rheumatology and orthopaedics

Question 1

what is osteomalacia

Answer 1

defective mineralisation of normally synthesised bone matrix in adults (produce osteoid, but this doesn’t become bone, and is osteopenic)

Question 2

2 types of osteomalacia

Answer 2

deficiency of vitamin D (causes hypocalcaemia), deficiency of PO4

Question 3

source of vitamin D, and how it increases Ca2+

Answer 3

from sunlight exposure and diet, acts to increase Ca2+ absorption in intestine, and reabsorption in kidney

Question 4

bone in osteomalacia

Answer 4

lots of osteoid, but not much mineralised bone

Question 5

signs/symptoms in osteomalacia

Answer 5

bone pain/tenderness, fracture, proximal weakness, bone deformity

Question 6

if Ca2+ stays low, what may occur

Answer 6

secondary hyperparathyroidism

Question 7

radiological signs of osteomalacia

Answer 7

mature skeleton, osteopenia, Looser’s zones, codfish vertebrae, bending deformities

Question 8

pseudo/insufficiency fracture 5 locations (Looser’s zones)

Answer 8

high tensile stress areas: medial proximal femur, lateral scapula, pubic rami, posterior proximal ulna, ribs

Question 9

pseudo/insufficiency fracture radiological features

Answer 9

short lucent lines with irregular sclerotic margins

Question 10

what are codfish vertebrae, what conditions are they seen in

Answer 10

biconcave deformity of vertebrae, seen in osteoporosis and osteomalacia (in osteomalacia, biconcave vertebral endplates and dark vertebrae)