Osteomalacia, Pagets, Osteoporosis

Question 1

what is osteomalacia

Answer 1

severe prolonged vitamin D deficiency (rickets in children)

Question 2

what happens in osteomalacia to the amount of bone and mineralisation

Answer 2

normal amount of bone, decr mineral content- have excess uncalcified osteoid and cartilage

Question 3

what are the causes of vitamin D deficiency

Answer 3

diet, poor sunlight, Asian, anti convulsant therapy, malabsorption, renal failure, vitamin D resistance

Question 4

what is the difference between rickets and osteomalacia

Answer 4

rickets- if process occurs during period of bone growth. osteomalacia- after fusion of epiphyses

Question 5

signs of rickets

Answer 5

growth retardation, hypotonia, apathy, knock kneed, bow legged

Question 6

signs of osteomalacia

Answer 6

bone pain, tender, fractures (typically femoral neck), proximal myopathy, osteoporosis

Question 7

causes of osteomalacia

Answer 7

vit D deficiency, renal osteodystrophy, drug induced, vit D resistance, liver disease, tumour induced

Question 8

investigations in osteomalacia

Answer 8

plasma- decr Ca, decr PO4, incr ALP, incr PTH, decr vit D. biopsy- incomplete mineralisation of bone, muscle normal. x ray- loss of cortical bone, partial fractures without displacement especially- lateral border scapula, inferior femoral neck, medial femoral shaft

Question 9

treatment osteomalacia

Answer 9

vit D. dietary- calcium D3 Forte. malabsorption- ergocalciferol or parenteral calcitriol. renal or vit D resistance- alfacalcidol or calcitriol

Question 10

what is another term for Pagets

Answer 10

osteitis deformans

Question 11

what is Pagets

Answer 11

increased bone turnover, incr number of osteoclasts and osteoblasts- with remodelling, bone enlargement, deformity, weakness. woven bone

Question 12

clinical features Pagets

Answer 12

asymptomatic in >70%. deep boring pain, bony deformity and enlargement- pelvis, lumbar spine, skull, femur, tibia- bowed sabre tibia.

Question 13

complications Pagets

Answer 13

fractures, OA, incr Ca, nerve compression due to bony enlargement,osteosarcoma

Question 14

diagnosis Pagets

Answer 14

x ray- localised enlargement bone, patchy cortical thickening- sclerosis, osteolysis, deformity. bloods- incr ALP, Ca and PO4 normal. isotope bone scan- incr uptake.

Question 15

treatment Pagets

Answer 15

analgesia, bisphosphonates- zoledronate, pamidronate, risedronate, alendronate

Question 16

what is osteoporosis

Answer 16

low bone mass. deterioration of bone mass.

Question 17

where are the common sites of fracture osteoporosis

Answer 17

spine, neck of femur, wrist

Question 18

what happens in bone remodelling osteoporosis

Answer 18

bone resorption is greater than bone formation- osteoclasts resorb greater amount of bone, osteoblasts lay down smaller amount of bone than was resorbed

Question 19

what are the primary and secondary causes osteoporosis

Answer 19

primary- age related. secondary- another condition or drugs

Question 20

what happens if trabecular bone is affected osteoporosis

Answer 20

crush fractures of vertebrae common

Question 21

why is osteoporosis more common in women

Answer 21

oestrogen low after menopause

Question 22

risk factors osteoporosis

Answer 22

SHATTERED- Steroids; Hyperthyroidism, hyperparathyroidism, hypercalciuria; Alcohol and tobacco; Thin; Testosterone decr; Early menopause; Renal/liver failure; Erosive; Dietary

Question 23

what are the complications of osteoporosis over time

Answer 23

kyphosis, loss of height, indigestion/reflux, pain, neck weak and head falls forward, breathing difficulties, stress incontinence

Question 24

investigations osteoporosis

Answer 24

x ray, DEXA (dual energy x ray absorptiometry). bloods- ca, po4, alp normal

Question 25

what is measures from DEXA

Answer 25

T score- number of standard deviations the BMD is from youthful average -2.5 or worse is osteoporosis. -1 to -2.5 is osteopenia

Question 26

indications for DEXA

Answer 26

prev low trauma fracture, FH, early menopause, prior to long term prednisolone, osteopenia, bone and remodelling disordera

Question 27

how do steroids predispose to osteoporosis

Answer 27

promote osteoclast bone resorption, decr muscle mass, decr Ca absorption from gut

Question 28

management osteoporosis lifestyle

Answer 28

stop smoking, weight bearing exercise, good calcium intake, HRT women early menopause.

Question 29

management osteoporosis pharmacological

Answer 29

bisphosphonates (alendronate 10mg/day SE photosensitivity, GI upset); calcium and vit D; strontium ranelate (decr fracture rates); HRT (prevent not treat); raloxifene (oestrogen receptor modulator); teriparatide; calcitonin; testosterone; denosumab