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musculoskeletal system > Osteoporosis and Metabolic Bone Disease > Flashcards

Osteoporosis and Metabolic Bone Disease Flashcards

1
Q

What is osteoporosis?

A

A metabolic bone disease characterised by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk

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2
Q

What is fracture risk related to?

A

Age
Bone mineral density
Falls
Bone turnover

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3
Q

What is referral for DXA scanning based on?

A

FRAX or Q Fracture score of > 10% fracture risk at any site over next 10 years, according to 2003 SIGN guidelines

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4
Q

What is the treatment threshold in terms of fracture risk?

A

Fracture risk around 20% 10 year risk would be the treatment threshold

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5
Q

What are the features of Q Fracture?

A

Developed in 2009 from large primary care populations in UK
Applicable for those aged 30-85, men and women
Contains multiple variale including CVS risks, falls and TCA
Does not have the ability to add BMD
Some of the variables and risks cannot be altered by osteoporotic medications

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6
Q

What are the endocrine causes of secondary osteoporosis?

A 
Hyperthyroid
Hyperparathyroid 
Hypoparathyroid
GH deficiency 
Hyperprolactinaemia 
Cushing's
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7
Q

What are the malabsorption causes of secondary osteoporosis?

A

Coeliac disease

CF

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8
Q

What malignancy causes secondary osteoporosis?

A

Myeloma

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9
Q

What are the rheumatic causes of secondary osteoporosis?

A

RA
Ankylosing spondylitis
PMR

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10
Q

What are the drugs that cause secondary osteoporosis?

A 
Steroids
Heparin
Warfarin
Anticonvulsants
PPIs
GnRH inhibitors
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11
Q

What are the causes of amenorrhoea, which can result in secondary osteoporosis?

A

Anorexia nervosa
Early menopause
Primary ovarian failure

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12
Q

What is involved in osteoporotic fracture prevention?

A

Minimise risk factors
Ensure good calcium and vitamin D status
Fall prevention strategies
Medications

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13
Q

What are the investigations used to confirm the diagnosis of osteoporosis?

A

Measure BMD via DXA hip and spine
If result is normal (T score above -1) then reassure and give lifestyle advice
If result indicates osteopenia (T score -1 to -2.5 then give lifestyle advice or treat if there has been a previous fracture
If result indicates osteoporosis (T score below -2.5) then give lifestyle advice and offer treatment

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14
Q

What are the types of drugs used in prevention and treatment of osteoporosis?

A 
HRT
Selective Oestrogen Receptor Modulators 
Bisphosphonates
Teriparatide
Denosumab
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15
Q

What are the risks of HRT treatment?

A

Increased risk of blood clots
Increased risk of breast cancer with extended use into late 50s/early 60s
Increased risk of heart disease and stroke if used after a large gap from menopause

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16
Q

What are the disadvantages of selective oestrogen receptor modulator treatment?

A

Hot flushes if taken close to menopause
Increased clotting risks
Lack of protection at hip site

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17
Q

What is the main treatment option for osteoporosis?

A

Bisphosphonates - oral bisphosphonates generally the first line of treatment

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18
Q

What is required for bisphosphonate treatment?

A

Adequate renal function
Adequate calcium and vitamin D status
Good dental health and hygiene advised

19
Q

What bisphosphonates inhibit osteoclasts?

A

Nitrogen containing bisphosphonates

20
Q

What are the potential side effects of bisphosphonates?

A

Oesophagitis
Iritis/uveitis
Atypical femoral shaft fractures

21
Q

What is teriparatide?

A

Recombinant form of parathyroid hormone

22
Q

What are the side effects/disadvantages of teriparatide?

A

Injection site irritation
Hypercalcaemia (rarely)
Allergy
Cost

23
Q

What is denosumab?

A

Monoclonal antibody against RANKL

Reduces osteoclastic bone resorption

24
Q

How is denosumab administered?

A

Subcutaneous injection every 6 months

25
Q

In what patients is denosumab safer than bisphosphonates?

A

Patients with significant renal impairment

26
Q

What are the side effects of denosumab?

A

Allergy
Rash
Symptomatic hypocalcaemia if given when vitamin D deplete
Possible ONJ
Possible atypical femoral shaft fractures

27
Q

What does severe nutritional vitamin D or calcium deficiency cause?

A

Insufficient mineralisation and rickets in a growing child, osteomalacia in an adult (where the epiphyseal lines are closed

28
Q

What does vitamin D stimulate?

A

Absorption of calcium and phosphate from the gut, so calcium and phosphate become available for bone mineralisation

29
Q

What happens to muscle function in low vitamin D states?

A

Muscle function is impaired

30
Q

What is Paget’s disease? What happens in this disease?

A

Localised disorder of bone turnover
Increased bone resorption followed by increased bone formation
Leads to disorganised bone - bigger, less compact, more vascular and more susceptible to fracture

31
Q

What percentage of cases of Paget’s disease are familial?

A

15-30%

32
Q

Mutations in what loci have been associated with Paget’s disease?

A

Loci of SQSTM1

33
Q

What are the symptoms of Paget’s disease?

A

Patients > 40 years
Bone pain
Occasionally presents with bone deformity, excessive heat over the Pagetic bone, or by neurological complications

34
Q

What is the presentation of Paget’s disease?

A

Isolated elevation of serum alkaline phosphatase - commonest presentation
Bone pain and local heat
Bone deformity or fracture
Hearing loss
Rare - development of osteosarcoma in affected bone

35
Q

What is the treatment of Paget’s disease?

A

No evidence to support treatment of asymptomatic disease, unless in the skull or in an area requiring surgical intervention
Should not be treated based on raised alkaline phosphatase alone
IV bisphosphonate therapy, one off IV xoledronic acid

36
Q

What is osteogenesis imperfecta?

A

Genetic disorder of connective tissue characterised by fragile bones from mild trauma and acts of daily life

37
Q

What is the clinical range of osteogenesis imperfecta?

A

Broad - from those that are prenatally fatal to those presenting in 40s with early osteoporosis

38
Q

What defect results in osteogenesis imperfecta?

A

Defects in type 1 collagen - 8 different types but the first 4 are the most common

39
Q

What are the features of type 1 osteogenesis imperfecta?

A

Milder form, presents when child starts to walk, but can present in adults

40
Q

What are the features of type 2 osteogenesis imperfecta?

A

Lethal by age 1

41
Q

What are the features of type 3 osteogenesis imperfecta?

A

Progressive deforming with severe bone dysplasia and poor growth

42
Q

What are the features of type 4 osteogenesis imperfecta?

A

Similar to type 1 but more severe

43
Q

What are the signs and symptoms of osteogenesis imperfecta?

A 
Growth deficiency 
Defective tooth formation (dentigenesis imperfecta) 
Hearing loss
Blue sclera
Scoliosis
Barrel chest
Ligamentous laxity 
Easy bruising
44
Q

What is the management of osteogenesis imperfecta?

A

Surgical - to treat fractures
Medical - fracture prevention, IV bisphosphonates
Social - educational and social adaptations
Genetic - genetic counselling for parents and next generation

musculoskeletal system (40 decks)

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