metabolic disease

Question 1

what is paget’s

Answer 1

chronic disorder which results in thickened, brittle and misshapen bones

Question 2

what is the cause of paget’s

Answer 2

abnormality of bone turn-over due to increased osteoclastic activity. The new bone fails to remodel sufficiently and the resulting bone is brittle

Question 3

what are the symptoms of paget’s

Answer 3

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

Question 4

what secondary malignancy is associated with paget’s

Answer 4

osteosarcoma

Question 5

what is the buzzword for paget’s

Answer 5

X-ray finding = thick excess bone with abnormal reversal lines giving a mosaic pattern

Question 6

what are the investigations for paget’s , what would you expect to see

Answer 6

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

Question 7

what is the treatment of paget’s

Answer 7

bisphosphonantes = inhibit osteoclasts
calcitonin = if lytic disease is extensive
joint replacement

Question 8

what is osteomalacia

Answer 8

defect in the normal bone with abnormal softening due to deficient mineralisation of the osteoid secondary to inadequate amounts of calcium and phosphorus

Question 9

what is rickett’s

Answer 9

osteomalacia but in kids

Question 10

what type of defect is osteomalacia/rickett’s

Answer 10

qualitative

Question 11

what is the cause of osteomalacia/rickett’s

Answer 11

insufficient calcium absorption from intestine
deficiency of/resistance to action of Vit D
phosphate deficiency due to renal loss
hypophsophatemia

Question 12

what could cause phosphate deficiency due to renal loss

Answer 12

long-term anti-convulsant use

CKD

Question 13

what could cause hypophsophatemia

Answer 13

re-feeding syndrome

alcohol abuse

Question 14

what are the symptoms of osteomalacia/rickett’s

Answer 14

bone pain
bone deformities
easily sustained pathological fractures
hypocalcaemia

Question 15

what bone deformities occur in osteomalacia/rickett’s

Answer 15

Bowed legs
Square heads
Pigeon chest
Rickety rosary

Question 16

what are the symptoms of hypocalcaemia

Answer 16

Paraesthesia
Muscle cramps
Irritability 
Fatigue
Seizures
Brittle nails

Question 17

what are the investigations of osteomalacia/rickett’s, what would you expect to find

Answer 17

x-ray = pseudofractures (aka looser’s zones)
abnormal serum bone chemistry:

• low calcium
• low serum phosphate
• high serum alkaline phosphatase

Question 18

what is the treatment of osteomalacia/rickett’s

Answer 18

vit D therapy

calcium + phosphate supplementation

Question 19

what is osteoporosis

Answer 19

bone defect characterised by reduced bone mineral density and increased porosity

Question 20

what type of defect is osteoporosis

Answer 20

quantitative defect

Question 21

what is the cause of osteoporosis

Answer 21

physiological phenomenon which starts at 30 with a gradual slowing down in osteoblastic activity which leads to loss of mineral density

Question 22

what is type 1 osteoporosis

Answer 22

post-menopausal osteoporosis

Question 23

what are the risk factors of type 1 osteoporosis

Answer 23

white
early menopause
smoking
alcohol
poor diet and exercise

Question 24

what are fractures common in type 1 osteoporosis

Answer 24

colles fractures

vertebral insufficient fractures

Question 25

what is type 2 osteoporosis

Answer 25

osteoporosis of old age

Question 26

what are the risk factors for type 2 osteoporosis

Answer 26

chronic disease
inactivity
reduced vit D exposure

Question 27

what fractures are common in type 2 osteoporosis

Answer 27

femoral neck

vertebral

Question 28

what is secondary osteoporosis

Answer 28

osteoporosis which occurs secondary to a condition

Question 29

what conditions may cause osteoporosis to occur secondary to

Answer 29

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

Question 30

what are the investigations of osteoporosis

Answer 30

DEXA scan

serum bone chemistry = normal

Question 31

what is the treatment of osteoporosis, what is the aim

Answer 31

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

Question 32

what is renal dystrophy

Answer 32

this describes the typical bone changes due to CKD

Question 33

what is hyperparathyroidism

Answer 33

overactivity of the parathyroid glands with high levels of parathyroid hormone (PTH)

Question 34

what are the MSK symptoms of hyperparathyroidism

Answer 34

fragility fractures
lytic lesions (aka brown tumours)