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Lecture Notes- Orthopaedics and Fractures > Metabolic Diseases of Bone > Flashcards

Metabolic Diseases of Bone Flashcards

1
Q

What are the metabolic functions of bone

A

control calcium and phosphate in the body

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2
Q

What factors influence calcium regulation

A

Parathyroid hormone - output increases increased when calcium level is low. It restores the calcium level to normal by increasing tubular re-absorption from the kidney and mobilising calcium from the bones
Calcitonin - Produced by the C cells of the thyroid gland - it inhibits bone resorption and is secreted in response to a raised serum calcium
Vitamin D - increases calcium absorption in the gut. Increased levels increase calcium and phosphate levels in the serum

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3
Q

How does secondary hyperparathyroidism occur

A

vitamin D deficiency - the parathyroids are stimulated to restore the calcium levels

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4
Q

What 3 factors can cause bone loss

A

decreased osteoid formation (osteopenia)
Decrease in mineralisation of osteoid (osteomalacia)
Increase in removal of bone by osteoclasts (osteolysis)

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5
Q

What is vitamin C necessary for

A

collagen synthesis and osteoid deposition especially at the growing ends of bones

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6
Q

What is the treatment of scurvy

A

Ascorbic acid

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7
Q

What can cause generalised osteopenia

A

cushing’s syndrome or steroid therapy

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8
Q

What is osteomalacia

A

a failure of bone mineralisation which may lead to pain, weakness and fragility f the bone

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9
Q

What are the causes of osteomalacia

A

lack of vitamin D or calcium (rickets)
Renal tubular acidosis
Parathyroid hormone insufficiency

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10
Q

What is Rickets

A

The childhood form of osteomalacia - failure of bon e mineral to ossify from lack of vitamin D
This leads to widening of the epiphyseal lines and generalised demineralisation
Epiphyses are widened and have accepted appearance usually best seen on an AP radiograph of the wrist

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11
Q

What are the clinical symptoms of Rickets

A

age 1 - the child is small and fails to thrive
bowing of the femora and tibiae
large head
deformity of the chest

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12
Q

Describe the biochemical findings in a patient with rickets

A

serum calcium normal
phosphate low
alkaline phosphatase raised

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13
Q

What is the treatment for Rickets

A

Vitamin D dose is curative

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14
Q

Can the deformities of rickets be corrected

A

yes - when the disease is under control

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15
Q

What are the main changes seen in adult osteomalacia

A

softening of the bones

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16
Q

What patients are more commonly affected by adult osteomalacia

A

Asian immigrants whose diet may be deficient

17
Q

What are the clinical features of Osteomalacia

A

generalised bone pain

anorexia, weight loss, muscle weakness, sometime bony deformities

18
Q

What are some radiological features of osteomalacia

A

Diffuse osteoporosis

pathological vertebral wedging and pseudo fractures

19
Q

How is a diagnosis of osteomalacia made

A

Serum calcium and phosphate lowered
alkaline phosphatase raised
Iliac crest bone biopsy

20
Q

What is the treatment for osteomalacia

A

Vitamin D

21
Q

What is osteolysis

A

Loss of mineralised bone due to osteoclastic resorption in excess of deposition

22
Q

What characterises primary hyperparathyroidism

A

generalised skeletal porous and the development of cystic lesions filled with soft brown connective tissue

23
Q

What are the clinical features of primary hyperparathyroidism

A

Generalised bone pains
indigestion
weakness
anorexia

24
Q

What are some radiological features of primary hyperparathyroidism

A

Generalised porous and characteristic localised lessons which are usually well circumscribed in long bones
Pepper pot appearance

25
Q

How is a diagnosis of primary hyperparathyroidism made

A

High serum calcium
low phosphate
raised alkaline phosphatase

26
Q

What is the treatment for primary hyperparathyroidism

A

parathyroid adenoma may be excised

27
Q

What is osteoporosis

A

reduction in bone mineral density as a result of reduced mineral mass as well as a change in the micro-architecture of the bone iteslef

28
Q

What are some causes of osteoporosis

A

Dietary deficiency

lack of stress on bone

29
Q

What are the clinical features of osteoporosis

A

Bone pains
lassitude and acute ack pain due to pathological vertebral fractures
gradual development of a kyphosis and loss of height

30
Q

What is seen on Xray in osteoporosis

A

generalised loss of density of bones and thinning of the cortices from within
ghostly quality

31
Q

What are the histological features of osteoporosis

A

Haversian canals are widened and the trabeculae are thin and sparse

32
Q

What is the treatment for osteoporosis

A

Encourage exercise and give dietary supplements of calcium, vitamin D and proteins
Calcitonin and bisphosphonates

33
Q

What is a method of prophylaxis for peri and post menopausal women

A

HRT

Lecture Notes- Orthopaedics and Fractures (23 decks)

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