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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
what levels are indicative of Vitamin D insufficiency
20-25 ng/mL
26
what levels are indicative of Vitamin D deficiency
<20 ng/mL
27
What are some other potential test you might want for osteoporosis/osteopenia
CBC CMP Phosphorus Vitamin D
28
What is the treatment of osteoporosis
PREVENTION (first line) weight bearing/resistance exercising fall prevention vitamin supplementation
29
Who gets pharmacologic treatment with osteoporosis?
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
What are the pharmacologic treatment options for osteoporosis?
Vit D + Calcium Bisphosphonates Denosumab Teriperatide SERMs Calcitonin
31
besides calcium and vitamin D, what is the first line pharmacologic agent for osteoporosis?
Bisphosphonates -alendronate, risendronate, zoledronic acid, ibandronate)
32
What are the side effects of bisphosphonates
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
What is Danuzomab
anti-resportive: recombinant antibody med used for osteoporosis inhibits RANK-ligand to bind to RANK IV twice a year
34
What is a decreased mineralization of newly formed osteoid at sites of bone turnover (vit D deficiency or defect in Vit D metablism)
osteomalacia
35
what does osteomalacia result in
hypocalcemia hypophosphatemia direct inhibition of mineralization process
36
What is a Vitamin D deficiency or defect in Vit D metabolism in CHILDREN
Rickets affects bones and cartilages
37
What is the clinical pressentation of osteomalacia
diffuse muscle weakness, especially pelvic girdle bone pain waddling gait fractures following minor (or no) trauma
38
What is the presentation of Rickets
children develop permanent skeletal deformities
39
what is the workup for osteomalacia
bone density measurement bone biopsy blood work - vit D, calcium, phosphate, PTH Xray
40
what are Milkman lines or looser zones diagnostic of
osteomalacia
41
What is the treatment of osteomalacia
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
What is Paget's disease of bone
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
What bones are commonly affecting with Pagets disease
skull, spine, pelvis (most common), long bones, ribs
44
what is the pathophysiology of Pagets disease
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
What is the presentation of pagets disease
often asymptomatic may be incidental finding on XR if symptomatic: bone and joint pain, neuro complication involving skull/spine, +/- nephrolithiasis
46
What tests are indicative of Pagets disease
PTH - usually elevated alkaline phosphate = high hypercalciuria is common
47
How is Pagets disease diagnosed
primarily made via XR and bone scans 'cotton ball' appearance of skull 'picture frame' appearance in spine
48
What is the mainstay treatment for Pagets disease of the bone
Bisphosphonates - inhibits osteoclasts IV- zolendronic acid is the most effective
49
What is another name for brittle bone disease
osteogenesis imperfecta
50
What is the most common cause of osteogenesis imperfecta
genetic disorder
51
what is the presentation of osteogenesis imperfecta
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
How is OI diagnosed
characteristic history and PE skin biopsy - abnormal collagen genetic testing (before and after birth)
53
what is the treatment of OI
best is prevention of fractures: exercise and PT, prophylactic rods to prevent long bone fractures, bracing genetic counseling
54
What is Fibrodysplasia ossificans progressiva
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
what are other names for Fibrodysplasia ossificans progressiva
Munchmeyers disease stoneman's disease myositis ossificans progressiva
56
what is the presentation of Fibrodysplasia ossificans progressiva
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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