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Metabolic Bone Disease Flashcards

1
Q

What does PTH do to calcium and phosphate

A

always increases serum calcium

PTH:

Kidneys: phos. wasting
Bone: increases phos. release
Serum: deceases phosphate

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2
Q

What does Vitamin D do to calcium and phosphate?

A

always increases serum calcium and phosphate through mineralization, GUT and Kidneys

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3
Q

PTH mechanism of action

A

Binds to osteoblasts–> Osteoblasts bind to RANK on osteoclasts —> calcium release

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4
Q

what are effected in ext. bone diseases?

A

serum calcium usually affected

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5
Q

Primary HPTIism labs?

A

high calcium, high PTH, high/normal Alk phos (marker of bone turnover)

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6
Q

primary HPTism presentation?

A

kidney stones, gi issues, bone turn over, psychiaytric

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7
Q

Osteitis Fibrosa Cystica is cause by what?

A

Hyperparathyroidism

  • the bone is resorbed causing cystic bone lesion “Brown Tumor”
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8
Q

2nd hyperparathyroidism causes?

A

chronically high phosphate and/or low calcium

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9
Q

2nd HTPism lab findings?

A

low/normal calcium

very high PTH- trying to elevate calcium

Very high ALK phos- bone turn over

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10
Q

2nd HPTism presentation

A

serum calcium WILL NOT be elevated

high bone turnover rate

OFC and brown tunmor

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11
Q

Renal Osteodystrophy is seen with what?

A

chronic kidney disease , causes secondary hyperparathyroidism

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12
Q

High Turn over RO etiology?

A

Kidney failure

decreases kidney phosphate excretion–>
leads to increased serum phosphate—>

1) Phosphate binds to serum Calcium —> decreased calcium
2) Phosphate inhibits hydroxylation of D3–> calcium, goes down

BOTTOM LINE:
Decreased Calcium and Phosphate= 2nd HPTism

Deceased Vit D3 –> Osteomalacia

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13
Q

Late Renal Osteodystrophy shows what?

A

Will produce soft tissue calcification AND osteosclerosis

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14
Q

What is tertiary hyperparathyroidism

A

desensitization of pth receptors

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15
Q

How does low turn over renal OD work?

A

Aluminum is deposited in bone mineralization site —> impaired osteoclasts and blasts

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16
Q

treatment for low turn over RO?

A

Po4 binding agents, alum. chelators, vit d replacement

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17
Q

Hypothyroidism labs?

A

low calcium and high po4?

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18
Q

What is Albright Hereditary OD?

A

hypothyroidism…end organ resistance to PTH

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19
Q

Physical exam of Hypocalcemia?

A

Troussea’s Sign– hand spasm

Chvostek Sign– eye twitching

20
Q

Osteomalacia/ and Rickets pathogenesis

A

Defective mineralization of normal osteoid

  • bones are soft
  • Low serum calcium

CA X Po4 > 30—-> poor mineralization

21
Q

causes of rickets

A

vitamin d deficiency

malnutrition

renal failure

lack of sun

22
Q

Hereditary Vit D. Dependent Rickets Type 1

A

defect in hydroxylase enzyme

23
Q

Hereditary Vit D. Dependent Rickets Type 2?

A

Defect in intracellular receptor

24
Q

hypophasphatemic rickets?

A

kidneys cannot reabsord phosphate

25
hypophosphatasia?
dont have enough alk phos.
26
rickets presentation?
bone pain, limp (bow legs), rosary
27
what is the ratio of osteoid to osteomalacia?
osteoid that doesn't become mineralized with hydroxyapetite
28
Describe the clinical presentation of osteomalacia?
bone pain, local tenderness, fractures
29
What are pseudofractures associated with?
osteomalacia consists of osteomalacic bone
30
what is hall mark of intrinsic bone diseases?
do not present with serum calcium abnormalities
31
What is osteoporosis?
normal calcium and bone - NOT ENOUGH BONE -Labs: Normal calcium and phosphate
32
What is the osteoporosis level?
2. 5 standard deviation below normal level | 2. 5 t-score on a text scale
33
What is osteoporosis?
normal calcium and bone - NOT ENOUGH BONE -Labs: Normal calcium and phosphate
34
Clinical presentation of post-menopausal osteoporosis?
distal radius and vertebral fractures high turn over!!
35
What type of bone is affected in PM OP?
trabecular bone
36
presentation of AR-OR?
proximal femur fractures and vertebral fractures low turn over!!
37
Etiology of AR-OP?
uncoupling of osteoblasts and osteoclasts with equal trabecular and cortical involvement
38
Causes of secondary osteoporosis?
hyperthyroidism | -steroid-induced (inhibits osteoblast precursor)
39
Causes of secondary osteoporosis?
- hyperthyroidism - steroid-induced (inhibits osteoblast precursor) - malignancies
40
What is Osteogenesis imperfecta?
Disorder of bone formation type 1 collagen defect ---> multiple fractures
41
Associated findings of OI?
Blue sclera, hearing loss, tooth abnormalitis
42
Causes of osteopetrosis?
Resorption disorder--> osteoclast failure Adult form- dominant kids- recessive
43
Osteoporisis buzzword?
erlenmeyer flask
44
Cause of Pagets?
Disorder of bone remodeling -- > high bone turnover from increased osteoclast function
45
Paget clinical?
high output HF, bone pain, arthritis

MSK (12 decks)

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