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MSK clinical > Metabolic bone disease > Flashcards

Metabolic bone disease Flashcards

1
Q

what is the main function of vitamin D?

A

Ca reabsorption from the gut

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2
Q

what is Paget’s disease?

A

localised disorder of bone turnover
increased bone resorption followed by increased bone formation
leads to disorganised bone- bigger, more vascular, less dense, deformity and fracture risk

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3
Q

what is the presentation of Paget’s disease?

A

patient > 40 years but < 60 yrs
bone pain - constant deep seated pulsating pain
occasionally bone deformity
excessive heat over pagetic bone
neurological complications such as nerve deafness

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4
Q

what is the main clinical signs of Paget’s disease?

A

increased serum alkaline phosphatase

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5
Q

what is the treatment of Paget’s disease?

A

no treatment is asymptomatic unless in skull

treatment with bisphosphonates - one off IV zoledronic acid

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6
Q

what is rickets and osteomalacia caused by?

A

severe vitamin D or calcium deficiency which causes insufficient mineralisation

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7
Q

what can be seen on x-ray which suggests osteomalacia?

A

looser zones
pseudo fractures which occur in proximal femur, ulna, ribs, lateral scapula etc
they never become full fractures

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8
Q

what is osteogenesis imperfecta?

A

genetic disorder of type 1 collagen characterised by fragile bones from mild trauma and even acts of daily life

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9
Q

what are the 4 most common types of osteogenesis imperfecta?

A

type 1: milder form
type 2: lethal by age 1
type 3: progressive deformity with severe bone dysplasia and poor growth
type 4: similar to type 1 but more severe

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10
Q

what are the signs/symptoms of osteogenesis imperfecta?

A 
fractures from normal daily life or mild trauma 
growth deficiency
defective tooth formation (dentigenesis imperfecta) 
hearing loss
blue sclera
scoliosis
barrel chest
ligamentous laxity (hypermobile)  
easy bruising
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11
Q

what scoring system is used to determine if someone is hyper mobile and what bone condition is this found in?

A

osteogenesis imperfecta

- The Beighton Score

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12
Q

what is the management for osteogenesis imperfecta?

A

surgical to treat fractures
medical to prevent fractures - IV bisphosphonates

social adaptations
genetic counselling for parents and children

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13
Q

what percentage of Paget’s disease cases are familial?

A

15-30%

- requires evironmental trigger i.e. chronic infection in susceptible individuals

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14
Q

what is osteoporosis?

A

metabolic bone disease characterised by low density bone mass and micro architectural deterioration of bone
leads to enhanced fragility and therefore increased risk of fracture

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15
Q

what result on a DXA scan is indicative of osteoporosis?

A

< -2.5 SDs
blow the young adult mean score in a post menopausal woman (T-score)
this basically means that their bone mass has decreased more than 2.5 SDs since they were a young adult and this amount of decrease is indicative of osteoporosis

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16
Q

what factors are related to risk of fracture?

A

age
bone mass density
fals
bone turnover

17
Q

what investigations can you carry out to diagnose osteoporosis?

A

DXA scan

isotope bone scan

18
Q

how common is osteoporosis in men and women?

A

1 in 2 women and 1 in 5 men will have osteoporotic fracture after 50

19
Q

what are the endocrine causes of osteoporosis?

A 
thyrotoxicosis
hyper and hypoparathyroidism
bushings
hyperprolactinaemia
hypopituitarism
early menopause
20
Q

what are the rheumatic causes of osteoporosis?

A

rheumatoid arthritis
ankylosing spondylitis
polymyalgia reumatica

21
Q

what are the GI causes of osteoporosis?

A

inflammatory: UC and crohns
liver: PBC,CAH, alcoholic cirrhosis, viral cirrhosis (hep C)
malabsorption: chronic pancreatitis, coeliac disease, whiles, ischaemic bowel, short gut syndrome

22
Q

what medications can cause osteoporosis?

A 
steroids
PPI
enzyme inducing antiepileptic drugs i.e. phenytoin
aromatase inhibitors
GnRH inhibitors
warfarin
23
Q

how we measure someones bone mass density?

A

DXA scan

24
Q

when is someone treated for osteoporosis?

A

when their DXA scanning and report-fracture risk is 20% 10 year risk

25
Q

what are the treatment options for osteoporosis?

A 
hormone replacement therapy 
selective oestrogen receptor modular 
bisphosphonates 
monoclonal antibodies i.e. Denosumab 
intermittent human parathyroid hormone i.e. Teriparatide
26
Q

what are the side effects of HRT?

A

blood clots
increased risk of breast cancer/prostate cancer
increased risk of heart disease and stroke if used after a large gap from menopause

27
Q

what are the side effects of SERM’s?

A

hot flushes if taken close to the menopause
increased clotting risk
no protection at hip site (doesn’t protect against fractures)

28
Q

what are the side effects of bisphosphonates?

A

oesophagi’s
atypical femur fracture
iritis/ uveitis
osteoporosis of the jaw

MSK clinical (25 decks)

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