibia 8%
What are clinical features of Paget’s?
Dull bone pain, night pain, deformity of long bones & skull, degenerative joint changes, spinal kyphosis, headache
What are complications of Paget’s?
Pathological fracture, non-union, stress-fracture, paraplegia
What medications are used in Paget’s?
Calcitonin & Bisphosphonates
What readiness for exercise questionnaire would you use in osteoporosis patients?
The ParQ questionnaire
