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NYCC MSP > Metabolic Disorders > Flashcards

Metabolic Disorders Flashcards

1
Q

When does peak bone density generally occur?

A

25-35 years

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2
Q

What factors contribute to higher peak bone density?

A
  • M>F
  • ethnicity/genetics (African American)
  • ^activity
  • nutrition (vit D, phosphorus, Ca)
  • hormones (estrogen = protective)
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3
Q

Name 2 potential causes of decreased bone synthesis leading to decreased bone density

A
  • decreased osteoblastic function: organic to inorganic ratio is maintained
  • decreased ability to make collagen with age, so less organic material to mineralize
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4
Q

Name a potential cause of decreased mineralization of osteoid leading to decreased bone density

A

lack of vit D or Ca2+ (osteomalacia, hyperparathyroidism), organic to inorganic ratio changes

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5
Q

Name a potential cause of increased bone destruction leading to decreased bone density

A

balance of osteoclastic and osteoblastic activity shifts

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6
Q

How does normal bone remodeling compare to that of elderly people?

A
  • normal: same amount of bone before & after cutting cone
  • elderly: net loss of bone
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7
Q

What condition in when the body’s bones become weak and break easily?

A

Osteoporosis

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8
Q

How does the organic to inorganic ratio change with osteoporosis?

A

Normal for age
(quality normal, quantity decreased)

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9
Q

What is the vitamin D deficiency which results in the abnormal softening of bone that occurs in adults?

A

Osteomalacia

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10
Q

In osteomalacia, bone quality is ____ and quantity may be ____

A

decreased
decreased
(bones soften AND weaken)

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11
Q

How does the organic to inorganic ratio change with osteomalacia?

A

increased
(bone mass also decreased)

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12
Q

What type of osteoporosis is characterized by a change in osteoclastic:osteoblastic balance?

A

Primary Osteoporosis

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13
Q

What is type 1 primary osteoporosis?

A

post-menopausal (exclusively females)
- estrogen drop increases osteoclastic activity

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14
Q

What is Type 2 primary osteoporosis?

A

Senile osteoporosis
- age related change of osteoblastic function

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15
Q

What hormone plays a major role in the regulation of bone remodeling in both men and women?

A

Estrogen

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16
Q

What physiological event poses a major risk for osteoporosis?

A

Menopause

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17
Q

How does estrogen act to maintain bone density?

A
  • blocks RANKL, suppressing osteoclastic activity
  • inhibits osteoblast apoptosis -> increases osteoblast lifespan
  • decreases production of bone-resorbing cytokines
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18
Q

How does hormone replacement therapy (HRT) work on bone modeling?

A
  • estrogens given to post-menopausal women
  • ^calcitriol (tries to ^Ca)
  • ^Ca absorption
  • slows loss, does not contribute to rebuilding
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19
Q

What category of drugs is advertised to help with bone density?

A

bisphosphonates (eg. Boneva)

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20
Q

How do bisphosphonates help with bone density?

A

decrease osteoclastic activity (does NOT increase deposition

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21
Q

What laboratory values would you be expect to see in a patient with osteoporosis?

A

All normal (slow process, no inflammation indicated)

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22
Q

Name 5 potential causes of secondary osteoporosis

A
  • disuse
  • endocrine & genetic abnormalities or malabsorption issues
  • chronic corticosteroid Rx
  • multiple myeloma
  • complex regional pain syndrome
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23
Q

Name 3 common areas of fracture in osteoporosis

A
  • hip
  • spine
  • distal radius
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24
Q

What % bone loss is necessary before visible radiographically?

A

30-50%

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25
Q

What tool is used to quantify severity of bone density loss?

A

DEXA scan

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26
Q

What is the T-score on a DEXA scan?

A
  • bone density compared with 18-25y/o of same race & sex
  • gives fracture risk
27
Q

What is the Z-score on a DEXA scan?

A

bone density compared with people of same age, race, sex
(useful for pre-menopausal evaluation of density)

28
Q

A T-score of +1 to -1 is considered ____

A

normal

29
Q

A T-score of -1 to -2.5 is considered ____

A

osteopenia

30
Q

A T-score of -2.5 or less is considered ____

A

osteoporosis

31
Q

A T-score of -2.5 or less, with a history of fragility fracture is considered ____

A

severe osteoporosis

32
Q

What are the fracture risks for T-scores of -2, -3, and -4?

A

-2 = 4x more likely
-3 = 8x
-4 = 16x

33
Q

Decreased bone density on x-ray is called ____

A

osteopenia

34
Q

In a patient with osteoporosis, the nucleus pulposus can break vertebral endplates causing a ____ appearance

A

bi-concave (AKA cod fish)

35
Q

What kind of fracture occurs at the distal radius and is usually do to falling on an outstretched hand?

A

Colles Fracture

36
Q

What terms describes the osteoporotic hyperkyphosis caused by multiple compression fractures?

A

Dowager’s Hump

37
Q

What Vitamin D deficiency results in the abnormal softening of bone leading to bowing of the legs in children?

A

Rickets

38
Q

Are the bone changes due to rickets generally reversible or irreversible?

A

Irreversible

39
Q

name 3 sources of acquired vitamin D deficiency

A
  • inadequate sun
  • inadequate dietary intake
  • decreased absorption
40
Q

What is vitamin D-dependent Rickets type I?

A

defective hydroxylation of metabolites in liver or kidney

41
Q

What is vitamin D-dependent Rickets type II?

A

end organ insensitivity to vitamin D

42
Q

What affects does Vitamin D deficiency have on the body?

A
  • decreased calbindin production –> decreased GI absorption of Ca2+ and PO4
  • lower plasma Ca2+ levels –> ^PTH secretion
  • lower calcitriol (active vit D) –> less Ca2+ retrieved from bone
  • phosphate excreted in urine, Ca2+ retained
  • Long term: hypophosphatemia and modest decrease Ca2+
43
Q

What is the net effect of vitamin D deficiency on the body?

A

decrease in bone mineralization
(excessive osteoid accumulates and is not well mineralized due to low Ca and Phosphate)

44
Q

Describe the diagnostic profile of vitamin D-dependent rickets type I

A
  • slightly reduced plasma Ca
  • greatly reduced plasma phosphate
  • elevated PTH
  • increased alkaline phosphatase
45
Q

What are some of the clinical manifestations of Osteomalacia?

A
  • no symptoms early, eventual dull, aching bone pain
  • lower back, pelvis, hips, legs ribs
  • pain may worsen at night or wt. bearing
  • muscle weakness
  • patients adopt waddling gait due to decreased muscle tone and leg weakness
46
Q

What radiographic finding consists of unmineralized osteoid seams which appear as a hazy, indistinct, dark line with callous formation?

A

Pseudofracture

47
Q

What are the radiographic findings in osteomalacia?

A
  • generalized osteopenia
  • pseudofractures
  • corticomedullary indistinction
  • no/minimal deformity (reversible)
48
Q

What are the characteristics of Rickets?

A
  • more severe consequences
  • irreversible growth impacts (bow-leg)
  • bilateral
  • lack of control of endplate growth (decreased cartilage formation & osteoid mineralization)
49
Q

What are the radiographic findings of Rickets?

A
  • generalized osteopenia
  • widened growth plates (paintbrush metaphysis)
  • bowing of wt. bearing bones
  • pseudofractures
  • discontinuities due to buckling, tearing of bone
50
Q

What type of bone deformity will weight bearing bones and ribs undergo in patients with Rickets?

A

Genu varum

51
Q

Name 2 clinical signs of Rickets

A
  • hypotonia
  • waddling gait
52
Q

What conditions is characterized by the excessive sensitivity to Vitamin D?

A

Hypervitaminosis D

53
Q

What is the most common reason for Hypervitaminosis D?

A

Over supplementation

54
Q

excessive sensitivity to vitamin D is called ____

A

sarcoidosis

55
Q

What are some clinical manifestations of Hypervitaminosis D?

A
  • hypercalcemia
  • ^urinary Ca excretion
  • nephrolithiasis
  • nephrocalcinosis
  • metastatic calcifications
56
Q

What are some of the generalized signs and symptoms of Hypercalcemia?

A
  • Dulled mentation
  • Headaches
  • Muscle weakness and hyporeflexia
  • Lethargy
  • Generalized musculoskeletal pain
  • Anorexia
  • Constipation
57
Q

What lab results would you expect to see in patients with Hypervitaminosis D?

A
  • Decreased PTH
  • Increased serum and urinary calcium levels
58
Q

vitamin C is an important cofactor in the hydroxylation of ____ and ____

A

proline & lysine

59
Q

What happens to collagen in a patient with scurvy?

A
  • collagen lacks tensile strength
  • changes in collagen synthesis –> reduced osteoblastic function –> decreased bone density
60
Q

What are some of the clinical manifestations of Scurvy?

A
  • Increased hemorrhage (vessel fragility)
  • Subperiosteal bleeding
  • Petechial hemorrhages, ecchymosis & purpura
  • Swollen, bleeding gums
  • Impaired bone growth
  • Joint & muscle pain
  • Delayed/impaired wound healing
61
Q

What are the radiographic findings of scurvy?

A
  • generalized osteopenia
  • white line of Frankel
  • Wimberger’s ring
  • Pelkin’s spurs
  • Trummerfeld zone
  • subperiosteal hemorrhage
62
Q

Extra deposition on the metaphyseal side of the growth plate is called ____

A

white line of Frankel

63
Q
A

NYCC MSP (28 decks)

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