pathological bone disease

Question 1

most common fractures seen in osteoporosis

Answer 1

colles fracture: forearm
spine: vertebral fracture
hip

Question 2

pathophysiology of osteoprorsis

Answer 2

-reduction in bone density
-defect in attaining peak bone mass or accelerated bone loss
-assoc. to menopause and OE deficiency which causes uncoupling of bone resorption and bone formation
osteoclast>osteoblast
-reduction in bone formation
environmental: exercise and calcium intake and smoking and alcohol affect

Question 3

types of osteoporosis

Answer 3

• post menopausal-colles
• ageing related equal m:f risk -vertebral
• male osteoporosis due to hypogonadism, steroids or alcohol=testosterone
• steroid induced osteoporosis
• pregnancy: 2nd or 3rd trimester vertebral fractures

Question 4

other causes of osteoporosis

Answer 4

• primary hyperparathyroidism: PTH
• cushing disease steroids
• anorexia
• cancers PTHrelated peptide and tnf
• chronic liver disease
• lungs eg copd and cf

Question 5

clinical features of osteoporosis

Answer 5

• asymptomatic until# occurs

- height loss and kyphosis of the spine

Question 6

dexa for bone mineral density scoring

Answer 6

normal >-1
osteopaenia -1.5 to -2.5
osteoporosis

Question 7

management of osteoporosis 7

Answer 7

-non pharma lifestyle
-bisphosphonate inhibit bone resorption and inhibit osteoclast eg risedronate
and zoledronic acid

• denosumab antibody that neutralises RANKL
• alfacalcidol =vit d
• strontium ranelate: inhib on bone resorb
• teriparatide injection synthetic PTH
• hormone replacement therapy Raloxifene and tibolone oe and prog)
• calcitriol

Question 8

side effects of bisphosponates

Answer 8

• upper gi upset
• oe reflux disease
• acute phase response fever, malaise,anorexia

Question 9

surgery for osteoporosis

Answer 9

-vertebroplasty: treats painful vertebral compression fractures
kyphplasty:

Question 10

osteoporosis key mechanism

Answer 10

loss of bone formation

Question 11

which is the only osteoporosis drug that acts to increase bone foramtion

Answer 11

teriparatide

Question 12

osteomalacia for endocrine

vs rickets

Answer 12

osteomalacia is in adults

rickets is in children

Question 13

causes of osteomalacia 5

Answer 13

1. vit d deficiency
2. failure of 1,25 vit d synthesis either renal failure or loss of renal 25 oh hydroxylase enzyme type 1 rickets
3. vit d II rickets loss of receptor
4. defect in phosphate and pyrophosphate mechanism
   - hypophosphataemic rickets
5. iatrogenic

Question 14

what is paget bone disease

Answer 14

common focal areas of increased and disorganised remodelling

• increase osteoclast with uncontrolled bone remodelling
• architecturally abnormal

Question 15

gene for pagets

Answer 15

S1STM1 gene linked

Question 16

clinical features of paget

Answer 16

• bone pain
• deformity
• deafness: osteosclersosis of temporal bone
• pathological #
• increased warmth over bones
• most evident on weight bearing
• cranial nerve defect due to compression

Question 17

management of paget

Answer 17

• bisphosphonate

- calcitonin

Question 18

investigation of paget

Answer 18

raised ALK PHOS and bone expansion