Metabolic Bone Disease

Question 1

What is MBD?

Answer 1

When there is a problem with bone quality or quantity due to build up or destruction

Question 2

What are some MBDs?

Answer 2

Osteoporosis
Osteomalacia
Osteogenesis Imperfecta
Pagets Disease
PTH disorders

Question 3

What are some risk factors for Osteoporosis

Answer 3

Women 
Smokers
Old
Early menses and menopause
Chronic steroid use
Hip fractures
FHx
Alcohol
Chemotherapy

Question 4

What are the levels for DEXA Scores?

Answer 4

> -1 Normal
-1 to -2.5 is Osteopenia
-2.5 Osteoporosis

Question 5

What is the DEXA T score?

Answer 5

T score compares to a mid-20 /30 year-old of the same gender and gives you a score of the bone density compared to that

Question 6

What is the DEXA Z score?

Answer 6

Z score compares to like population: Age and gender (can be normal, but still have osteoporosis)

Question 7

How do you investigate Osteoporosis

Answer 7

Bone Profile

DEXA Scan

Question 8

What is a DEXA Scan?

Answer 8

Dual energy X Ray absorbtiometry
Looks at L1-L4 and the head of the femur
Gives you a T and Z score

Question 9

At risk/osteopenia treatment?

Answer 9

Dietary improvement
exercise and physiotherapy
 weight training
Ca2+/vit D over the counter
Stop smoking and drinking

Question 10

Osteoporosis treatment?

Answer 10

Bisphosphonates for at least 5 years then re-scan

Calcium and vitamin D

Question 11

Side effects and CI of Bisphosphonates?

Answer 11

Stress fractures
Oesophagitis (CI in Barretts)
Flu-like if IV

Question 12

What is Osteoporosis?

Answer 12

Osteoporosis is a disease of bone quantity, there is a decrease in the activity of osteoblasts but not osteoclasts which causes a low bone density

Question 13

Complications of Osteoporosis?

Answer 13

Fragility Fractures (spine!)

Question 14

What is Paget’s Disease?

Answer 14

Condition where there is over-activity of osteocytes and you get increased bone turnover.
Tends to be more vascular and poorer quality, non-lamellar bone

Question 15

What is Paget’s associated with?

Answer 15

FHx

Viral Infections

Question 16

Symptoms of Paget’s?

Answer 16

Asymptomatic 
Fractures
Bone Pain
Headaches, Hearing Loss
Deformities – frontal bossing, occipital lobe larger
Warm over joints

Question 17

Investigations in Pagets?

Answer 17

Isolated raised ALP
Normal Calcium and PO4
Bloods: Myeloma screen, bone profile, FBC, U&Es, LFTs
Bone Biopsy to exclude cancer
X Ray
(ECG, BP, Hearing Test)

Question 18

X Ray Findings in Pagets?

Answer 18

Thickening, cotton wool bone

Osteolysis

Question 19

Complications in Pagets?

Answer 19

Arthritis 
Deformity - kyphosis, frontal bossing, bowing
Raised TPR (Heart Failure, HTN)
Hearing Loss
Increased risk of Osteosarcoma
Haemorrhage if fracture
Spinal Stenosis

Question 20

Treating Pagets?

Answer 20

Mobility aid
Analgesia
Bisphosphonates
Monitor for malignancy and heart failure

Question 21

What is Osteogenesis Imperfecta?

Answer 21

Autosomal Dominant condition
Defect in Collagen I
Causes short stature, weak fragile bones, blue sclera

Question 22

What is Osteomalacia?

Treatment?

Answer 22

Vitamin D or calcium deficiency leads to poor quality of bone formation
Can have bone pain – tends to be middle of long bones or back pain due to deformities
Can have deformities – Varus knees “bowed legs”
More common in children, of Asian or afro-Caribbean ethnicity (need to absorb more sunlight)

Treat:
Calcium and Vitamin D tablets
UV Light therapy – sun exposure (30 mins without sunscreen a day)