Osteoporosis and Other Metabolic Bone Disorders

Question 1

What happens first in bone remodeling?

Answer 1

The osteoclasts secrete enzymes and acids that degrade bone. They then secrete messenger molecules that activate osteoblasts.

Question 2

Osteoblasts secrete _______________.

Answer 2

osteoid

Question 3

Where do osteocytes come from?

Answer 3

Osteoblasts

Question 4

Osteoclasts are activated by the ligand ____________.

Answer 4

RANK

Question 5

Osteoblasts are activated by the __________ pathway.

Answer 5

Wnt

Question 6

Osteoporosis predisposes people to fragility fractures. What are those?

Answer 6

Fractures due to minor trauma

Question 7

Osteoporosis is more severe than _____________.

Answer 7

osteopenia

Question 8

In wedge fractures of the vertebra, the __________ side is narrower.

Answer 8

anterior (leading to kyphosis)

Question 9

Once you’ve had one fragility fracture, your risk of having another is ______________.

Answer 9

fivefold

Question 10

What is the most common critical period for bone resorption?

Answer 10

Menopause

Question 11

What formula needs to be satisfied to mineralize bone?

Answer 11

[Ca] x [PO4] must be greater than 24

Question 12

95% of all genetic rickets is _____________.

Answer 12

congenital hypophosphatemic rickets (resistant to vitamin D)

Question 13

The pathognomonic radiologic finding for osteomalacia is _________________.

Answer 13

pseudofractures –lines of demineralization where arteries press against bone

Question 14

What two things are thought to cause Paget’s disease?

Answer 14

• Genetic predisposition

- Paramyxovirus infection

Question 15

________________ is usually the gene implicated in familial Paget’s.

Answer 15

SQSTM (sequestasome)

Question 16

______________ ownership has been linked to Paget’s disease.

Answer 16

Dog

Question 17

What symptoms are typical of Paget’s?

Answer 17

Bone pain
Fractures
Osteoarthritis
Bone deformity

Question 18

Paget’s can cause ___________ by two ways.

Answer 18

deafness (the ways being ossification of the foramen through which the cochlear nerve exits and ossification of the ossicles)

Question 19

Alkaline phosphatase is secreted by osteo-_________.

Answer 19

blasts

Question 20

What are the radiologic signs of Paget’s disease?

Answer 20

“Blade of grass” lesions in long bones and punched-out lesions in flat bones

Question 21

On pathologic slides, the bone of someone with Paget’s will display _______________.

Answer 21

disorganized trabeculae and expanded cortex

Question 22

How might you hear osteoclasts histologically described?

Answer 22

Multinucleated giant cells

Question 23

_______________ function as the mechanoreceptors in bone, increasing deposition of minerals when stress increases.

Answer 23

Osteocytes

Question 24

Binding to ____________ stimulates bone resorption.

Answer 24

RANK

Question 25

What densitometry scores correspond to osteopenia and osteoporosis?

Answer 25

Osteopenia: less than 1.0 SD below average
Osteoporosis: less than 2.5 SD below average

Question 26

What doses of calcium and vitamin D are recommended in those with osteoporosis?

Answer 26

1,500 mg of calcium and 1,000 units of vitamin D

Question 27

Bisphosphonates and SERMs are classified as ______________ agents.

Answer 27

anti-resorptive

Question 28

What causes vitamin D-dependent Rickets types 1 and 2?

Answer 28

Type 1: defect of 1-alpha hydroxylase (type 1 = 1-alpha)

Type 2: defect of vitamin D receptor

Question 29

Hypophosphatemic Rickets is also called _______________.

Answer 29

vitamin D resistant Rickets

Question 30

What are the three phases of Paget’s disease?

Answer 30

• Osteoclast predominance (5 years; high N-telopeptides)
• Osteoblast predominance (10 years; alk phos elevated)
• Osteoclast predominance ( indefinite; high N-telopeptides)

Question 31

The most frequent kind of osteoporosis fracture is __________.

Answer 31

spinal

Question 32

The incidence of Paget’s disease went down, perhaps due to the introduction of the _________ vaccine.

Answer 32

measles

Question 33

Those with ____________ also have cardiovascular features.

Answer 33

Paget’s