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Year 5 Histopath > Metabolic Bone Disease > Flashcards

Metabolic Bone Disease Flashcards

1
Q

What are 5 metabolic bone diseases?

A 
Pagets disease
Renal Osteodystrophy
Osteoporosis
Osteomalacia/rickets
Hyperparathyroidism (primary)Pagets disease
Renal Osteodystrophy
Osteoporosis
Osteomalacia/rickets
Hyperparathyroidism (primary)Pagets disease
Renal Osteodystrophy
Osteoporosis
Osteomalacia/rickets
Hyperparathyroidism (primary)
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2
Q

What is the composition of bone?

A

80% compact/cortical
20 % anellous/spongy80% compact/cortical
20 % anellous/spongy80% compact/cortical
20 % anellous/spongy

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3
Q

What is cancellous/spongy bone important for?

A

Calcium metabolism, found especially in the vertebra and pelvis

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4
Q

What disease features are seen in osteoporosis?

A

Decreased bone mass
DEXA scan: Tscore >2.5 SD below normal (1-2.5 = osteopaenia)Decreased bone mass
DEXA scan: Tscore >2.5 SD below normal (1-2.5 = osteopaenia)Decreased bone mass
DEXA scan: Tscore >2.5 SD below normal (1-2.5 = osteopaenia)

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5
Q

What disease features are seen in Osteomalacia/rickets?

A

Decreased bone mineralization

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6
Q

What disease features are seen in Primary hyperparathyroidism?

A

Bone changes of osteitis fibrosa cystica

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7
Q

What disease features are seen in Pagets disease?

A

Both lytic and lerotic lesions

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8
Q

What can cause osteoporosis

A

Mostly age related
Post-menopause in women
Secondary to systemic disease/drugsMostly age related
Post-menopause in women
Secondary to systemic disease/drugsMostly age related
Post-menopause in women
Secondary to systemic disease/drugs

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9
Q

What can cause rickets?

A

Decreased Vit D

Decreased dietray Vit D,
decreased sunlight,
malabsoprtion of Vit D (GI causes)
genetic causesDecreased Vit D

Decreased dietray Vit D,
decreased sunlight,
malabsoprtion of Vit D (GI causes)
genetic causesDecreased Vit D

Decreased dietray Vit D,
decreased sunlight,
malabsoprtion of Vit D (GI causes)
genetic causes

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10
Q

Define pagets disease:

A

Paget’s disease chronically disrupts the normal cycle of bone renewal and repair, causing bones to become weakened and enlarged/deformed

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11
Q

What is the aetiology of primary hyperparathyroidism?

A

Excess PTH production –> increased calcium reabsorption and increased phosphate excretion

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12
Q

What can cause primary hyperparathyroidism?

A 
Parathyroid adenoma
MEN
Carcinoma
HyperplasiaParathyroid adenoma
MEN
Carcinoma
HyperplasiaParathyroid adenoma
MEN
Carcinoma
Hyperplasia
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13
Q

Define Renal Osteodystrophy

A

a bone disease that occurs when your kidneys fail to maintain proper levels of calcium and phosphorus in the blood. It’s common in people with CKD and affects most dialysis patients.

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14
Q

What are the symptoms of Pagets disease?

A 
Bone pain
Microfractures
Nerve compression
Skull changes (increased head size)
Deafness
High output cardiac failureBone pain
Microfractures
Nerve compression
Skull changes (increased head size)
Deafness
High output cardiac failureBone pain
Microfractures
Nerve compression
Skull changes (increased head size)
Deafness
High output cardiac failure
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15
Q

What are the symptoms of hyperparathyroidism?

A

Hypercalcaemia: Moans, Stones, Bones, Groans

Depression/confusion
Renal stones
Bone pain and fractures
Constipation
Pancreatitis
POlyuria
PolydipsiaHypercalcaemia: Moans, Stones, Bones, Groans
Depression/confusion
Renal stones
Bone pain and fractures
Constipation
Pancreatitis
POlyuria
PolydipsiaHypercalcaemia: Moans, Stones, Bones, Groans
Depression/confusion
Renal stones
Bone pain and fractures
Constipation
Pancreatitis
POlyuria
Polydipsia
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16
Q

What are symptoms of Hypercalcaemia?

A 
Moans 
Stones
Bones
GroansMoans 
Stones
Bones
GroansMoans 
Stones
Bones
Groans
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17
Q

What are the symptoms of osteoporosis?

A

Low impact fractures (hip - NOF, vertebrae, wrists - colles’)

Back painLow impact fractures (hip - NOF, vertebrae, wrists - colles’)

Back pain

18
Q

What is the difference between rickets and osteomalacia?

A

Osteomalacia (adults) and rickets (children) are caused by inadequate mineralisation of bone matrix. Vitamin D deficiency causes low calcium and phosphate, which lead to secondary hyperparathyroidism. Osteomalacia results from a loss of skeletal mass caused by inadequate mineralisation of the normal osteoid tissue after the closure of the growth plates. Rickets results from the same underlying process, occurring in children and adolescents before the growth plates have closed.

19
Q

What are the symptoms of osetomalacia?

A

Bone pain/tenderness
Proximal muscle weaknessBone pain/tenderness
Proximal muscle weakness

20
Q

What are the symptoms of rickets?

A 
Bowing tibia
Bone pain
Frontal bossing
Rachitic rosary (expansion of the anterior rib ends at the costochondral junctions and is most frequently seen in rickets as nodularity at the costochondral junctions)
Pigeon chest
Delayed walkingBowing tibia
Bone pain
Frontal bossing
Rachitic rosary (expansion of the anterior rib ends at the costochondral junctions and is most frequently seen in rickets as nodularity at the costochondral junctions)
Pigeon chest
Delayed walking
21
Q

What are the risks factors for Osteoporosis?

A 
Increased age
Female
Smoking
Poor diet
Low BMIIncreased age
Female
Smoking
Poor diet
Low BMI
22
Q

What are the risks factors for Osteomalacia/rickets?

A 
Poor diet
Malabsorption
CLD (chronic liver disease)
CKD
lack of sunlightPoor diet
Malabsorption
CLD (chronic liver disease)
CKD
lack of sunlight
23
Q

What are the risks factors for Hyperparathyroidism??

A 
Secondary hyperPTH --> CRF
Decreased vit D
MalabsorptionSecondary hyperPTH --> CRF
Decreased vit D
Malabsorption
24
Q

What are the risks factors for Pagets disease?

A

> 50 years
Caucasian> 50 years
Caucasian

25
Q

What is seen on X-ray for Osteoporosis?

A

Usually nothing

26
Q

What is seen on X-ray for Osteomalacia/Rickets?

A

Looser’s zones (pseudo fractures)
Splaying of metaphysisLooser’s zones (pseudo fractures)
Splaying of metaphysis

27
Q

What is seen on X-ray for HyperPTH?

A

Browns tumours
Salt and pepper skull
Subperiosteal bone resorption in phalangesBrowns tumours
Salt and pepper skull
Subperiosteal bone resorption in phalanges

28
Q

What is seen on X-ray for Pagets?

A

Mixed lytic and sclerotic

SKULL: Osteoporosis circumscripta
Cotton Wool

VERTEBRAE: Picture frame
Ivory vertebrae

PELVIS: Sclerosis and lucencyMixed lytic and sclerotic

SKULL: Osteoporosis circumscripta
Cotton Wool

VERTEBRAE: Picture frame
Ivory vertebrae

PELVIS: Sclerosis and lucency

29
Q

What are browns tumours

A

The brown tumor is a fibrotic, cystic bony change that arises in settings of excess osteoclast activity, such as hyperparathyroidism. These lesions are termed “Brown Tumors” due to the presence of old hemorrhage in the lesion.

30
Q

What are salt and pepper skulls?

A

Salt and pepper sign of the calvaria refers to multiple tiny hyperlucent areas in the skull vault caused by resorption of trabecular bone in hyperparathyroidism. There is loss of definition between the inner and outer tables of the skull and a ground-glass appearance as well as spotty deossification.

31
Q

What are ivory vertebrae

A

The term ivory vertebra refers to a single sclerotic vertebra, that stands out due to its very dense white appearances, like the ivory tusks of an elephant. Often seen in pagets

32
Q

What is the histology of Osteoporosis?

A

Loss of cancellous bone

33
Q

What is the histology of Osteomalacia/rickets?

A

Excess of unmineralized bone (osteoid)

34
Q

What is the histology of HyperPTH?

A

Osteitis fibrosa cystica (marrow fibrosis + cysts - aka brown tumour)

35
Q

What is the histology of Pagets disease?

A

Huge osteoclasts w > 100 nuclei

Mosaic pattern of lamellar bone (like a jigsaw puzzle)

36
Q

What is the biochem of Osteoporosis?

A

Normal Ca
Normal PO4
Normal ALP

37
Q

What is the biochem of Osteomalacia/rickets?

A

Normal or low Ca
Decreased PO4
Increased ALP

38
Q

What is the biochem of HyperPTH?

A

Increased Ca
Decreased or normal PO4
Increased or normal ALP

39
Q

What is the biochem of Pagets disease?

A

Normal PO4

+++ increased ALP

40
Q

What is the biochem of Renal osteodystrophy?

A

Decreased Ca
Increased PO4
Secondary hyperPTH
Metabolic acidosis

Year 5 Histopath (17 decks)

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