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MSK > Patho of Osteo, Paget and more > Flashcards

Patho of Osteo, Paget and more Flashcards

1
Q

Define osteopenia

A

Radiographically bone mass 1 to 2.5 standard deviasions below meak PEAK bone mass

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2
Q

Define osteoporosis

A

radiographically bone mass at least 2.5 standard deviations below mean peak bone mass
presence of atraumatic vertebral compression
localized disuse osteoporosis
generalized primary and secondary to a variety of conditions

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3
Q

Key forms of osteoporosis

A

Idiopathic
Postmenopausal
Senile

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4
Q

Define senile osteoporosis

A

bone density is reduced due to aging

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5
Q

define postmenopausal osteoporosis

A

bone density reduced due to lack of estrogen
decreased estrogen actually increases both bone resoption and formation - formation cannot keep up with resorption, net loss of bone
most bone loss within 5 years of onset

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6
Q

Fators effecting bone mass

A 
Age: F>50 M>70
F>M
Asian, White, Hispanic
genetics
gonadal steroids
growth hormone
timing of puberty
calcium intake
exercise
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7
Q

Key genetic factors for osteoporosis

A

Bone hoemeostasis pathway LRP5
RANKL, OPG, RANK
HLA locus unfluencing inflammation and calcium metabolism
varieant in Vit D receptor and signalling

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8
Q

Clinical manifestations of osteoporosis

A

Silent disease - loss without symptoms
present with bone pain and fracture in weight-bearing area
vertebral fractures in thoracic and lumbar
complications from fractures of femoral neck, pelvis, or spine

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9
Q

Detection of osteooporosis

A

Blood levels of calcium, phosphorus, PTH and alkaline phosphatase are normal
Eual-Energy X-ray Absorption scan (DEXA) wwith quatitiative computed tomography to measure bone density

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10
Q

Prevention of osteoprorsis

A

Starts in young adults
can regain density with:
wight-bearing exercises,
dietary Vit D and calcium (decrease with caffeine, alcohol, and smoking),
medicines to treat and prevent bone loss

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11
Q

Osteoporosis amenorrhea

A

Absence of regular menstrual cycle for three months or longer
3% young female
due to premature ovarian failure, excessive exercise, athletes, eating disorders, pituitary gland tumors.
Negatively affect peak bone mass and increase risk of osteoporosis

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12
Q

Paget’s disease overview

A

Disease of increased but organized and structurally unsound bone mass) clast and blast imbalance)
Etiology unknown: genetic link with 40% having it in the family. Environmental show signs of Paramyxoviridae within clasts. Measels and respiratory syncytial virus

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13
Q

Paget disease 3 phases

A
  1. osteolytic stage - uncontrolled osteoclast activity
  2. mixed osteoclast-blast stage - osteoblasts try to catch up
  3. Burn out quiescent osteoclastic stage - clasts burn out, osteoblasts continue to make bone but no remodeling by osteoclasts
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14
Q

Paget’s disease demographics

A

Late adulthood (>50)
M>F
3% of autopsies
More in people of English decent. Nonexistent in Scandanavia, Asia, Africa, and south Africa

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15
Q

Paget’s disease clinical manifestations

A

enlarged head - hat doesn’t fit
deafness
increased limb volume
increased warmth over bone

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16
Q

Paget’s disease lab results

A

Increased alkaline phosphatase due to osteoblast activity
Increased Urinary hydroxyproline due to collogen destruction
(Calcium, phosphate, PTH all normal)

17
Q

Paget’s disease other symptoms

A

Fatigue
increased hat size
bone pain and deformity
pathological fracture
osteoarthritis secondary to bone deformity
nerve compression leading to deafness or blindness
increased risk of osteosarcoma (3x)

18
Q

Paget’s disease recurrence

A

1/3 bone scan
1/3 biomarkers (increased ALP and urine hydroxyproline)
1/3 both

19
Q

Rickets age and determining factors

A

children

deranged bone growth

20
Q

Osteomalacia

A

Adults
remodeled bone is inadequately mineralized
osteopenia and factures

21
Q

Vitamin D deficiency

A

Decreased sun exposure
poor diet
malabsorption
liver and renal failure

22
Q

Rickets disease histological findings

A

palisades of cartilage are lost

23
Q

Ricket’s presentation

A 
Low vit D in children
Pigeon breast deformity
frontal bossing
rachitic rosary
craniotabes
lumbar lordosis
24
Q

Ostoemalacia presentation

A

Low vit d in adults
increased fractures due to weak bones
inadequate mineralization of osteoid in remodeled bone (weight-bearing bones in the vertebra and hips_)
abnormal labs: decreased serum calcium and phosphate. Increased PTH. Elevated alk phos

25
Q

Osteomalacia histology

A

Trabecular bone covered in excessive amounts of osteoid

26
Q

Parathyroid hormone role in bone formation

A

increased RANKL expression in osteoblasts leading to osteoclast activation and calcium mobilization
increase resorption of calcium by renal tubules
increased urinary excretion of phosphates
increased synthesis of active vit d
net elevation of serum calcium should inhibit PTH production

27
Q

Hyperthyrodism and bone changes

A

Excessive or inappropriate levels of PTH
Stones, bones, moans, and groans
entire skeleton affected
fractures, bone deformation, joint problems

28
Q

Hyperparathyroidism and bone morphology

A

osteoporosis
brown tumors - microfractures and secondary hemorrhages, influx of macrophages, reparative fibrous tissue
osteitis fibrosa cystica - combination bone cell activity, cystic brown tumors, peritrabecular fibrosis, severe hyperparathyroidism, rarely encountered now

29
Q

Renal osteodystrophy

A

Skeletal changes in chronic renal disease

  1. osteopenia/porosis
  2. osteomalacia
  3. secondary hyperparathyroidism
  4. growth retardation
30
Q

Renal osteodystrophy types

A
  1. high-turnover - increased bone resorption and bone formation with former predomination
  2. Low-turnover or aplastic disease - adynamic bone due to decreased osteoblast and clast activity
  3. Mixed pattern - areas of high turnover and areas of low turnover

MSK (6 decks)

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