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MSK > Osteoporosis and Metabolic Disease > Flashcards

Osteoporosis and Metabolic Disease Flashcards

1
Q

Definition of osteoporosis

A

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

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2
Q

Causes of osteoporosis

A 
thyrotoxicosis
hyper/hypo parathyroidism 
cushings
hyperprolactinaemia
hypopituitarism 
low sex hormone levels 
RA
ankylosing spondylitis 
polymyalgia rheumatica 
UC/chrones
liver diseases
- PBC, CAH, alcoholic cirrhosis, viral cirrhosis (Hep C)
malabsorption 
- CF
- Chronic pancreatitis 
- coeliac disease 
- whipples disease
- short gut syndrome
- ischaemic bowel 
medications
- steroids
- PPI
- enzymes inducing antiepileptic medications
- aromatase inhibitors (used in breast cancer)
- GnRH inhibitors
- Warfarin
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3
Q

Risk of fractures in osteoporosis

A

age
BMD
Falls
Bone turnover

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4
Q

What assessment in done to indicate whether someone is at risk of osteoporosis?

A

FRAX - fracture risk assessment tools

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5
Q

What is considered as a significant risk of fracture in osteoporosis?

A

> 10 % risk of osteoporotic fracture over 10 days

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6
Q

What should be done if a patient has significant risk of fracture?

A

Be referred for a DXA scan (dual energy X ray absorptiometry)

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7
Q

Who should be sent for a DXA scan in osteoporosis regardless of their %?

A

Oral steroids

suffer a low trauma fracture

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8
Q

Prevention of osteoporotic fractures

A

minimise risk factors
ensure good calcium and vit D status
falls prevention strategies
medications

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9
Q

Treatment of osteoporosis

A 
HRT
SORMR (selective oestrogen receptor modulator) - raloxifene
bisphosphonates - MAIN TREATMENT
Denosumab 
Teriparatide
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10
Q

Side effects of HRT

A

Increased risk of

  • blood clots
  • breast cancer with extended use into 50s/60s
  • heart disease and stroke if used after a large age gap from menopause
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11
Q

Side effects of SERMS

A

Hot flushes if close to menopause
increased clotting risks
lack of protection at hipsite

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12
Q

First line of treatment for osteoporosis

A

Oral biphosphonates

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13
Q

Side effects of biphosphonates

A

oesophagitis
iritis/uveitis
ONJ
atypical femoral shaft fractures

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14
Q

What needs to be done In long term use of bisphosphonates?

A

drug holiday for 1 - 2 years

usually after 10 years oral biphosphonates

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15
Q

What does denosumab do?

A

reduces osteoclast bone resorption

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16
Q

How is denosumab taken?

A

SC injection every 6 months

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17
Q

Side effects of denosumab

A

allergy/rash

symptomatic hypocalcaemia if given when vit D deplete

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18
Q

What is teriparatide?

A

intermittent human parathyroid hormone

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19
Q

side effects of teriparatide

A

injection site irritation
rarely hypercalcaemia
allergy
cost

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20
Q

What do osteoblasts do?

A

Fill in pit produced by the osteoclasts

controlling cell

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21
Q

What do osteoclasts do?

A

secretes acid into bone environment to dissolve it and produces a pit in the bone

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22
Q

Bone remodelling time; adult vs child

A

adult - very slow

child - really fast

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23
Q

What controls osteoblasts?

A

Parathyroid hormone

Vitamin D

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24
Q

What are the bone active hormones?

A

parathyroid hormone

vitamin D

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25
Q

When does accelerated loss of bone mass begin?

A

menopause

26
Q

What is the difference between rickets and osteomalacia?

A

They are both the same condition, just occur at different times

27
Q

When does osteomalacia occur?

A

After the epiphyseal plates fuse

28
Q

When does rickets occur?

A

Before the epiphyseal plates fuse

29
Q

What casues rickets/osteomalacia?

A

severe nutritional vit D or calcium deficiency

30
Q

Presentation of rickets

A 
Stunted growth 
odd curve to spine or back 
large forehead
odd shaped ribs and breast bones
large abdomen 
wide bones
wide ankles
odd shaped legs 
failure to thrive
31
Q

Osteomalacia symptoms

A 
bone pain 
muscle weakness
increased falls risk 
dont get deformities you can visualise
microfractures of the bone
32
Q

Definition of osteogenesis imperfecta

A

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

33
Q

Pathology of osteogenesis imperfecta

A

Defects in type I collagen
Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine
Failure of maturation of collagen in all of the connective tissues

34
Q

Presentation of osteogenesis imperfecta

A 
early osteoporosis 
growth deficiency 
defective tooth formation - dentigenesis imperfecta
hearing loss
blue sclera
scoliosis/barrel chest
ligamentous laxity 
easy bruising
35
Q

Treatment of osteogenesis imperfecta

A

surgical - to treat fractures
medical - to prevent fractures
- IV bisphosphonates
educational and social adaptations

36
Q

Paget’s disease of bone definition

A

Localised disorder of increased and uncontrolled bone turnover

37
Q

Pathology of Paget’s disease of bone

A

Excessive osteoclastic resorption followed by increased osteoblastic activity
increased bone resorption by increased bone formation
not occurring in a structured fashion
Leads to disorganised bone
- bigger
- less compact
- more vascular
- more susceptible to deformity and fracture
leading to pulsating pain

38
Q

Causes of paget’s disease of bone

A 
Strong genetic component (15-30%)
Restricted geographical distribution 
- those of Anglo-Saxon origins 
Environmental trigger
- possibly of chronic viral infection with osteoclast
39
Q

Symptoms of pagets disease of bone

A

> 40 y/o
Bone pain
occasionally bone deformity
excessive heat over pagetic bone
neurological complications e.g. nerve deafness
ISOLATED ELEVATION OF SERUM ALKALINE PHOSPHATE (ALP)
Calcium and phosphate typically normal
bowed bone tibia
broad forehead
rarely the development of osteosarcoma in affected bone

40
Q

Where can you get pagets disease of bone?

A

can be localised i.e. in one bone or
can be widespread i.e. in bits all over the body
never affects the WHOLE skeleton

41
Q

Who with pagets is treated?

A

Bone pain
Skull or long bone deformity
Fracture
Periarticular pagets

42
Q

Most common areas to get pagets

A

Skull
Spine
Pelvis
Long bones of the lower extremities

43
Q

Predisposing factors to pagets

A

Increasing age
Male
Northern latitude
FH

44
Q

What % of patients with pagets disease are symptomatic?

A

5%

45
Q

Other markers of bone turnover

A

PINP
CTx
NTx
Urinary hydroxyproline

46
Q

Is pagets easy to treat?

A

Yes

47
Q

Treatment of pagets disease

A

IV biphopshonates

48
Q

How do bisphosphonates work?

A

Analogues of pyrophosphate - inhibit osteoclasts by reducing recruitment and promoting apoptosis

49
Q

Management of patients at risk of corticosteroid induced osteoporosis - the two groups

A
  1. Patients > 65 y/o or those who have previously had a fragility fracture SHOULD be offered bone protection
  2. Patients < 65 y/o should be offered a BONE DENSITY SCAN with further management dependent on this
50
Q

Results of the bone density scan in the < 65s and their treatment

A

T > 0 = Reassure
T 0 to -1.5 = Repeat bone density scan in 1 - 3 years
T < - 1.5 = Offer bone protection

51
Q

Subtypes of osteogenesis imperfecta

A

Type I - Type 4

52
Q

Type I osteogenesis imperfecta

A

Collagen normal quality but insufficient quality

53
Q

Type II osteogenesis imperfecta

A

Poor collagen quality and quantity

54
Q

Type III osteogenesis imperfecta

A

Collagen poorly formed

Normal quantity

55
Q

Type IV osteogenesis imperfecta

A

Sufficient collagen quantity but poor quality

56
Q

What is osteopetrosis?

A

Bones become harder and more dense which can lead to pathological fractures

57
Q

Who gets osteopetrosis?

A

Young adults

58
Q

Inheritance of osteopetrosis

A

AR

59
Q

What does radiology of osteopetrosis show?

A

Lack of differentiation between the cortex and the medulla described as - MARBLE BONE

60
Q

What blood tests is osteoporosis associated with?

A

NORMAL blood tests (Ca, P, PTH, ALP)

61
Q

What is the Z score of DEXA scans adjusted for?

A

Age
Gender
Ethnic factors

62
Q

What do the T and Z scores of the DEXA scan look at?

A

T - bone density compared to a healthy 30 year old

Z - compares your bone density to someone your age and body size

MSK (25 decks)

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