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BDS3 BAMS Diseases of Human Systems > Rheumatology - Bone Diseases > Flashcards

Rheumatology - Bone Diseases Flashcards

1
Q

What is arthritis

A

inflammation of the joints

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2
Q

What is arthrosis

A

non-inflammatory joint disease

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3
Q

What is arthralgia

A

joint pain

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4
Q

What is bone

A

mineralized connective tissue

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5
Q

What are the features of bone

A

load bearing
dynamic
self repairing
calcium store

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6
Q

What does the formation of bone require

A

correct amount of calcium, phosphate and vitamin D

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7
Q

How does bone act as a store for calcium

A

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

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8
Q

What hormone helps promote the correct concentration of calcium

A

parathyroid hormone

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9
Q

What happens if there is low dietary calcium

A

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

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10
Q

What are the functions of parathyroid hormone

A

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

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11
Q

What are conditions that can effect parathyroid hormone

A

hypoparathyroidism

hyperparathyroidism

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12
Q

What is the result of hypoparathyroidism

A

low serum calcium

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13
Q

What are the types of hyperparathyroidism

A

primary

secondary

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14
Q

What is primary hyperparathyroidism

A

gland dysfunction - tumor

high serum calcium results as there is inappropriate activation of osteoclasts

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15
Q

What is secondary hyperparathyroidism

A

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

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16
Q

What does hyperparathyroidism result in

A

increased bone resorption

can see this on radiographs as radiolucencies and reabsorption

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17
Q

How does vitamin D go from diet to the gut

A

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

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18
Q

What are issues that can result in vitamin D problems

A

low sunlight exposure
poor GI absorption
drug interactions

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19
Q

Who are at risk of low sunlight exposure

A

housebound

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

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20
Q

How can someone have poor GI absorption of vitamin d

A

poor nutrition

small intestine disease resulting in malabsorption

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21
Q

What drug interactions can cause vitamin d problems

A

antiepileptics

carbamazepine
phenytoin

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22
Q

What is osteomalacia

A

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

poorly mineralized cartilage growth plate

23
Q

What is osteoporosis

A

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

24
Q

What is osteomalacia that occurs during bone formation called

A

rickets

25
Q

What is rickets and osteomalacia related to

A

calcium deficiency

serum calcium preserved at expense of bone

26
Q

What are the bone effects of osteomalacia

A

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

27
Q

What are the hypocalcemia effects seen in osteomalacia

A

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

28
Q

What is the serum calcium compared to normal in osteomalacia

A

decreased

29
Q

What is the serum phosphate compared to normal in osteomalacia

A

decreased

30
Q

What is the alkaline phosphate compared to normal in osteomalacia

A

very high

31
Q

What is the plasma creatine compared to normal in osteomalacia

A

increased if renal cause

32
Q

What is the plasma parathyoird hormone compared to normal in osteomalacia

A

increased if secondary hyperparathyroidism

33
Q

What is the management of osteomalacia

A

correct the cause if there is malnutrition and control GI disease

sunlight exposure - 30 mins x 5

dietary vitamin D - easiest way

34
Q

What is osteoporosis defined as

A

reduced quantity in normally mineralized bone

35
Q

What is osteoporosis related to

A

age

inevitable

36
Q

What are osteoporosis risk factors

A 
age
female sex
endocrine 
genetic
patient factors
medical drug use
37
Q

What are the endocrine risk factors for OP

A

ostestrogen and testosterone deficiency

cushings syndromes

38
Q

What are the genetic risks for OP

A

family history
race - caucasian & asian women
early menopause

39
Q

What are the patient factor risks for OP

A

inactivity
smoking
excess alcohol use
poor dietary calcium

40
Q

What are the medical drugs use risk factors for OP

A

steroids

anti epileptics as they can effect calcium metabolism

41
Q

What is the peak bone mass at

A

age 24-35

42
Q

Why are women more at risk of OP

A

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

43
Q

Why is having a higher bone mass reducing risk of OP

A

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

44
Q

What are the effects of OP

A

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

45
Q

What are the effects of OP on the vertebrae

A

see height loss because of the bending forward of the spine

kyphosis and scoliosis

nerve root compression - back pain

46
Q

What are the to ways of preventing osteoporosis

A

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

47
Q

How do we build maximal peak bone mass

A

exercise

high dietary calcium intake

48
Q

How do we reduce rate of bone mass loss

A

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

49
Q

What does estrogen only HRT do

A

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

50
Q

How do we use drugs to help prevent osteoporosis

A

consider osteoporosis prevention drugs - biphosphonates

51
Q

How do bipshonates work

A

poison osteoclasts and reduce their numbers

52
Q

What are the two types of biphosphonates

A

non nitrogenous

nitrogenous

53
Q

What are the 3 main bisphonates used

A

alendronate
ibandronate
zolendronate

BDS3 BAMS Diseases of Human Systems (11 decks)

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