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MSK > Osteoporosis, Pagets, Osteomalacia + Polymyalgia > Flashcards

Osteoporosis, Pagets, Osteomalacia + Polymyalgia Flashcards

1
Q

What are the features of osteosarcoma?

A

Associated with lifting of periosteum off bone producing Codman triangle
+ sunburst appearance on X ray

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2
Q

What is the cause of pseudogout + what is seen in the synovial fluid?

A

Due to deposition of calcium pyrophosphate dihydrate (CPPD)

Synovial fluid shows rhomboid crystals with weak birefringence under polarised light

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3
Q

Describe the features of achondroplasia

A

Mutation in fibroblast growth factor receptor 3 (FGFR3) leads to impaired cartilage proliferation

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4
Q

What are the key lab findings in osteomalacia + why?

A

Low calcium - due to low Vit D
Low phosphate
High PTH - to compensate for low Ca
High alkaline phosphatase - due to osteoblast hyperactivity

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5
Q

What is osteopetrosis?

A

Marble bone disease

Due to poor osteoclast function due to carbonic anhydrase II mutation

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6
Q

What is osteogenesis imperfecta?

A

Brittle bone disease

Congenital defect of bone formation - defect in synthesis of collagen

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7
Q

What is Paget’s disease of the bone?

A

Paramyxovirus infection of osteoclasts
Imbalance between osteoblasts + osteoclasts
Causes mosaic pattern of lamellar bone

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8
Q

What is osteoporosis?

A

Disease with low bone mass + structural deterioration of bone tissue
Increase in bone fragility

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9
Q

What are the characteristic osteoporotic fractures?

A

Wrist, spine, hip

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10
Q

What is a fragility fracture?

A

Fracture following a fall from standing height or less, or as a result of routine activities

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11
Q

What are the RF for osteoporosis?

A 
o	Female gender.
o	Increasing age.
o	Menopause.
o	Oral corticosteroids.
o	Smoking.
o	Alcohol.
o	Previous fragility fracture.
o	Rheumatological conditions, such as rheumatoid arthritis and other inflammatory arthropathies.
o	Parental history of hip fracture.
o	Body mass index of less than 18.5 kg/m2.
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12
Q

How is a fragility risk score calculated?

A

OFracture or FRAX online calculator

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13
Q

When should a DXA be offered?

A

> 50 w/ fragility fractures
<40 w/ major RF for fragility fractures
Vertebral or hip fractures
People at high risk from OFracture score

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14
Q

What is the T score?

A

Number of standard deviations below mean bone mineral density of young adults at peak bone mass

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15
Q

When should bisphosphonates be given in osteoporosis?

A

BMD T score of -2.5 or less

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16
Q

What is the management of osteoporosis?

A

HRT for women
Oral corticosteroids
Bisphosphonates

17
Q

What is PMR?

A

Polymyalgia rheumatica
Chronic, systemic rheumatic inflammatory disease characterised by aching + morning stiffness in neck, shoulder + pelvic girdle

18
Q

RF for PMR

A

Old age
Females
Northern europeans
Infections + winter

19
Q

Complications of PMR

A

GCA

Complications of long term steroids

20
Q

When should PMR be suspected?

A

> 50 y/o with:
Bilateral shoulder/ pelvic girdle aching >2 weeks
Morning stiffness
Evidence of acute phase response
More general symptoms eg fever, fatigue, anorexia, weight loss

21
Q

What is the management of PMR?

A

Corticosteroids

Assessing risk of osteoporosis

22
Q

What bones are most commonly affected by Pagets?

A 
Pelvis 
Femur 
Lumbar spine 
Skull
Tibia
23
Q

What is the pathology of Pagets?

A

Affects osteoclasts - increase in number + size
Increases bone formation of poorer quality
Collagen fibres form mosaic pattern

24
Q

What is seen macroscopically in Pagets?

A

Thickened shafts + deformities in long bones
Cysts + stress fractures
Localised softening called osteoporosis circumscripta

25
Q

What are the 3 phases of microscopic change in Pagets?

A

Initial ostelytic phase - large excavations filled with vascular fibrous tissue
Mixed lytic + sclerotic phase - osteoblasts lay down woven bone which is resorbed by osteoclasts
Burnt out quiescent osteosclerotic stage - osteoclasts less active + eroded areas filled with brittle, woven bone

26
Q

How does Pagets present?

A

Asymptomatic
Usually found on x ray
Features: bone pain, bone deformities, fractures, nerve palsies from thickening of skill

27
Q

Management of Pagets

A

Bisphosphonates

Vitamin D + calcium

28
Q

Complication of bisphosphonates

A

Osteonecrosis of jaw

29
Q

S+S of osteomalacia

A

Bone pain, tenderness, muscle weakness, difficulty walking, waddling gait

30
Q

What are the characteristic radiological findings in osteomalacia?

A

Looser pseudofractures, fissures, narrow radiolucent lines

31
Q

When should osteomalacia be suspected?

A 
Bone pain associated with:
Malabsorption
Gastric bypass surgery 
Celiac sprue 
Hepatitis 
CKD
32
Q

What is the management of osteomalacia?

A

Vitamin D

33
Q

What is the role of vitamin D?

A

Regulates calcium + phosphate homeostasis

34
Q

What are the 2 main forms of vitamin D?

A

Cholecalciferol (D3)

Ergocalciferol (D2)

MSK (10 decks)

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