Metabolic Bone Disease

Question 1

What is Paget’s Disease of Bone?

Answer 1

Increased bone resorption followed by increased formation

Bigger, less compact more vascular bone

Question 2

Paget’s Disease of Bone presents in which patients?

Answer 2

Family history
Anglo-Saxon
Chronic viral infection within osteoclast

Question 3

What are the symptoms of Paget’s Disease of Bone?

Answer 3

Raised Alk Phos
Bone pain, deformity
Heat over bone 
Neurological complications
Hearing loss 
Osteosarcoma

Question 4

How is Paget’s Disease of Bone managed?

Answer 4

1 time IV Bisphosphonate

Question 5

What is Osteogenesis Imperfecta?

Answer 5

Fragile bones from childhood

Defects in type 1 collagen

Question 6

What are the main types of osteogenesis imperfecta?

Answer 6

Type 1: mild, presents as child
Type 2: lethal as baby
Type 3: Progressive deformation
Type 4: More severe type 1

Question 7

What is the presentation of osteogenesis imperfecta?

Answer 7

Growth deficiency
Defective teeth
Hearing loss
Blue sclera 
Scoliosis
Barrel chest 
Lax ligaments
Easy bruising

Question 8

How is Osteogenesis Imperfecta managed?

Answer 8

Fractures - surgery
Bisphosphonates
genetic counselling

Question 9

What is Osteoporosis?

Answer 9

Low bone mass
Micro-architectural deterioration
Increased risk of low trauma fracture

Question 10

What scoring systems are used for risks of bone fractures?

Answer 10

FRAX

Q Fracture

Question 11

How is Osteoporosis assessed?

Answer 11

Prodigy scanner

DXA scans spine/hips

Question 12

Who is at risk of osteoporotic fracture?

Answer 12

1/2 women over 50
1/5 men over 50
1 vertebral fracture = 5 times risk of second

Question 13

What are the endocrine causes of Osteoporosis?

Answer 13

Thyrotoxicosis
Hyper/hypoparathyroidism
Cushings
Hyperprolactinaemia 
Hypopituitarism
Early menopause

Question 14

What are the rheumatic causes of Osteoporosis?

Answer 14

RA
Ankylosing spondylitis
Polymyalgia rheumatica

Question 15

What are the GI causes of Osteoporosis?

Answer 15

IBD
Liver cirrhosis
Malabsorptive diseases

Question 16

What are the drug causes of Osteoporosis?

Answer 16

Steroids
PPI
Enzyme inducing anti-epileptics
Aromatase inhibitors 
GnRH inhibitors 
Warfarin

Question 17

How are osteoporotic fractures prevented?

Answer 17

Minimise risk factors
Good calcium + vitamin D
Falls prevention
Medications

Question 18

When should medication be offered in osteoporosis?

Answer 18

T-sore below -2.5

Question 19

What medications are used for osteoporosis?

Answer 19

Bisphosphonates++
HRT
SERMs
Denosumab
Teriparatide

Question 20

What risks are associated with HRT?

Answer 20

Blood clots
Breast cancer
Heart disease
Stroke

Question 21

What risks are associated with SERMs?

Answer 21

Hot flushes
Clotting risk increased
Don’t protect hips

Question 22

What are SERMs?

Answer 22

Selective Estrogen Response Modulators

Question 23

What is required for the prescription of bisphosphonates?

Answer 23

Good renal function
Calcium + vit D status good
Good dental hygiene

Question 24

What are the side effects of bisphosphonates?

Answer 24

Oesophagitis
Iritis/uveitis
Atypical Fractures
Osteonecrosis of the jaw

Question 25

How does Denosumab work?

Answer 25

Reduce osteoclast bone resorption

Question 26

What are the side affects of Denosumab?

Answer 26

Allergy/rash

Hypocalcaemia

Question 27

What are the side affects of Teriparatide?

Answer 27

Injection site irritation
Hypercalcaemia
Allergy
Very expensive