Metabolic bone disease

Question 1

What is Paget’s disease?

Answer 1

Increased bone resorption followed by increased bone formation
Leads to bigger, less compact, more vascular bones which are more susceptible to deformity and fracture

Question 2

What are some symptoms of Paget’s disease?

Answer 2

Patient >40 years
Bone pain
Sometimes bone deformity
Excessive heat over Pagetic bone
May have neuro complications such as nerve deafness

Question 3

What is a blood test result often seen in Paget’s disease?

Answer 3

Isolated elevation of serum alkaline phosphatase

Question 4

How are Ricket’s and Osteomalacia caused?

Answer 4

Severe nutritional VitD or Ca deficiency leading to insufficient mineralisation

Question 5

How does Vitamin D affect bone growth?

Answer 5

Vitamin D stimulates the absorption of calcium and phosphate from the gut and calcium and phosphate then become available for bone mineralisation

Question 6

What’s the difference between rickets and osteomalacia?

Answer 6

Rickets occurs in growing children and osteomalacia in adults when the epiphyseal lines are closed

Question 7

What is osteogenesis imperfecta?

Answer 7

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

Question 8

What kind of collagen is affected on osteogenesis imperfecta?

Answer 8

Type 1

Question 9

What are some signs of OI?

Answer 9

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

Question 10

Which scoring system is used to asses OI?

Answer 10

Beighton score

Question 11

What are the defining characteristics of osteoporosis?

Answer 11

Low bone mass
Deterioration of bone tissue/structure
These result in fragility and increased fracture risk

Question 12

What is the WHO tool for assessing risk of fracture?

Answer 12

FRAX

Question 13

When should an individual be referred for DXA bone scan?

Answer 13

Risk of fracture over 10 years is >10%

Patient is on oral steroids or suffer a low trauma fracture

Question 14

What are some endocrine causes of osteoporosis?

Answer 14

Thyrotoxicosis
Hyper and Hypoparathyroidism
Cushings
Hyperprolactinaemia
Hypopituitarism
Low sex hormone levels

Question 15

What are some rheumatic causes of osteoporosis?

Answer 15

Rheumatoid arthritis
Ankylosing Spondylitis
Polymyalgia Rheumatica

Question 16

What are some GI causes of osteoporosis?

Answer 16

UC
Crohns
PBC
CAH
Cirrhosis
Malabsorption

Question 17

What are some medications which may cause osteoporosis?

Answer 17

Steroids
PPI
Enzyme inducting anti-epileptics
Aromatase
GnRH
Warfarin

Question 18

How do we prevent osteoporotic fractures?

Answer 18

Minimise risk factors
Ensure good calcium and VitD status
Strategies to prevent falls
Medications

Question 19

What are some side effect of HRT for fracture prevention?

Answer 19

Increased risk of blood clots
Increased risk of breast cancer with use into 50s/60s
Increased risk of heart disease and stroke

Question 20

What are some side effects associated with bisphosphonates?

Answer 20

Oesophagitis
Uveitis
Not safe when eGFR<30mls/min
ONJ
Atypical femoral shaft fractures

Question 21

What are some side effects associated with denosumab?

Answer 21

Allergy
Rash
Hypocalcaemia

Question 22

What are some drawbacks of teriparatide?

Answer 22

Injection site irritation
Hypercalcaemia
Allergy
Cost