metabolic disease Flashcards
what is paget’s
chronic disorder which results in thickened, brittle and misshapen bones
what is the cause of paget’s
abnormality of bone turn-over due to increased osteoclastic activity. The new bone fails to remodel sufficiently and the resulting bone is brittle
what are the symptoms of paget’s
asymptomatic arthritis = if close to a joint deafness = if affecting ear ossicles pain = fractures or nerve compression enlargement and abnormal shape increased metabolism = warm skin, AV shunt, high output HF secondary malignancy
what secondary malignancy is associated with paget’s
osteosarcoma
what is the buzzword for paget’s
X-ray finding = thick excess bone with abnormal reversal lines giving a mosaic pattern
what are the investigations for paget’s , what would you expect to see
high serum ALK phosphatase
normal calcium
normal phosphorus
X-ray = Enlarged with thickened cortices and coarse, thicken trabeculae mixed with areas of lysis and sclerosis
bone scans = marked increase in uptake in the affected bones
what is the treatment of paget’s
bisphosphonantes = inhibit osteoclasts
calcitonin = if lytic disease is extensive
joint replacement
what is osteomalacia
defect in the normal bone with abnormal softening due to deficient mineralisation of the osteoid secondary to inadequate amounts of calcium and phosphorus
what is rickett’s
osteomalacia but in kids
what type of defect is osteomalacia/rickett’s
qualitative
what is the cause of osteomalacia/rickett’s
insufficient calcium absorption from intestine
deficiency of/resistance to action of Vit D
phosphate deficiency due to renal loss
hypophsophatemia
what could cause phosphate deficiency due to renal loss
long-term anti-convulsant use
CKD
what could cause hypophsophatemia
re-feeding syndrome
alcohol abuse
what are the symptoms of osteomalacia/rickett’s
bone pain
bone deformities
easily sustained pathological fractures
hypocalcaemia
what bone deformities occur in osteomalacia/rickett’s
Bowed legs
Square heads
Pigeon chest
Rickety rosary
what are the symptoms of hypocalcaemia
Paraesthesia Muscle cramps Irritability Fatigue Seizures Brittle nails
what are the investigations of osteomalacia/rickett’s, what would you expect to find
x-ray = pseudofractures (aka looser’s zones)
abnormal serum bone chemistry:
- low calcium
- low serum phosphate
- high serum alkaline phosphatase
what is the treatment of osteomalacia/rickett’s
vit D therapy
calcium + phosphate supplementation
what is osteoporosis
bone defect characterised by reduced bone mineral density and increased porosity
what type of defect is osteoporosis
quantitative defect
what is the cause of osteoporosis
physiological phenomenon which starts at 30 with a gradual slowing down in osteoblastic activity which leads to loss of mineral density
what is type 1 osteoporosis
post-menopausal osteoporosis
what are the risk factors of type 1 osteoporosis
white early menopause smoking alcohol poor diet and exercise
what are fractures common in type 1 osteoporosis
colles fractures
vertebral insufficient fractures
what is type 2 osteoporosis
osteoporosis of old age
what are the risk factors for type 2 osteoporosis
chronic disease
inactivity
reduced vit D exposure
what fractures are common in type 2 osteoporosis
femoral neck
vertebral
what is secondary osteoporosis
osteoporosis which occurs secondary to a condition
what conditions may cause osteoporosis to occur secondary to
o Corticosteroid use
o Alcohol abuse
o Malnutrition
o Chronic diseases e.g. CKD, cancer, rheumatoid arthritis
o Endocrine disorders e.g. Cushing’s, hyperthyroidism, hyperparathyroidism
what are the investigations of osteoporosis
DEXA scan
serum bone chemistry = normal
what is the treatment of osteoporosis, what is the aim
aim is to slow deterioration
Reduce risk
- Exercise
- Good diet
- Sunlight exposure
Prevent fragility fractures:
- Calcium and Vitamin D supplements
- Bisphosphonates
e.g. alendronate, risedronate, etidronate
e.g. zoledronic acid = once a year via IV. reduces osteoclastic resorption
- Monoclonal antibodies
e.g. Desunomab =
reduce osteoclast activity
e.g. strontium = increases osteoblast replication and reduces absorption
HRT can be considered if side effects occur with the above medications
what is renal dystrophy
this describes the typical bone changes due to CKD
what is hyperparathyroidism
overactivity of the parathyroid glands with high levels of parathyroid hormone (PTH)
what are the MSK symptoms of hyperparathyroidism
fragility fractures lytic lesions (aka brown tumours)
