Metabolic Bone Disease Flashcards
What is Paget’s Disease of Bone?
Increased bone resorption followed by increased formation
Bigger, less compact more vascular bone
Paget’s Disease of Bone presents in which patients?
Family history
Anglo-Saxon
Chronic viral infection within osteoclast
What are the symptoms of Paget’s Disease of Bone?
Raised Alk Phos Bone pain, deformity Heat over bone Neurological complications Hearing loss Osteosarcoma
How is Paget’s Disease of Bone managed?
1 time IV Bisphosphonate
What is Osteogenesis Imperfecta?
Fragile bones from childhood
Defects in type 1 collagen
What are the main types of osteogenesis imperfecta?
Type 1: mild, presents as child
Type 2: lethal as baby
Type 3: Progressive deformation
Type 4: More severe type 1
What is the presentation of osteogenesis imperfecta?
Growth deficiency Defective teeth Hearing loss Blue sclera Scoliosis Barrel chest Lax ligaments Easy bruising
How is Osteogenesis Imperfecta managed?
Fractures - surgery
Bisphosphonates
genetic counselling
What is Osteoporosis?
Low bone mass
Micro-architectural deterioration
Increased risk of low trauma fracture
What scoring systems are used for risks of bone fractures?
FRAX
Q Fracture
How is Osteoporosis assessed?
Prodigy scanner
DXA scans spine/hips
Who is at risk of osteoporotic fracture?
1/2 women over 50
1/5 men over 50
1 vertebral fracture = 5 times risk of second
What are the endocrine causes of Osteoporosis?
Thyrotoxicosis Hyper/hypoparathyroidism Cushings Hyperprolactinaemia Hypopituitarism Early menopause
What are the rheumatic causes of Osteoporosis?
RA
Ankylosing spondylitis
Polymyalgia rheumatica
What are the GI causes of Osteoporosis?
IBD
Liver cirrhosis
Malabsorptive diseases
What are the drug causes of Osteoporosis?
Steroids PPI Enzyme inducing anti-epileptics Aromatase inhibitors GnRH inhibitors Warfarin
How are osteoporotic fractures prevented?
Minimise risk factors
Good calcium + vitamin D
Falls prevention
Medications
When should medication be offered in osteoporosis?
T-sore below -2.5
What medications are used for osteoporosis?
Bisphosphonates++ HRT SERMs Denosumab Teriparatide
What risks are associated with HRT?
Blood clots
Breast cancer
Heart disease
Stroke
What risks are associated with SERMs?
Hot flushes
Clotting risk increased
Don’t protect hips
What are SERMs?
Selective Estrogen Response Modulators
What is required for the prescription of bisphosphonates?
Good renal function
Calcium + vit D status good
Good dental hygiene
What are the side effects of bisphosphonates?
Oesophagitis
Iritis/uveitis
Atypical Fractures
Osteonecrosis of the jaw
How does Denosumab work?
Reduce osteoclast bone resorption
What are the side affects of Denosumab?
Allergy/rash
Hypocalcaemia
What are the side affects of Teriparatide?
Injection site irritation
Hypercalcaemia
Allergy
Very expensive
