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Year 3 MSK (JK) > Metabolic bone disease > Flashcards

Metabolic bone disease Flashcards

1
Q

Osteoclasts and progenitor cell

A

bone resorption

myeloid

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2
Q

osteoblasts and progenitor cell

A

bone formation

mesenchymal

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3
Q

Pagets disease

A

increased bone resorption followed by increased bone formation

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4
Q

Describe how pagetic bone compares to normal bone

A

bigger, less compact, more vascular and more susceptible to fracture and deformity

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5
Q

what % of pagets is familial?

A

strong genetic component: 15-30%

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6
Q

Environmental and geographical - Paget’s

A

anglo-saxan

chronic viral infection in osteoclast

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7
Q

Symptoms of Paget’s disease

A 
over 40's
bone pain 
bone deformity? 
excessive heat over bone 
neurological complications eg nerve deafness
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8
Q

Most common presentation of Paget’s in 21st century

A

isolated elevation of serum alkaline phosphatase

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9
Q

presentation of pagets

A

bone pain and local heat
hearing loss
bone deformity or fracture
rarely osteosarcoma

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10
Q

Treatment of Paget’s

A

IV bisphosphonates - one off zoledronic acid infusion

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11
Q

Cause of rickets/osteomalacia

A

vit D or calcium deficiency leading to insufficient mineralisation

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12
Q

difference between osteomalacia and rickets

A

rickets in a growing child and osteomalacia when the growth plates have fused

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13
Q

What does vit D do for calcium and phosphate?

A

stimulates absorption from the gut

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14
Q

symptoms of osteomalacia

A

bone pain, muscle weakness and increased falls risk

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15
Q

Osteogenesis imperfecta

A

genetic disorder of connective tissue meaning the bones are fragile

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16
Q

Connective tissue affected in osteogenesis imperfecta

A

type 1 collagen

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17
Q

how many types of Osteogenesis imperfecta are there and which types are most common?

A

8

first 4

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18
Q

Type 1 Osteogenesis imperfecta

A

milder - when child starts to walk, can present in adults

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19
Q

Type 2 Osteogenesis imperfecta

A

lethal by age 1

20
Q

type 3 Osteogenesis imperfecta

A

progressive deforming with severe bone dysplasia and poor growth

21
Q

type 4 Osteogenesis imperfecta

A

similar to type 1 but more severe

22
Q

Other features of Osteogenesis imperfecta

A

growth deficiency - hearing loss - defective tooth formation - blue sclera - ligamentous laxity - scoliosis - easy bruising

23
Q

The brighton score is for what?

A

Osteogenesis imperfecta

24
Q

describe the brighton score

A

1 point for each thumb touching wrist, each finger more than 90 degrees, each elbow more than 10 degrees, each knee more than 10 degrees and touch floor with straight legs

25
Q

4 management principles of Osteogenesis imperfecta

A

surgery - treat fractures
medical - IV bisphosphonates
social - education and adaptions
genetic counselling

26
Q

Osteoporosis

A

low bone mass, microarchitectural degeneration and increased bone fragility and fracture risk

27
Q

FRAX

A

fracture risk assessment - age, BMD, falls etc

28
Q

What does DXA stand for?

A

dual energy x-ray absorptiometry

29
Q

Endocrine causes of osteoporosis

A 
thyrotoxicosis 
hypo/hyper parathyroidism 
hypopituitarism 
low sex levels 
cushings 
hyperprolactinaemia
30
Q

rheumatic causes of osteoporosis

A

RA, ankylosing spondylitis, polymyalgia rheumatica

31
Q

GI causes of osteoporosis

A

inflammatory - UC and crohn’s
liver disease - PBC, cirrhosis, Hep C
malabsorption - coeliac, CF, ischaemic bowel

32
Q

6 medications which cause osteoporosis

A 
PPI 
steroids 
GnRH inhibitors 
aromatase inhibitors 
warfarin
enzyme inducing anti-epileptics
33
Q

peak BMD

A

about 30

34
Q

When does BMD start to decrease rapidly?

A

menopause

35
Q

How do we prevent osteoporotic fractures?

A

minimise risk factors
ensure good calcium and vitamin D
falls prevention strategies
medications

36
Q

Side effects of HRT

A

blood clots, breast cancer and heart disease and stroke

37
Q

Example of selective oestrogen receptor modulator

A

raloxifene

38
Q

Side effects of selective oestrogen receptor modulator

A

hot flushes, clotting risk and lack of hip protection

39
Q

1st line for osteoporosis

A

oral bisphosphonates

40
Q

What are the requirements of the individual for oral bisphosphonates in osteoporosis?

A

renal function, vit D and calcium - adequate

good dental hygiene

41
Q

SE of oral bisphosphonates

A

oesophagitis - iritis/uveitis - eGFR <30ml/min - atypical femoral shaft fractures

42
Q

Denosumab

A

monoclonal ab against RANKL

43
Q

How does denosumab work?

A

osteoclast formation function and survival inhibited

reduce osteoclatic bone resorption

44
Q

How is denosumab administered?

A

subcut injection every 6 months

45
Q

Side effects of denosumab

A

allergy/rash, symptomatic hypocalcaemia if vit D deplete,? ONJ, atypical femoral shaft fractures

46
Q

What is teriparatide?

A

intermittent human parathyroid hormone

47
Q

Disadvantages of teriparatide

A

injection site irritation - allergy - ? hypercalcaemia - cost

Year 3 MSK (JK) (30 decks)

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