Rheumatology - Bone Diseases

Question 1

What is arthritis

Answer 1

inflammation of the joints

Question 2

What is arthrosis

Answer 2

non-inflammatory joint disease

Question 3

What is arthralgia

Answer 3

joint pain

Question 4

What is bone

Answer 4

mineralized connective tissue

Question 5

What are the features of bone

Answer 5

load bearing
dynamic
self repairing
calcium store

Question 6

What does the formation of bone require

Answer 6

correct amount of calcium, phosphate and vitamin D

Question 7

How does bone act as a store for calcium

Answer 7

exchangeable calcium can move from the bone into the ECF

calcium can be lost through the gut and urine

calcium in the blood must be at a precise level for nerve and muscle function

Question 8

What hormone helps promote the correct concentration of calcium

Answer 8

parathyroid hormone

Question 9

What happens if there is low dietary calcium

Answer 9

can result in plasma calcium falling, this causes PTH to increase activating vitamin D production and decrease loss of calcium in the kidney and will promote bone resorption and the calcium will be absorbed into the ECF restoring plasma levels

Question 10

What are the functions of parathyroid hormone

Answer 10

maintains serum calcium level
raised if calcium levels fall
increases calcium release from bone
reduces renal calcium excretion

Question 11

What are conditions that can effect parathyroid hormone

Answer 11

hypoparathyroidism

hyperparathyroidism

Question 12

What is the result of hypoparathyroidism

Answer 12

low serum calcium

Question 13

What are the types of hyperparathyroidism

Answer 13

primary

secondary

Question 14

What is primary hyperparathyroidism

Answer 14

gland dysfunction - tumor

high serum calcium results as there is inappropriate activation of osteoclasts

Question 15

What is secondary hyperparathyroidism

Answer 15

it is caused by low serum calcium which activates the PTH which activates osteoclasts but appropriately to maintain serum calcium level

Question 16

What does hyperparathyroidism result in

Answer 16

increased bone resorption

can see this on radiographs as radiolucencies and reabsorption

Question 17

How does vitamin D go from diet to the gut

Answer 17

it is absorbed by the diet and sent to the blood and processed by the livers and kidneys to produce 1,25-dihydroxycolecalciferol which is the active version necessary for ca gut absorbtion

Question 18

What are issues that can result in vitamin D problems

Answer 18

low sunlight exposure
poor GI absorption
drug interactions

Question 19

Who are at risk of low sunlight exposure

Answer 19

housebound

dark skinned in northern countries (those with melanin absorb sunlight through skin less efficiently)

Question 20

How can someone have poor GI absorption of vitamin d

Answer 20

poor nutrition

small intestine disease resulting in malabsorption

Question 21

What drug interactions can cause vitamin d problems

Answer 21

antiepileptics

carbamazepine
phenytoin

Question 22

What is osteomalacia

Answer 22

poorly mineralized osteoid matrix (bone is formed normally but it is not mineralized properly)

poorly mineralized cartilage growth plate

Question 23

What is osteoporosis

Answer 23

loss of mineral and matrix (less matrix so correct bone mass it not achieved but matrix that is present is normally mineralized)

reduced bone mass

Question 24

What is osteomalacia that occurs during bone formation called

Answer 24

rickets

Question 25

What is rickets and osteomalacia related to

Answer 25

calcium deficiency | serum calcium preserved at expense of bone

Question 26

What are the bone effects of osteomalacia

Answer 26

bones bend under pressure - bow legs vertebral compression in adults causing pain in nerves effecting lower limbs bones ache to touch

Question 27

What are the hypocalcemia effects seen in osteomalacia

Answer 27

muscle weakness trosseau and Chvostek signs positive carpal muscle spasm facial twitching from VII tapping

Question 28

What is the serum calcium compared to normal in osteomalacia

Answer 28

decreased

Question 29

What is the serum phosphate compared to normal in osteomalacia

Answer 29

decreased

Question 30

What is the alkaline phosphate compared to normal in osteomalacia

Answer 30

very high

Question 31

What is the plasma creatine compared to normal in osteomalacia

Answer 31

increased if renal cause

Question 32

What is the plasma parathyoird hormone compared to normal in osteomalacia

Answer 32

increased if secondary hyperparathyroidism

Question 33

What is the management of osteomalacia

Answer 33

correct the cause if there is malnutrition and control GI disease sunlight exposure - 30 mins x 5 dietary vitamin D - easiest way

Question 34

What is osteoporosis defined as

Answer 34

reduced quantity in normally mineralized bone

Question 35

What is osteoporosis related to

Answer 35

age | inevitable

Question 36

What are osteoporosis risk factors

Answer 36

``` age female sex endocrine genetic patient factors medical drug use ```

Question 37

What are the endocrine risk factors for OP

Answer 37

ostestrogen and testosterone deficiency | cushings syndromes

Question 38

What are the genetic risks for OP

Answer 38

family history race - caucasian & asian women early menopause

Question 39

What are the patient factor risks for OP

Answer 39

inactivity smoking excess alcohol use poor dietary calcium

Question 40

What are the medical drugs use risk factors for OP

Answer 40

steroids | anti epileptics as they can effect calcium metabolism

Question 41

What is the peak bone mass at

Answer 41

age 24-35

Question 42

Why are women more at risk of OP

Answer 42

men have higher peak bone mass estrogen withdrawal increases (menopause)bone mass loss rate in women less exercise in women (not really anymore)

Question 43

Why is having a higher bone mass reducing risk of OP

Answer 43

the OP clinical effects are not based on changes relative to bone mass but the absolute peak bone mass

Question 44

What are the effects of OP

Answer 44

increased bone fracture risk esp in long bones such as the femur

Question 45

What are the effects of OP on the vertebrae

Answer 45

see height loss because of the bending forward of the spine kyphosis and scoliosis nerve root compression - back pain

Question 46

What are the to ways of preventing osteoporosis

Answer 46

build maxilla peak bone mass reduce rate of bone mass loss reduce drug related effects

Question 47

How do we build maximal peak bone mass

Answer 47

exercise | high dietary calcium intake

Question 48

How do we reduce rate of bone mass loss

Answer 48

continue exercise and calcium intake reduce hormone related effects such as estrogen hormone replacement therapy but this is most effective if early menopause

Question 49

What does estrogen only HRT do

Answer 49

reduces OP risk increases breast cancer risk increases endometrial cancer risk for patients who have not had a hysterectomy. can be combined with progestogen to reduce risk may reduce ovarian cancer risk increases DVT risk benefit lost after hRT stops

Question 50

How do we use drugs to help prevent osteoporosis

Answer 50

consider osteoporosis prevention drugs - biphosphonates

Question 51

How do bipshonates work

Answer 51

poison osteoclasts and reduce their numbers

Question 52

What are the two types of biphosphonates

Answer 52

non nitrogenous | nitrogenous

Question 53

What are the 3 main bisphonates used

Answer 53

alendronate ibandronate zolendronate