osteoperosis, osteomalacia + Pagets- 4th

Question 1

what is Pagets disease?

Answer 1

Increased and uncontrolled bone turnover
-excessive osteclast absorption followed by increase ostrablastic activity

-the bone turnover is not coordinated leading to high density (sclerosis) and low density (lysis)

Question 2

who most commonly gets Pagets?

Answer 2

Most common in >40 years
M>F

Question 3

Presentation Pagets?

Answer 3

Bone pain
Bone deformity
Fractures
Hearing loss
Bossing of skull

Question 4

where in the body does Pagets most commonly affect?

Answer 4

AXIAL SKELETON
-skull, spine, thoracic cage, sacrum type of area

Question 5

bloods of someone with pagets? + explain whyyy

Answer 5

-raised ALP
-normal phosphate
-normal calcium

ALP released from osteoblast activity- increased OB activity so ALP is raised

Calcium + phosphate are not raised as the body compensates

Question 6

what is seen on Xray - Pagets

Answer 6

-bone enlargement + deformity
-Osteoperosis circunscripta (well defined osteolytic lesions)
-cotton wool appearance of the skull
-V shaped osteolytic defects on long bones

Question 7

Management of Pagets?

Answer 7

1st line = Biphosphonates
(alendronate / risendronate)

Other:
-calcitonin
-NSAID (for bone pain)
-Calcium + vit D

Question 8

why are biphosphonates used to treat Pagets?

Answer 8

they inhibit the osteoclast activity

Question 9

SE of biphosphonates? (alendronate + risendronate)

Answer 9

-Reflux + oesophageal erosions
-Osteonecrosis of jaw and auditory canal

Question 10

complications of Pagets?

Answer 10

• Hearing loss (bones in ear affected)
  
  • HF
  • Osteosarcoma
  • Spinal stenosis
    Spinal cord compression

Question 11

what is osteomalacia?

Answer 11

Soft bones resulting from vit D deficiency
-same process in children causes rickets

Question 12

who is at higher risk of getting osteomalacia?

Answer 12

• Malabsorption disorders (IBS)
  
  • CKD
  • Low exposure to sunlight
  • Live in colder climates
  • Spend time indoors
  • Darker skin
    Secondary hyperparathyroidism

Question 13

why is Vit D important for healthy bones?

Answer 13

Vit D is needed for the absorption of calcium + phosphate in the intestines and kidneys

low vit D= low calcium + phosphate

Parathyroid glands are triggered by low calcium levels + release PTH

PTH triggers increased osteclast activity leading to further bone breakdown

Question 14

presentation of osteomalacia?

Answer 14

May be asymptomatic

* Fatigue
* Bone pain
* Muscle weakness
* Muscle aches
* Pathological or abnormal fractures
* Bowing deformity

May have a Waddling gate

Question 15

what would someone with osteomalacias bloods look like?

Answer 15

Low serum- 25 hydroxyvitamin D (lab investigation for vit D)

Low serum calcium
Low serum phosphate
High alkaline phosphatase (osteoblast)
High parathyroid hormone (secondary PTH)

Question 16

what investigation would be done to check the vitamin D?

Answer 16

serum 25- hydroxyvitamin D

Question 17

what would an Xray shoe of someone with osteomalacia?

Answer 17

Osteopenia (looks more transluscent)

-Looser zones AKA pseudo fractures (fragility fractures that go partially through the bone)

Question 18

management of osteomalacia?

Answer 18

Colecalciferol (vit D3)

Question 19

what is osteoperosis?

Answer 19

significant reduction in bone density

Question 20

pathophysiology of osteoperosis?

Answer 20

Reduction in bone density due to:
-increased bone breakdown by osteoclasts + decreased bone formation by osteoblasts

Question 21

who is at higher risk- osteoperosis?

Answer 21

-Increase age
-Post menopausal women lack of eostrogen
-Reduced mobility + activity
-Low BMI (<19)
-Low calcium/ vit D intake increases osteoclast activity
-Alcohol + smoking
-Chronic disease (CKD, hyperthyroidism, RA)
-Long term corticosteroids (e.g. prednisolong >3 months)

Question 22

what medications increase risk of osteoperosis?

Answer 22

SSRIs
PPIs
Anti epileptics
Anti oestrogens

Question 23

what medications are protective for osteoperosis?

Answer 23

HRT

Tamoxifen

Question 24

how is osteoperosis diagnoseD?

Answer 24

DEXA scan
<-2.5

Question 25

osteoperosis vs severe osteoperosis vs osteopenia on DEXA?

Answer 25

T score <-2.5

Severe osteoporosis= T score <-2.5 plus a fracture

Osteopenia -1 to -2.5

Question 26

tool used to decide to do a DEXA scan- osteoperosis

Answer 26

10 year of major osteoporotic facture + hip fracture can be calculated:
* Qfracture tool (preferred)
* FRAX tool (may underestimate risk)

Patients >10% are considered for DEXA scan

Question 27

treatment- osteoperosis?

Answer 27

1st line= bisphosphonates
* Alendronate (oral)
* Risedronate (oral)
* Zoledronic acid (IV once yearly)

(Inhibit osteoclast activity)