metabolic bone disease Flashcards
what is Paget’s disease of bone ?
localised disorder of bone turnover
increased bone resorption followed by increased bone formation
leads to disorganised bone - bigger, less compact, more vascular, more susceptible to deformity and fracture
what causes Paget’s disease ?
strongly genetic 15-30%
SQSTMI
anglo-saxon
possible chronic viral infection within osteoclast
what are the presenting features of Paget’s disease ?
>40 bone pain occasionally deformity excessive heat over bone neurological complications - deafness elevated serum alkaline phosphatase
how do you treat Paget’s disease
IV bisphosphonate therapy, one off zoledronic acid
do not treat based on ALKP alone and only treat in skull
what are rickets and osteomalacia ?
severe nutritional vitamin D deficiency in child or adult
what is osteogenesis imperfecta ?
genetic disorder of connective tissue (type 1 collagen)
characterised by fragile bones from mild trauma and even acts of daily life
wide ranger between ages - early osteoporosis
what are the different types of osteogenesis imperfecta ?
type 1 - milder form, from walking to presenting as adults
type 2 - lethal by age 1
type 3 - progressive deforming with severe bone dysplasia and poor growth
type 4 - similar to type 1 but more severe
what are other signs of osteogenesis imperfecta ?
growth deficiency defective tooth formation hearing loss blue sclera scoliosis barrel chest ligamentous laxity easy bruising
how do you manage osteogenesis imperfecta ?
surgical - treat fractures
medical - IV bisphosphonates
social
genetic
what is osteoporosis ?
metabolic disease characterised by low bone mass, enhanced bone fragility, increase fracture risk
micro-architectural deterioration
what sex is more at risk of osteoporosis ?
females - 50% have osteoporotic fracture before death
1/5 men
what are endocrine causes of osteoporosis ?
thyrotoxicosis hyper/hypo parathryroidism Cushings hyperprolactinaemia hypopituitarism early menopause
what are rheumatic causes of osteoporosis ?
RA
AS
polymyalgia rheumatica
what are GI causes of osteoporosis ?
IBD
liver disease
malabsorption - chronic pancreatitis, coeliac
what medications can cause osteoporosis ?
steroids PPI enzyme inducting anticonvulsants aromatase inhibitors GnRH inhibitors warfarin
