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MSK > Metabolic bone disease > Flashcards

Metabolic bone disease Flashcards

1
Q

What is the biologically active form of vitamin D?

A

Calcitriol

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2
Q

What is Paget’s disease of bone?

A

Degenerative bone disease - localised disorder of bone turnover

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3
Q

What happens pathological in Paget’s disease of bone?

A

Increased bone resorption followed by increased bone formation
Leads to disorganised bone: bigger, less compact, more vascular, more susceptible to fracture and deformity

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4
Q

What is the aetiology of Paget’s disease of bone?

A

Genetic: familial
Geographic distribution
Environmental trigger

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5
Q

What are the signs/symptoms of Paget’s disease of bone?

A

> 40yrs
Bone deformity
Excessive heat over Pagetic bone
Nerve deafness

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6
Q

What is the presentation of Paget’s disease of bone?

A

Isolated elevation of serum alkaline phosphatase (ALP)
Bone pain/local heat
Bone deformity/fracture
Hearing loss
Rare - development osteosarcoma in affected bone

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7
Q

When should you not treat Paget’s disease of bone?

A

Not treated if asymptomatic unless in skull/area requiring surgical intervention
Do not treat based on ALP raise alone

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8
Q

When you should treat Paget’s disease of bone, what is the treatment?

A

IV biphosphonate therapy

One of IV zoledronic acid

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9
Q

What group of drugs treat Paget’s disease of bone?

A

Bisphosphonates

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10
Q

What is Rickets/osteomalacia caused by?

A

Severe nutritional vitamin D or calcium deficiency causes insufficient mineralisation

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11
Q

What is the difference between Ricket’s and osteomalacia?

A

In children, the disease is rickets but after fusion of the epiphyseal plates it is known as osteomalacia

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12
Q

Why is vitamin D important?

A

Stimulates the absorption of calcium and phosphate from the gut
Calcium and phosphate then available for bone mineralisation

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13
Q

What function is impaired in low vitamin D states?

A

Muscle function

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14
Q

What are the physical signs of Ricket’s in a child?

A 
Generally unwell
Stunted growth
Odd curve to spine/back
Odd-shaped legs, ribs, breast bones
Wide bones/ankles
Large abdomen
Wide joints elbow/wrist
Large forehead
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15
Q

What are some signs of Ricket’s?

A

Generally unwell
Delayed walking / crawling / sitting
Rachitic Rosary – bead like nodules on the ribs
Kyphoscoliosis
Bowed legs and ‘knock knees’ only occur in severe cases in older children

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16
Q

What are clinical signs of Ricket’s/osteomalacia?

A 
Muscle aches
Muscle weakness
Bone pain/pain on walking
Predisposition to fractures
Tetany: parasthesia of lips, tongue, face
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17
Q

What is the treatment for Ricket’s/osteomalacia?

A

Vit D supplements

Calcium

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18
Q

What are the investigations for Ricket’s/osteomalacia?

A 
Vit D
ALP
PTH
Calcium
Phosphate
XR
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19
Q

What is osteogenesis imperfecta (OI)?

A

Genetic disorder of connective tissue characterised by fragile bones from mild trauma and acts of daily life

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20
Q

What is OI caused by?

A

Defects in type 1 collagen

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21
Q

What are the 4 most common types of type 1 collagen defect seen in OI?

A

Type I: mild, when child starts to walk, can present in adults
Type II: lethal by age 1
Type III: progressive deforming with severe bone dysplasia and poor growth
Type IV: similar to type I but more severe

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22
Q

What are other signs/symptoms of OI?

A 
Growth deficiency
Defective tooth formation
Hearing loss
Blue sclera
Scoliosis
Barrel chest
Ligamentous laxity
Easy bruising
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23
Q

What are the different approaches to management of OI?

A

Surgical: treat fractures
Medical: prevent fractures with IV bisphosphonates
Social: adaptations
Genetic: genetic counselling

24
Q

What is the medical management of someone with OI?

A

IV bisphosphonates

25
Q

What is osteoporosis?

A

A metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and increase in fracture risk

26
Q

What are osteoporotic bones at risk of?

A

Increased risk of fracture

27
Q

What is the DXA bone T-score?

A

This is the number of standard deviations from the mean bone density of a 30 year old adult

28
Q

At what T-score should you treat osteoporosis?

A
29
Q

When does accelerated bone mass start to decrease in women?

A

Menopause

30
Q

What is the risk of fracture related to?

A

Age
BMD
Falls
Bone turnover

31
Q

What scoring system do you use to calculate risk of fracture?

A

FRAX

Fracture Risk Assessment Tool

32
Q

What are investigations for osteoporosis?

A

DEXA scans
XR
Bloods

33
Q

What are endocrine causes of osteoporosis?

A 
Thyrotoxicosis
Hyper and hypoparathyroidism
Cushings
Hyperprolactinaemia
Hypopituitarism
Early menopause
34
Q

What are rheumatic causes of osteoporosis?

A

RA
Ankylosing spondylitis
Polymyalgia rheumatica

35
Q

What are GI causes of osteoporosis?

A

IBD
Liver: PBC, CAH, alcoholic cirrhosis, viral cirrhosis
Malabsorption: chronic pancreatitis, coeliac disease, whiles disease, short gut syndromes and ischaemic bowel

36
Q

What are medications which cause osteoporosis?

A 
Steroids
PPI
Enzyme inducting anti epileptic medications
Aromatase inhibitors
GnRH inhibitors
Warfarin
37
Q

How do we prevent osteoporotic fractures?

A

Minimise risk factors
Good calcium and vit D status
Falls prevention strategies
Medication

38
Q

How do you measure bone mineral density (BMD)?

A

DXA Hip and Spine

39
Q

What are the treatment options for osteoporosis?

A

Oral bisphosphonates
HRT
Denosumab
Teriparatide

40
Q

What are side effects of HRT?

A

Increased risk blood clots
Increased risk breast cancer with extended use
Increased risk heart disease and stroke after used large gap from menopause

41
Q

What medication can be used to prevent osteoporosis in post-menopausal women?

A

Selective oestrogen receptor modulators (SERMs)

42
Q

What are negative effects of SERMs?

A

Hot flushes if taken close to menopause
Increased clotting risks
Lack of protection at hip site

43
Q

What are first line treatment for osteoporosis?

A

Oral bisphosphonates

44
Q

What do you need to have before starting oral bisphosphonates for osteoporosis?

A

Adequate renal function
Adequate calcium and vit D status
Good dental health

45
Q

What is the mode of action of bisphosphonates in osteoporosis?

A

Inhibit osteoclasts from breaking down bone

46
Q

What are side effects of bisphosphonates?

A

Oesophagitis
Iritis/uveitis
ONJ (osteonecrosis of jaw)
Femoral shaft fracture

47
Q

When do you take a drug holiday from oral bisphosphonates?

A

Usually after 10yrs for 1-2yrs

48
Q

What is denosumab?

A

Monoclonal antibody against RANKL ( a signaller released by osteoblasts and taken up by osteoclasts)

49
Q

How does denosumab work in osteoporosis?

A

Reduces osteoclastic bone resorption

50
Q

How is denosumab administered for osteoporosis?

A

Subcut injection every 6mo

51
Q

What medication is safer for patients with renal impairment and osteoporosis?

A

Denosumab

52
Q

What are side effects of denosumab?

A

Allergy/rash
Symptomatic hypocalcaemia if given when vitamin D deplete
?ONJ
?femoral shaft fracture

53
Q

What is teriparatide?

A

A synthetic parathyroid hormone

54
Q

What is the function of teriparatide?

A

Increases bone formation

55
Q

What are the side effects of teriparatide?

A

Injection site irritation
Rarely hypercalcaemia
Allergy

MSK (17 decks)

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