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DIT Rheumatology And Dermatology > Reu 2- Bone Disorders > Flashcards

Reu 2- Bone Disorders Flashcards

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1
Q

How do we diagnose osteoporosis?

A

Thru bone mineral density test, usually DEXA scan (dual energy x-ray absroptiometry) at the spine or the hip.

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2
Q

Why is it important to stop PPIs and H2-blockers for someone with osteoporosis?

A

Because you need acid in the stomach to absorb calcium.

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3
Q

What are 3 bisphosphonates and how do they work?

A

They end in -dronate: alendronate, risendronate, etidronate. They inhibit osteoclasts.

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4
Q

What are the side effects of bisphosphonates?

A

Erosive esophagitis, osteonecrosis of the jaw.

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5
Q

What is the cause of osteopetrosis?

A
  1. Defect of bone resorption, osteoclasts are deficient in the enzyme carbonic anhydrase II.
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6
Q

How are the labs in osteopetrosis?

A

Labs are usually normal. If severe, there might be slight decrease of serum calcium and slight increase of PTH. Some forms of osteopetrosis, slight increase of alkaline phosphate.

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7
Q

What is Paget Disease of Bone and what is the cause?

A

Localized disorder of the boney architecture, increased osteoblastic AND osteoclastic activity. It leaves disorganized bone remodeling.

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8
Q

What are the symptoms of Paget disease?

A

No major symptoms, but can cause bone pain, bone deformities, fractures and narrowing of the auditory foramen and hearing loss. Some patients might complain of growing hat size. They have increased risk of osteosarcoma.

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9
Q

How are the labs of Paget’s disease of the bone?

A

Calcium, phosphate and PTH levels are normal. Alkaline phosphate levels are increased.

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10
Q

What is the treatment for Paget’s disease of the bone?

A

Bisphosphonates.

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11
Q

What is the cause of rickets and osteomalacia?

A

Vitamin D deficiency.

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12
Q

Why is vitamin D important to calcium?

A

Vitamin D increases calcium absorption in the gut.

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13
Q

How are the labs of vitamin D deficiency?

A
  • Low serum calcium.
  • Increases PTH secretion (stimulates the osteoclasts to break down the bone and release calcium into the circulation and increases calcium reabsorption in the renal tubules).
  • Decreases serum phosphate (PTH is phosphate trashing hormone).
  • Normal or elevated alk phos (any time there is increased bone turnover).
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14
Q

What is another name for osteitis fibrosa cystic?

A

Von Recklinghausen disease of bone.

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15
Q

What is the cause of osteitis fibrosa cystic?

A

It is a bony manifestation of an endocrine disorder. Can be caused by hyperparathyroidism or by Type 1A pseudohypoparathyroidism. Either cause high PTH, which causes excess osteoclastic activity, causing “Brown tumors” in bone which are cystic spaces lined by osteoclastic filled w/ fibrous stroma and blood.

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16
Q

Why does hyperparathyroidism cause von Recklinghausen disease of the bone?

A

High PTH leads to high serum calcium, low serum phosphate, high alkaline phosphatase.

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17
Q

Why does Type 1A pseudohypoparathyroidism cause osteitis fibrosa cystic?

A

It causes PTH resistance at the renal tubules, which leads to low serum calcium and high phosphate. But that low calcium stimulates high PTH production.

18
Q

What is another name for Type IA pseudohypoparathyroidism?

A

Albright hereditary osteodystrophy.

19
Q

What is Polyostotic Fibrous Dysplasia?

A

Bone is replaced by collagen and fibroblasts. There is also irregular trabeculae.

20
Q

What are is the triad of symptoms seen in McCune-Albright syndrome?

A

Precocious puberty, cafe-au-lait spots, and fibrous dysplasia of bone.

21
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Osteoporosis?

A

Everything is normal.

22
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Osteopetrosis?

A

Everything is normal, but maybe calcium little low, alk phos and PTH little high.

23
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Paget disease of bone?

A

Everything normal except alk phos, which should be increased, due to increased bone turnover.

24
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Rickets/osteomalacia?

A

Calcium low, phosphate low, normal or high alk phos, and high PTH.

25
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Renal deficiency?

A

Low calcium, phosphate up, alk phost is normal or little up, and PTH up. (Phosphate is up even though PTH is up because the lesioned renals can’t get rid of phosphate).

26
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Vitamin D intox?

A

Increased Calcium, decreased PTH, increased phospahte, alk phos normal.

27
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Primary hyperparathyroidism?

A

PTH is up, calcium up, Phosphate down, and alk phos up.

28
Q

How is calcium, phosphate, alkaline phosphatase and PTH in Osteitis fibrosa cystica?

A

PTH is up, calcium up, phos down, and alk phos up.

29
Q

What cell types are most similar to osteoclasts?

A

Macrophages.

30
Q

Which bony disease is reversible when vitamin D is replaced?

A

Osteomalacia and rickets.

31
Q

Which bony disease has excess osteoclastic activity that results in disorganized boney architecture?

A

Paget disease of the bone.

32
Q

Which bony disease has bone that is replaced by fibroblast, collagen and irregular bony trabeculae?

A

Polyostotic fibrous dysplasia.

33
Q

Which bony disease has soft bones due to defective mineralization of osteoid?

A

Osteomalacia and rickets.

34
Q

Which bony disease has failure of bone resorption that leads to thickened and dense bones?

A

Osteopetrosis.

35
Q

Which bony disease has genetic deficiency of carbonic anhydrase II?

A

Osteopetrosis.

36
Q

What measures can be taken to prevent osteoporosis?

A

Weight bearing exercise, calcium an vitamin D intake, risk factors such as smoking and glucocorticoids and heparin and treating any hypogonadism.

37
Q

RFF: bone enlargement, bone pain, arthritis.

A

Paget disease of the bone.

38
Q

RFF: Vertebral compression fractures.

A

Osteoporosis.

39
Q

Which selective estrogen receptor modulator is used to treat breast cancer?

A

Tamoxifen, toremifene.

40
Q

Which selective estrogen receptor modulator is used to treat osteoporosis?

A

Raloxifene.

41
Q

What is the cause of osteoporosis?

A

Imbalance of osteoclasts and osteoblasts: osteoclasts more active than osteoblasts.

DIT Rheumatology And Dermatology (7 decks)

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