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MSK - ABDN > metabolic bone disease > Flashcards

metabolic bone disease Flashcards

1
Q

what is the role of osteoclasts

A

to break down bone

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2
Q

what is the role of osteoblasts

A

to build up bone

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3
Q

where is vitamin D produced

A

by the skin

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4
Q

where is vitamin D stored

A

in the liver

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5
Q

where is vitamin D activated

A

at the kidneys

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6
Q

what is the name of the vitamin D that has been activated by the kidneys

A

calcitrol

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7
Q

what is the role of calciferol

A

to increase the amount of calcium that is absorbed from the gut

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8
Q

what will happen is there is a calcium or vitamin D deficiency in children

A

rickets

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9
Q

what will happen if there is a calcium or vitamin D deficiency in adults

A

osteomalacia

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10
Q

what is the difference between rickets and osteomalacia

A

fusion of the epiphyseal plates

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11
Q

name some clinical signs of rickets

A
  • stunted growth
  • large abdomen
  • large forehead
  • bent out legs
  • wide bones and joints
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12
Q

what is the cause of rickets

A

a deficiency in calcium or vitamin D in children

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13
Q

what is Paget’s disease

A

this is a disorder in which there is too much bone resorption and formation which leads to the formation of disordered bone

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14
Q

what is the treatment of rickets and osteomalacia

A

increased intake of calcium and vitamin D (if there is kidney failure you may need to give the patient activated vitamin D)

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15
Q

where is the mutation in Paget’s

A

on the loci of SQSTMI

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16
Q

what proportion of Paget’s is familial

A

15-30%

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17
Q

what are the symptoms of Paget’s disease

A
  • long history of bone pain
  • bone deformity
  • excessive heat over the affected bone
  • neurological problems (e.g. hearing loss) - Paget’s can occur in the skull bones
  • may present with an osteosarcoma
18
Q

what serum test will be raised in those with Paget’s

A

alkaline phosphatase

19
Q

what is the treatment of Paget’s disease

A

SHOULD NOT BE TREATED IF ASYMPTOMATIC UNLESS IN THE SKULL

  • IV bisphosphonate
20
Q

what is osteogenesis imperfecta

A

this is a genetic disorder characterised by fragile bones - there are different types and prognosis depends on the type

21
Q

what are the different types of osteogenesis imperfect

A

Type 1 = mild and potentially a few fractures
Type 2 = this is the most severe form and children usually die within weeks of being diagnosed
Type 3 = progressive deformity and bone dysplasia however not as severe as type 2
Type 4 = similar to type 1 but more severe

22
Q

what are the clinical signs of osteogenesis imperfecta

A
  • blue sclera
  • scoliosis
  • barrel chest
  • defective tooth formation
  • hearing loss
  • ligamentous laxity
23
Q

what is the management of osteogenesis imperfecta

A
  • IV bisphosphonates
  • surgery to repair fractures
  • social adaptations
  • genetic counselling
24
Q

what is osteoporosis

A

this is a bone disease that is characterised by low bone mass and micro architectural deterioration - enhances bone fragility and fracture risk

25
Q

what investigation can be used to diagnose osteoporosis

A

a bone DXA scan - a score of -2.5 SD or more from the normal adult healthy mean in post-menopausal woman

those with a score of -2.5 or more should be offered treatment and those with a score between -1 and -2.5 should be offered lifestyle advice (unless they have had a previous fracture - they should be offered treatment in this case)

26
Q

when should someone be referred for a DXA scan

A

if they have a fracture risk assessment score of more than 10%

27
Q

name the WHO fracture risk assessment tool

A

FRAX

28
Q

name the fracture risk assessment tool that is most commonly used in Scotland

A

Q fracture risk assessment

29
Q

name some conditions that can cause secondary osteoporosis

A
  • bushings
  • hyperthyroidism
  • hyperparathyroidism
  • hypoparathyroidism
  • coeliac disease
  • cystic fibrosis
  • steroids, heparin and warfarin
30
Q

how can you minimise someones osteoporotic fractures

A
  • ensure good calcium and vitamin D status
  • medications
  • fall prevention strategies
  • minimise the risk factors if possible
31
Q

name the different types of medications that are used in the management of osteoporosis

A
  • hormone replacement therapy
  • selective oestrogen receptor modulator
  • bisphosphonates
  • teriparatide
  • denosumab
32
Q

what is the benefit of using hormone replacement therapy

A

it is effective on all bones

33
Q

what are the side effects of hormone replacement therapy

A
  • increased risk of blood clots
  • increased risk of heart disease and stroke
  • increased risk of breast cancer

SHOULD NOT BE USED A LONG TIME AFTER MENOPAUSE

34
Q

what are the side effects of using selective oestrogen receptor modulators

A
  • only works on vertebrae
  • increased risk of blood clotting
  • hot flushes if taken to close to menopause
35
Q

what is the main treatment used in the management of osteoporosis

A

oral bisphosphonates

36
Q

what are the side effects of using bisphosphonates

A
  • oesphagitis
  • uveitis
  • femoral shaft fractures
  • osteonecrosis of the jaw
  • must have good renal function
  • must have good calcium/vit D status
  • drug holiday of 1-2 years needed after every 10 years
37
Q

how do bisphosphonates work

A

bisphosphonates inhibit the osteoclasts and therefore prevent the breakdown of bone

38
Q

what is teriparatide

A

this is an injection that works by building the bone up (this is the only anabolic treatment for osteoporosis)

39
Q

what are the side effects of using teriparatide

A
  • injection site reaction
  • allergy
  • cost
  • hypercalcaemia
40
Q

what is denosumab

A

a subcutaneous injection given every 6 months that reduces osteoclast bone resorption

this drug targets RANKL which usually inhibits the osteoblasts

41
Q

what are the side effects of denosumab

A
  • allergy
  • hypocalcaemia
  • osteonecrosis of the jaw
  • atypical femoral shaft fractures

MSK - ABDN (33 decks)

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