Metabolic Bone Disease Flashcards
What is Paget’s Disease of Bone?
Disorder of bone turnover, increased bone resorption followed by increased formation
What does Paget’s lead to?
Bigger, less compact, more vascular bone that is more susceptible to deformity and fracture
Who is at risk of Paget’s disease?
Family history
Those of Anglo-Saxon origins
Possibility of chronic viral infection within osteoclast
What are general clinical features of Paget’s?
Isolated elevation of serum Alkaline Phosphatase
Hearing loss
Presents in patients >40 with bone pain
Occasionally presents with bone deformity
Excessive heat over Paget’s bone
Neurological complications such as nerve deafness
How is Paget’s treated?
No treatment for asymptomatic unless in skull
If symptomatic IV bisphosphonate therapy - zoledronic acid
What is the difference between rickets and osteomalacia?
Rickets is in children before epiphyseal growth plates have sealed and vice versa for adults
What causes rickets/osteomalacia?
Severe vitamin D or calcium deficiency leading to insufficient mineralisation
Vitamin D required for calcium and phosphate absorption
What is osteogenesis imperfecta?
Genetic disorder of connective tissue characterised by fragile bones from mild trauma and even acts of daily life
Broad clinical range from presenting in 40s to prenatally fatal
What is type 1 osteogenesis imperfecta?
Milder form - when child starts to walk and can present in adults
What is type 2 osteogenesis imperfecta?
Lethal by age 1
What is type 3 osteogenesis imperfecta?
Progressive deforming with severe bone dysplasia and poor growth
What is type 4 osteogenesis imperfecta?
Similar to type 1 but more severe
What are clinical features of osteogenesis imperfecta?
Growth deficiency Defective tooth formation Hearing loss Blue sclera Scoliosis Barrel chest Ligamentous laxity Easy bruising
How is osteogenesis imperfecta managed?
Surgical - to treat fractures
Medical -prevent fractures with IV bisphosphonates
What is osteoperosis?
Metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk
What happens to bone mass as age increases?
It decreases
What happens to bone mass in menopausal/post menopausal women?
Decreases
What is the most important aspect of osteoperosis?
Increased risk of fracture
What tool can be used to determine risk of fracture?
Q Fracture or FRAX
How common is osteoperosis?
50% of women over 50 will have an osteoperotic fracture and 20% of men
What are endocrine causes of osteoperosis?
Thyrotoxicosis Hyper/hypoparathyroidism Cushings Hyperprolactinaemia Hypopituitarism Early menopause
What are rheumatic causes of osteoperosis?
Rheumatoid arthritis
Ankylosing spondylitis
Polymyalgia rheumatica
What are Gastroenterological causes of osteoperosis?
Inflammatory diseases - Ulcerative colitis and Crohn’s
Liver diseases - Cirrhosis, primary biliary cholangitis,
Malabsorption - pancreatitis, coeliac disease, ischaemic bowel
What medications can cause osteoporosis?
Steroids
Proton pump inhbitors
Enzyme inducting antiepileptic medications
Growth Hormone Releasing Hormone inhibitors
Warfarin
