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Clin Med3: Endocrine > Metabolic Bone Diseases - waldron > Flashcards

Metabolic Bone Diseases - waldron Flashcards

1
Q

What resorbs bone

A

osteoclasts

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2
Q

what forms new bones

A

osteoblasts

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3
Q

what does the imbalance between new bone formation and resorption lead to

A

bone disease

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4
Q

what is any bone disorder resulting from chemical aberrations

A

metabolic bone disease

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5
Q

what are building blocks for bone formation

A

calcium
phosphorus
IGF
osteoblasts and osteoclasts

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6
Q

what is a low bone density

A

osteopenia and osteoporosis

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7
Q

what increases risk of developing osteopenia and osteoporosis

A

age
+FH
small framed caucasian and asian women (highest risk)

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8
Q

what is primary osteoporosis

A

type 1: postmenopausal most prevalent form
type 2: senile (age related, men and women >70)

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9
Q

what is secondary osteoporosis

A

bone loss associated with other conditions
-malignancies, long-term corticosteroid use, GI disorders, hormonal imbalances

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10
Q

what hormone disorders can expedite bone loss

A

Cushings
thyroid disorders
hyperparathyroidism
DM

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11
Q

What medications can expedite bone loss

A

Corticosteroids*
SSRIs
PPIs
Aromatase inhibitors
DM medications (SGLT2, Pioglitazone)
Hepatin

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12
Q

at what age does bone remodeling become ‘unbalanced’

A

after age 30

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13
Q

what are modifiable risk factors of osteoporosis and osteopenia

A

ETOH, smoking, low body weight, sedentary lifestyle
Low Ca, low vitamin D, cortiocosteroid use

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14
Q

what are non-modifiable risk factors of osteoporosis and osteopenia

A

advanced age
caucasian or asian race
female gender (biological)

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15
Q

What are fragility fractures

A

any fracture that results from low-injury
typically, fall from standing height or less or no identifiable trauma

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16
Q

What is the gold standard screening test for osteoporosis and osteopenia

A

DEXA (dual-energy x-ray absorptiometry)
T-scores

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17
Q

what are indications for bone density testing?

A

All women (post menopausal) > 65, Men >70
women <65, men <70 with risk factors or +FH
women who have been on HRT
anyone with fragility fracture
patients with RA

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18
Q

What is measured with DEXA scan

A

bone density
lumbar spine L1-4, femoral neck and total femur (hip)

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19
Q

What is a normal bone density range

A

+1 to -1

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20
Q

what is the osteopenia bone density range (below average)

A

-1 to -2.5

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21
Q

What is osteoporosis bone density range (significantly below average)

A

-2.5 to -4

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22
Q

How often should DEXA scans be repeated

A

based on T score
-1 to -1.5: every 5 years
-1.5 to -2.0: every 3-5 years
score under -2.0: every 1-2 years

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23
Q

What tests do you ALWAYS want to check for osteomalacia?

A

Vitamin D
co-occuring vitamin D deficiency common
all osteopenic and osteoporotic patients should get screened

24
Q

How do we assess vitamin D levels?

A

25-hydroxyvitamin D (25(OH)D) is the best measure
circulating (active) form of vitamin D
Normal is 25-80 ng/mL

25
Q

what levels are indicative of Vitamin D insufficiency

A

20-25 ng/mL

26
Q

what levels are indicative of Vitamin D deficiency

A

<20 ng/mL

27
Q

What are some other potential test you might want for osteoporosis/osteopenia

A

CBC
CMP
Phosphorus
Vitamin D

28
Q

What is the treatment of osteoporosis

A

PREVENTION (first line)
weight bearing/resistance exercising
fall prevention
vitamin supplementation

29
Q

Who gets pharmacologic treatment with osteoporosis?

A

DEXA, FRAZ and hx fragility fractures guide treatment decision
T-score of < -2.5
osteopenia and 10-year hip fracture risk >3%
10 year major fracture risk of >10%
any patient with a fragility fracture

30
Q

What are the pharmacologic treatment options for osteoporosis?

A

Vit D + Calcium
Bisphosphonates
Denosumab
Teriperatide
SERMs
Calcitonin

31
Q

besides calcium and vitamin D, what is the first line pharmacologic agent for osteoporosis?

A

Bisphosphonates
-alendronate, risendronate, zoledronic acid, ibandronate)

32
Q

What are the side effects of bisphosphonates

A

abdominal pain, heart burn, esophageal irritation, ulcers
acute inflammatory response with arthralgia and myalgia
hypocalcemia post-infusion
osteonecrosis of the jaw
atypical subtroachanteric femur fracture

33
Q

What is Danuzomab

A

anti-resportive: recombinant antibody med used for osteoporosis
inhibits RANK-ligand to bind to RANK
IV twice a year

34
Q

What is a decreased mineralization of newly formed osteoid at sites of bone turnover (vit D deficiency or defect in Vit D metablism)

A

osteomalacia

35
Q

what does osteomalacia result in

A

hypocalcemia
hypophosphatemia
direct inhibition of mineralization process

36
Q

What is a Vitamin D deficiency or defect in Vit D metabolism in CHILDREN

A

Rickets
affects bones and cartilages

37
Q

What is the clinical pressentation of osteomalacia

A

diffuse muscle weakness, especially pelvic girdle
bone pain
waddling gait
fractures following minor (or no) trauma

38
Q

What is the presentation of Rickets

A

children develop permanent skeletal deformities

39
Q

what is the workup for osteomalacia

A

bone density measurement
bone biopsy
blood work - vit D, calcium, phosphate, PTH
Xray

40
Q

what are Milkman lines or looser zones diagnostic of

A

osteomalacia

41
Q

What is the treatment of osteomalacia

A

high dose vitamin D (50,000U PO 2x/week for 6-12 months then 1,000-2,000U QD)
phosphate and vit D supplementation in renal phosphate wasting
calcium supplementation

42
Q

What is Paget’s disease of bone

A

inflammatory disorder of the bone
accelerated rate of bone remodeling resulting in overgrowth f bone in aging skeleton
M>W; predominantly after age 55

43
Q

What bones are commonly affecting with Pagets disease

A

skull, spine, pelvis (most common), long bones, ribs

44
Q

what is the pathophysiology of Pagets disease

A

Lytic phase: hypervascularity, osteoclast dysfunction- bond resorption
Mixed phase: osteoclast dysfunction persists, osteoblast activity increases to compensate, rapid formation of dysfunctional, disorganized bone
Sclerotic phase: bones ‘burn out’, disorganized matrix persists, but cell function declines, vascularity is reduced

45
Q

What is the presentation of pagets disease

A

often asymptomatic
may be incidental finding on XR
if symptomatic: bone and joint pain, neuro complication involving skull/spine, +/- nephrolithiasis

46
Q

What tests are indicative of Pagets disease

A

PTH - usually elevated
alkaline phosphate = high
hypercalciuria is common

47
Q

How is Pagets disease diagnosed

A

primarily made via XR and bone scans
‘cotton ball’ appearance of skull
‘picture frame’ appearance in spine

48
Q

What is the mainstay treatment for Pagets disease of the bone

A

Bisphosphonates - inhibits osteoclasts
IV- zolendronic acid is the most effective

49
Q

What is another name for brittle bone disease

A

osteogenesis imperfecta

50
Q

What is the most common cause of osteogenesis imperfecta

A

genetic disorder

51
Q

what is the presentation of osteogenesis imperfecta

A

MSK: fragile bones, deformities, ligamentous laxity, short stature, scoliosis
non-MSK: Blue sclera, dysmorphic-trangle fascies, hearing loss, brownish-opalescent teeth(kids), thin skin, hypermetabolism, MVP or AR

52
Q

How is OI diagnosed

A

characteristic history and PE
skin biopsy - abnormal collagen
genetic testing (before and after birth)

53
Q

what is the treatment of OI

A

best is prevention of fractures: exercise and PT, prophylactic rods to prevent long bone fractures, bracing
genetic counseling

54
Q

What is Fibrodysplasia ossificans progressiva

A

very rare disorder
characterized by progressive extra-skeletal ossification of soft tissues resulting in original skeleton being encased in unyielding new bone; leads to disability and ultimately death from cardiorespiratory failure

55
Q

what are other names for Fibrodysplasia ossificans progressiva

A

Munchmeyers disease
stoneman’s disease
myositis ossificans progressiva

56
Q

what is the presentation of Fibrodysplasia ossificans progressiva

A

malformed big toes that present at birth
most are bedridden by age 20 and have a life expectancy of 40 years

Clin Med3: Endocrine (7 decks)

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