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Rheumatology and Orthopaedics > Metabolic bone disease > Flashcards

Metabolic bone disease Flashcards

1
Q

What are some drugs to treat osteoporosis?

A 
ANTI-RESPORPTIVE
bisphosphonates 
denosumab - monoclonal antibody
HRT
ANABOLIC
teriparatide - PTH analogue
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2
Q

What are some risk factors for fractures?

A 
low trauma fracture 
inflammatory disease 
endocrine disease
malabsorption 
low BMI 
immobility 
medication 
family history of hip fracture 
alcohol 
vit D deficiency
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3
Q

What is the T score?

A

standard deviation relating to normal young adult of same gender
under -2.5 = osteoporosis

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4
Q

What are some tests to find underlying causes of osteoporosis?

A 
Ca, PTH, vit D 
serum and urine electrophoresis 
TSH
coeliac antibody 
FBC, ESR
sex hormones
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5
Q

What are some examples of bisphosphonates?

A

alendronate, risedonate, ibandronate, zoledronate

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6
Q

What are the triad of symptoms for Paget’s?

A

pain, deformity, fracture

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7
Q

What are the tests for paget’s?

A

XR, isotope scan, alkaline phsphatase

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8
Q

How would you treat Pagets?

A

Only if symptomatic
- bisphosphonates, alendronate
analgesia

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9
Q

What is osteomalacia?

A

softening of bones caused by impaired bone metabolism - normally caused by inadequate levels of phosphate, calcium and vit D

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10
Q

What are the symptoms of osteomalacia?

A

weakness, fatigue
bone pain
fractures

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11
Q

How would you treat osteomalacia?

A

high dose Vit D and calcium

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12
Q

What are the normal and abnormal levels of Vit D?

A

> 50 nmol/l
<25 deficient
- we all need 10 micrograms per day

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13
Q

Who is at risk of vit D deficiency?

A

no sunlight - housebound, dark skin, clothing
renal failure
anticonvulsants

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14
Q

What are some symptoms of hypercalcaemia?

A

polyuria, thirst, constipation, confusion

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15
Q

What tests would you do in hypercalcaemia and what would results mean?

A

U&E
PTH
- high = primary hyperparathyroidism
-low = hypercalcaemia

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16
Q

What is the emergency level of hypercalcaemia?

A

> 3 mmol/l

17
Q

How would you treat hypercalcaemia?

A

0.9% Saline - 4-6l in 24 hr

IV bisphosphonates or steroids in extreme cases

18
Q

How would you treat dangerous hypocalcaemia? What level is that?

A

<2
10mls 10% calcium gluconate
calcium gluconate infusion

19
Q

What are causes of low magnesium?

A

High alcohol
diabetes
diuretics
chemo

20
Q

What T score indicates osteopenia?

A

between -1 and -2.5

21
Q

At what age is HRT no longer desirable as osteoporosis treatment?

A

over 60s

22
Q

What age do you go onto bisphosphonate if on a steroid, regardless of bone density?

A

65 years old

23
Q

What is a treatment for severe osteoporosis?

A

teraperitide

24
Q

What happens to PTH when serum calcium starts to fall?

A

PTH goes up

25
Q

What does PTH do?

A

increased bone turnover
increased renal absorption
increase calcium absorption in gut

26
Q

How would you monitor osteoporosis?

A

BMD
T score: -1 normal
Z score
FRAX score - risk of serious fracture in next 10 years

27
Q

Which 3 factors contribute to bone strength?

A

bone density
bone size
bone quality (turnover, mineralisation, architecture)

28
Q

What happens in ankylosing spondylitis?

A

calcium line down spine
can lead ot severe kyphosis of thoracic and cervical spine
inflammation - erosive damage - repair - new bone formation

29
Q

What is Paget’s disease?

A

increased bone turnover resulting in bone remodelling, enlargement, deformity and weakness
formation >resorption

30
Q

What is hyperphosphataemic rickets?

A

X linked defect to phosphate transport in proximal tubule
= low serum phosphate, high urine phosphate
growth retardation, bowing of long bones, dental abscesses

31
Q

What is fibrous dysplasia?

A

can be part of mcCune-Albright syndrome
fibrous tissue development
= swelling in jaw, gaps in teeth, weak fibrous bone tissue

32
Q

What is osteopetrosis?

A

osteoclasts cannot resorb bone

= skeletal fragility with high bone density

33
Q

What is tumoral calcinosis?

A

massive periarticular soft tissue deposition of calcium and phosphate (esp. upper body), causes chronic renal failure

34
Q

What is osteogenic/tumour induced osteomalacia?

A

small bony or soft tissue tumours secrete FGF23 and cause hypophsophataemia

35
Q

What is Beal’s arachnodactyly?

A

mutation in gene that builds fibrillin-2
= aortic enlargement, unable to extend joints, joints can be deformed
(similar to Marfan’s)

36
Q

What is a pneumonic to remember the risk factors for osteoporosis?

A

SHATTERED
steroids, hyperparathyroid/hyperthyroid, age, thin, testosterone deficient, early menopause rheumatology/renal disease, eating poorly, vitamin D deficient

Rheumatology and Orthopaedics (5 decks)

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