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Orthopedics > Metabolic bone dz > Flashcards

Metabolic bone dz Flashcards

1
Q

Osteoporosis

A

Most common metabolic bone dz in the US.

Imbalance of bone homeostasis

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2
Q

PTH Causes…

A

Increased Ca resorption in tubules
Increased osteoclast activity
Conversion of Vitamin D to active form
Increased Ca abs in GI

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3
Q

Thyroid and Bone

A

Hyperthyroid stimulates clastic activity

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4
Q

What does the thyroid release with high serum calcium?

A

Calcitonin

Inhibits clasts

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5
Q

Osteoporosis Pneumonic

A

Low calcium intake

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6
Q

oSteoporosis Pneumonic

A

Seizure meds

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7
Q

osTeoporosis

A

Thin build

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8
Q

ostEoporosis

A

ETOH

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9
Q

osteOporosis

A

Hypogonadism

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10
Q

osteoPorosis

A

Previous fracture

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11
Q

osteopOrosis

A

Thyroid excess

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12
Q

osteopoRosis

A

Race (white, asian)

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13
Q

osteoporOsis

A

Other relatives (genetics)

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14
Q

osteoporoSis

A

Steroids

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15
Q

osteoporosIs

A

Inactivity

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16
Q

osteopososiS

A

Smoking

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17
Q

DEXA scan

A

Dual-energy x-ray absorptiometry

Test to eval bone mineral density

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18
Q

Osteoporosis medical tx

A

Calcium
VItamin D
Exercise

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19
Q

Calcium dose

A

1200 mg daily

Citrate is better absorbed if concominant use of acid blocking agents

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20
Q

Vitamin D dose

A

800 IU DR daily

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21
Q

Bisphosphonate MOA

A

Inhibit bone resorption by decreasing number and fxn of osteoclasts

22
Q

Bisphosphonate CI

A

Barrett’s esophagus
Active upper GI dz
If GFR not greater than 30-35

23
Q

Bisphosphonate types

A

Alendronate (Fosamax)
Risedronate (Actonel)
Zoledronic acid (Reclast)
Ibandronate (Boniva)

24
Q

What must patient do post bisphosphonate dose?

A

Remain upright for 30 - 60 mins

25
Q

Bisphosphonate SE

A 
Reflux, esophagitis
Ulcers
Esophageal CA?
Hypocalcemia
MS Pain
Eye pain, blurred vision
Osteonecrosis of the jaw
26
Q

Estrogen agonists

A

Less effective that estrogen and bisphosphonates.

SE: DVT, hot flashes, cancer

27
Q

Calcitonin

A

Reduces risk for vertebral body fxs
Antagonizes PTH
Miacalcin or fortical

28
Q

Hormone therapy

A

Initiate if other tx options have failed
Prempro
SE: MI, CVA, Breast CA, PE, DVT

29
Q

Parathyroid hormone replacement

A

Forteo
Actually builds bone
Use if bisphosphonates fail

30
Q

Pagets dz of the bone

A

2nd most common metabolic bone dz

Lesions can occur at various sites

31
Q

Common paget sites in descending order

A 
Skull
Thoracolumbar spine
Pelvis
long bones
LE
32
Q

Pagets patho

A 
Dz of osteoclasts
Increased bone remodeling
Genetic, onset after 55
Mostly men
Associated w/ osteosarcoma
33
Q

T-score of -1.0 to -2.5 =

A

Osteopenia

34
Q

T-score of less than -2.5

A

Osteoporosis

35
Q

Pagets s/s

A 
Arthritis, pain
Bone deformity/ fractures
Hearing loss, HA, vertigo, tinnitus
High output heart failure
Hypercalciuria
Increased incidence of stones
36
Q

Pagets labs

A

Increased alkaline phosphatase

37
Q

Pagets imaging

A

Mixed lytic and sclerotic lesions
Long bone bowing
Bone thickening and enlargement

38
Q

Pagets tx

A

Vitamin D, Calcium

Bisphosphonates

39
Q

Osteomalacia

A

Decreased mineralization of newly formed bone

Bone is soft, but no matrix loss

40
Q

2 main causes of osteomalacia

A 
Insufficient Ca abs in intestine
Phosphate deficiency
(celiac sprue, kidney, hepatic dz)
41
Q

Osteomalacia s/s

A

Bone pain and muscle weakness
Bone tenderness
Fracture
Difficulty walking

42
Q

Osteomalacia imaging

A

Reduced bone density w/ thinning of cortex

Fissures, pseudofractures

43
Q

Looser’s lines

A

Fractures from osteomalacia

44
Q

Osteomalacia tx

A

Tx underlying condition

Vitamin D supplementation

45
Q

Most common fx sites in osteomalacia

A

Distal radius and prox femur

NOT significant cause of hip fxs

46
Q

Rickets

A

Deficient mineralization at growth plate

Usually occurs w/ osteomalacia if growth plates have not fused.

47
Q

Rickets cause

A

Vitamin D and calcium deficiency

48
Q

Rickets Imaging

A

Bow legs

49
Q

Renal osteodystrophy

A

Bone dz secondary to kidney dz

50
Q

Osteitis fibrosis

A

High turnover secondary to hyperPTH

51
Q

Adynamic bone dz

A

Low turnover.
Most common CKD bone dz
PTH suppression

52
Q

Is osteomalacia common in CKD?

A

not really

Orthopedics (11 decks)

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