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Scientific Basis of Medicine > The case of the Crumbling Spine > Flashcards

The case of the Crumbling Spine Flashcards

1
Q

Fragility fracture?

A

Fragility fracture

fracture caused by fall from standing height or less or spontaneous

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2
Q

Causes of Fragility Fractures (4)

A

reduced bone mineral density
altered bone architecture
changed bone material properties
treatment non-adherence

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3
Q

how do we measure bone mineral density?

A 
how do we measure bone mineral density?
bone densitometry (DEXA)
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4
Q

how do we evaluate bone architecture?

A

how do we evaluate bone architecture?
trabecular bone score
high res peripheral CT

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5
Q

what bone materials can change causing fragility fractures?

A

type 1 collagen

hydroxyapatite crystals

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6
Q

what bone materials can change causing fragility fractures?

A

get advanced glycation end products which can damage collagen

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7
Q

how can collagen be linked to fragility fractures?

A

mutations causing not enough or abnormal collagen

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8
Q

Bone remodelling cycle

A

Quiescence, resorption, reversal, formation

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9
Q

osteoclast action

A

resorption of bone

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10
Q

How are osteoblasts activated?

A

growth factors are released by osteoclasts

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11
Q

how do oestoblasts and osteoclasts change in menopause?

A

osteoclasts become more active than osteoblasts

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12
Q

How are osteoclasts activated?

A

RANKL from osteoblasts binds and causes osteoclast precursors to mature

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13
Q

Osteoprotegerin (OPG)

A

decoy receptor
blocks binding of RANK to RANK-L > reduces osteoclast differentiation
increases bone density

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14
Q

How does menopause cause osteoporosis?

A

reduced oestrogen causes reduced Osteoprotegerin expression

osteoclasts more active

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15
Q

mechanism of demosumab

A

decoy receptor for RANKL, mimics action of OPG

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16
Q

how is demosumab administered?

A

6 monthly injection

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17
Q

sclerostin

A

Made by osteocytes and suppresses bone formation

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18
Q

Wnt pathway in osteoporosis

A

canonical wnt pathway enhances osteoblast differentiation, upregulates OPG and down regulates RANKL

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19
Q

mechanism of romosozumab

A

antisclerostin antibody so enables Wnt system to remain active
get bone rebuilding

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20
Q

2 monoclonal antibodies used in the treatment of osteoporosis

A

denosumab

romosozumab

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21
Q

grancalcin

A

a protein that represses osteogenesis

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22
Q

what secretes grancalcin?

A

senescent immune cells

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23
Q

Osteoporosis

A

disorder of bone characterised by low bone mass and microarchitectural deterioration, increased fracture risk

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24
Q

primary osteoporosis type 1

A

postmenopausal, accelerated decrease in bone mass that occurs when estrogen falls

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25
Q

primary osteoporosis type 2

A

senile

affects men and women>70 yo

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26
Q

Primary osteoporosis T1 vs T2

A

postmenopausal, accelerated decrease in bone mass that occurs when estrogen falls = t1

senile
affects men and women>70 yo = t2

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27
Q

which sex suffer from primary osteoporosis more?

A

females

28
Q

secondary osteoporosis

A

conditions in which bone is lost because of the presence of another disease, such as rheumatoid arthritis or certain drug use

29
Q

what drugs cause secondary osteoporosis?

A 
steroids
aromatase inhibitors
anti-epileptics
thyroxine
proton pump inhibitors
30
Q

what determines bone mass?

A
  • heredity
  • nutrition
  • exercise
  • hormone function
31
Q

DEXA

A

dual-energy x-ray absorptiometry

32
Q

which sites does DEXA image?

A

lumbar spine
hip
right forearm

33
Q

when do you DEXA scan right forearm?

A

in hyperparathyroidism or non-diagnostic spine/hip

34
Q

How does DEXA work?

A

measures bone density based on how easily low dose x-rays go through the bone

35
Q

T score

A

Standard deviation between BMD and that of a young healthy adult (30?)

36
Q

Z score

A

standard deviation between BMD and that of someone the same age

37
Q

what factors do the T and Z scores take into account?

A

gender and ethnicity

38
Q

normal T score for post menopausal women or men over 50

A

equal or greater than -1

39
Q

What T score shows osteoporosis?

A

equal or below -2.5

40
Q

what T score shows osteopenia?

A

what T score shows osteopenia?

between -1 and -2.5

41
Q

what does a Z score of below -2 mean?

A

BMD lower than it should be for someone age matched

42
Q

which score out of the sites imaged should you use for diagnostic purposes?

A

lowest score out of total spine, total hip, NOF or total forearm

43
Q

which DEXA score do you use for premenopausal women or men under 50?

A

Z score only

44
Q

FRAX

A

Fracture risk assessment tool developed by WHO

45
Q

what does FRAX use?

A

femoral neck BMD score

clinical risk factors e.g. age, steroid use, height

46
Q

what does FRAX calculate?

A

10yr risk of osteoporotic fracture

47
Q

do people under 50 need a low BMD for diagnosis of osteoporosis?

A

no, can give diagnosis if they have a fragility fracture regardless

48
Q

cortical bone

A

dense outer bone, strength determined by thickness and porosity

49
Q

trabecular bone

A

interior, spongy bone with a porous, honeycomb structure, strength determined by thickness, lattice number and porosity

50
Q

trabecular bone score

A

from textural analysis of DEXA

independent fracture risk assessment

51
Q

can the same BMD score have a different trabecular bone score?

A

yes

52
Q

HR-pQCT

A

research tool that does high res CT of wrist and ankles, looks at volume of bone

53
Q

what does osteoporosis look like on X-ray?

A

cortical thinning/increased radiolucency
pencilling of vertebrae

osteoporosis x-ray
the time abnormalities defected by X-ray 25-30 % of bone tissue may have been lost

54
Q

interventional radiology - what is it?

A

image guided diagnostic or therapeutic procedures achieved through percutaneous puncture of a vessel or organ

55
Q

examples of IR

A

iliac angioplasty
interventional oncology
visceral embolisation
stenting

56
Q

what are most preventable deaths from trauma caused by?

A

unrecognised haemorrhage, especially abdomen

57
Q

aortic transection

A

Injury to the aorta consisting of laceration of all 3 layers of the vessel wall

58
Q

Sign of aortic transection

A

aortic transection

59
Q

fatality rates in aortic transection

A

30% fatal within 6hrs, 40% in 24hrs

60
Q

what can you repair aortic transection with?

A

Dacron graft

61
Q

how can a fracture cause limb ischaemia?

A

how can a fracture cause limb ischaemia?

oedema or bone compresses artery causing ischaemia

62
Q

examples of embolic agents

A

coils
cyanoacrylate glue
temporary gelatin sponge

63
Q

Grades of renal trauma

A
64
Q

TACE interventional oncology

A

high dose chemo straight into tumour via arteries which feed them

65
Q

radiofrequency ablation

A

thin needle in core of tumor extends prongs, these are heated and cook tumour

66
Q

optimum tumour size for radio frequency ablation

A

2cm

67
Q

cryoablation

A

removing tumours with liquid nitrogen causing cell apoptosis

Scientific Basis of Medicine (35 decks)

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