Osteoporosis and Bone Disease

Question 1

State 3 characteristics of Bone.

Answer 1

Mechanical - supports muscle attachment. Protective - vital organs and bone marrow. Metabolic - reserve of calcium and phosphate ions.

Question 2

State 3 types of bone.

Answer 2

Long bone. Short bone. Flat bone. Irregular bone. Sesamoid bone. Sutural bone.

Question 3

What is the dense outer surface of the bone that forms a protective layer around the internal cavity?

Answer 3

Cortical/compact bone.

Question 4

State another name for Trabecular bone.

Answer 4

Cancellous bone/compact bone.

Question 5

Where is spongy bone located?

Answer 5

At the ends of long bones (epiphyses).

Question 6

What is meant by bone resorption?

Answer 6

Where steoclasts break down the tissue in bones and release the minerals, resulting in a transfer of calcium from bone tissue to the blood. Help in formation of new bone.

Question 7

What is responsible for bone resorption?

Answer 7

Osteoclasts (large multinucleated bone cells that contain numerous mitochondria and lysosomes).

Question 8

State two bone turnover markers.

Answer 8

Urine - hydroxyproline, C telopeptide of type 1 collagen. Serum - NTX, CTX.

Question 9

State two bone formation markers.

Answer 9

Serum e.g. osteocalcin.

Question 10

What is a DEXA scan?

Answer 10

Bone density scan uses densitometry X-ray to measure how much mineral in area.

Question 11

State a characteristic of osteoporosis.

Answer 11

Skeletal disorder characterized by low bone mass. Deterioration of bone tissue.

Question 12

What is meant by osteopenia?

Answer 12

Bone density between low end of normal range and osteoporosis.

Question 13

What is meant by a fragility fracture?

Answer 13

Fracture following a fall from a standing height or less.

Question 14

Why are women at greater risk of osteoporosis?

Answer 14

Decrease in oestrogen production at menopause (accelerates bone loss).

Question 15

State 2 modifiable risk factors asssociated with low bone structure.

Answer 15

Low body mass index. Alcohol intake. Smoking. Frequent use of glucocorticoids. Vitamin D and calcium homeostasis.

Question 16

State 2 non-modifiable risk factors associated with low bone strucutre.

Answer 16

Age (older the age, lower the bone density). Gender (women accummulate less peak bone mass and loses more post menopause). Ethnicity (caucasians and asians higher risk).

Question 17

State 2 diseases associated with low bone mass.

Answer 17

Diabetes. Inflammatory rheumatic diseases (interleukins, steriods). Gastrointestinal diseases (inflammation, intestinal malabsorption). Chronic liver disease (malnutrition, low BMI, cholestasis (stoppage of bile flow)). Chronic kidney disease (renal osteodystrophy - kidney fails to maintain proper levels of calcium in the blood).

Question 18

State 2 things which effect osteoporosis.

Answer 18

Primary hyperparathyroidism (parathyroid hormones effect cortical bone). Post-menopausal.

Question 19

State 2 investigations for osteoporosis.

Answer 19

Bone profile (blood test that assesses the proteins, minerals and enzymes present in bone that are essential for healthy bone structure and development). Parathyroid hormone. Vitamin D. Renal/liver function. Coeliac screen (as calcium not absorbed).

Question 20

State 2 ways to treat osteoporosis.

Answer 20

Exercise. Diet - adequate calcium in diet. Pharmacological treatment e.g. biphosphonates - prevent vertebral/non-vertebral hip fractures, HRT - menopausal women, testosterone replacement - hypogonadal men.

Question 21

State a benefit of vitamin D.

Answer 21

Essential for musculoskeletal health - enables mineralisation of newly formed osteoid tissue.

Question 22

State 3 non-osteoporosis bone conditions.

Answer 22

Paget’s disease of the bone - disorganized mosaic of new bone formation (bone pain, deformities, fractures). Enzyme deficiencies e.g. hypophosphatasia (heritable rickets), homocysteinuria (autosomal recessive disorder), mucopolysaccharidosis (body is unable to properly breakdown long chains of sugar in body), alkaptonuria (discolouration of urine and connective tissue). Cancer.