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DEMS: Unit III > Metabolic Bone Disease > Flashcards

Metabolic Bone Disease Flashcards

1
Q

Bone Remodeling Rank-L Signaling

A

RANK-L: Bone Resorption

OPG: Bone Resorption

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2
Q

FRAGILITY FRACTURES

A

caused BY Compromised Bone Strength (osteoporosis)

1.5 million/yr in US

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3
Q

Fragility Fractures Risk Factors

A

Previous Fractures (Increases Fracture Risk 5 Fold)
Age
Falls
Low Bone Mass

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4
Q

Resorption > Formation

A

Bone Mass is Lost

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5
Q

Non-modifiable Risk Factors for Low Bone Mass

A 
Age 
Race 
Gender 
Family History
Early Menopause
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6
Q

modifiable Risk Factors for Low Bone Mass

A 
Low Calcium Intake 
Low Vitamin D Intake 
Estrogen Deficiency 
Sedentary Lifestyle 
Cigarette Smoking 
Excess Alcohol (> 2/day) 
Excess Caffeine (> 2/day) 
Medications
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7
Q

Pre-Fracture Diagnosis of Osteoporosis

A

Normal T-score > -1.0
Osteopenia T-score = -1.0 to -2.5
Osteoporosis T-score < -2.5
Dx made @ lowest site

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8
Q

T or F: Low Bone Mass is Not Always Osteoporosis

A

True

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9
Q

Eval of low bone mass

A

Calcium, Alkaline Phosphatase Creatinine (eGFR) 25 OH Vitamin D Total Testosterone (Men) Thyroid Stimulating Hormone (TSH) Tissue Transglutaminase IgA Antibody 24 Hour Urine Calcium, Sodium, Creatinine

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10
Q

Who to Treat in 2014?

A
  • Anyone with a Fragility Fracture Vertebral Fracture Hip Fracture
  • T-Score < -2.5
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11
Q

Osteoporosis Prevention

A
  • Ca++
  • Vit D
  • Exercise
  • Fall prevention
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12
Q

Osteoporosis Tx

A
  • Anti-ResorptiveAgents: Bisphosphonates, Denosumab , Raloxifene, Calcitonin Estrogens
  • Anabolic Agents: Teriparatide Romosozumab
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13
Q

What is Osteomalacia and Rickets?

A
  • Impaired Bone Mineralization Resulting in Soft, Weak Bones
  • Inadequate Calcium x Phosphate Product for Bone Mineralization
  • Osteomalacia -Adults
  • Rickets -Children
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14
Q

Phosphate Disorders

A

-Acquired Hypophosphatemia (dec Oral Intake renal loss)
-Congenital Hypophosphatemic Rickets:
“Vitamin D Resistant Rickets”
Renal Phosphate Wasting
Impaired 1,25 (OH)2 Vitamin D Formation

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15
Q

Features of rickets

A

Pain Deformities Muscle Weakness Short Stature

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16
Q

Features of osteomalacia

A

Pain Deformities Fractures

17
Q

Lab findings in osteomalacia & Rickets

A 
Low Serum Calcium 
low Serum Phosphate 
High Serum Alkaline Phosphatase 
High Serum PTH 
Low Urine Calcium
18
Q

Radiologic findings in Rickets

A
  • Deformities: Bowing of Long Bones &Flaring Ends of Long Bones
  • Delayed Epiphyseal Calcification
19
Q

Paget’s Disease of Bone

A 
An Idiopathic Bone Condition Characterized by Excessive/Unregulated Bone Resorption and Formation
Causes:
-Genetic Predisposition
-Chronic Paramyxovirus Infection
-Linked w/ dog ownership
20
Q

Mutation of Sequestosome 1/P62 Gene

A
  • 40-80% of Paget’s Families
  • SQSTMI: ubiquitin binding protein. Forms ubiquitinated chains that function as protein scaffolds for IL-1 and TNF induced NF-B activation, which regulates RANK signaling that controls osteoclast differentiation, activity and survival.
21
Q

Development of Paget’s Disease Requires:

A
  1. Genetic Component:enhances osteoclast formation/reactivity
  2. Paramyxovirus Infection:induces changes in osteoclast precursors
22
Q

Paget’s clinical features

A
  • Skeletal: pain, fractures, deformity, fractures, etc
  • Neurologic: deafness, CN & spinal compression
  • CV: atherosclerosis, aortic stenosis, CHF
23
Q

Describe the clinical progression of Paget’s

A

The disease progression starts w/:

  1. predominant bone resorption (Inc NTX/CTX)
  2. Equal resorption and formation (inc NTX & alk phos)
  3. Dec both, yet bone formation is higher (low NTX, high/low alk phos)
24
Q

Bone remodeling markers

A
  • Urine NTX / CTX (Resorption): seen early/mid paget’s

- Serum Alkaline Phosphatase (Formation) mid phase/late?

25
Q

Paget’s radiology findings

A

-Osteolytic lesions: “blades of grass” in long bones
-Thickend, expanded cortex
-Expansion of bone size
Bone Scan: focal areas of intense uptake
Finding are usually very specific

26
Q

Paget’s Histo findings

A

Increased Osteoclast Numbers
Increased Osteoclast Nuclei
Increased Osteoblasts in Periphery
Disorganized, Mosaic, Woven Bone

DEMS: Unit III (21 decks)

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