Metabolic Disorders Flashcards
When does peak bone density generally occur?
25-35 years
What factors contribute to higher peak bone density?
- M>F
- ethnicity/genetics (African American)
- ^activity
- nutrition (vit D, phosphorus, Ca)
- hormones (estrogen = protective)
Name 2 potential causes of decreased bone synthesis leading to decreased bone density
- decreased osteoblastic function: organic to inorganic ratio is maintained
- decreased ability to make collagen with age, so less organic material to mineralize
Name a potential cause of decreased mineralization of osteoid leading to decreased bone density
lack of vit D or Ca2+ (osteomalacia, hyperparathyroidism), organic to inorganic ratio changes
Name a potential cause of increased bone destruction leading to decreased bone density
balance of osteoclastic and osteoblastic activity shifts
How does normal bone remodeling compare to that of elderly people?
- normal: same amount of bone before & after cutting cone
- elderly: net loss of bone
What condition in when the body’s bones become weak and break easily?
Osteoporosis
How does the organic to inorganic ratio change with osteoporosis?
Normal for age
(quality normal, quantity decreased)
What is the vitamin D deficiency which results in the abnormal softening of bone that occurs in adults?
Osteomalacia
In osteomalacia, bone quality is ____ and quantity may be ____
decreased
decreased
(bones soften AND weaken)
How does the organic to inorganic ratio change with osteomalacia?
increased
(bone mass also decreased)
What type of osteoporosis is characterized by a change in osteoclastic:osteoblastic balance?
Primary Osteoporosis
What is type 1 primary osteoporosis?
post-menopausal (exclusively females)
- estrogen drop increases osteoclastic activity
What is Type 2 primary osteoporosis?
Senile osteoporosis
- age related change of osteoblastic function
What hormone plays a major role in the regulation of bone remodeling in both men and women?
Estrogen
What physiological event poses a major risk for osteoporosis?
Menopause
How does estrogen act to maintain bone density?
- blocks RANKL, suppressing osteoclastic activity
- inhibits osteoblast apoptosis -> increases osteoblast lifespan
- decreases production of bone-resorbing cytokines
How does hormone replacement therapy (HRT) work on bone modeling?
- estrogens given to post-menopausal women
- ^calcitriol (tries to ^Ca)
- ^Ca absorption
- slows loss, does not contribute to rebuilding
What category of drugs is advertised to help with bone density?
bisphosphonates (eg. Boneva)
How do bisphosphonates help with bone density?
decrease osteoclastic activity (does NOT increase deposition
What laboratory values would you be expect to see in a patient with osteoporosis?
All normal (slow process, no inflammation indicated)
Name 5 potential causes of secondary osteoporosis
- disuse
- endocrine & genetic abnormalities or malabsorption issues
- chronic corticosteroid Rx
- multiple myeloma
- complex regional pain syndrome
Name 3 common areas of fracture in osteoporosis
- hip
- spine
- distal radius
What % bone loss is necessary before visible radiographically?
30-50%
What tool is used to quantify severity of bone density loss?
DEXA scan