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MSK > Metabolic Bone Disease > Flashcards

Metabolic Bone Disease Flashcards

1
Q

What is osteoporosis?

A

Reduction in the density of bones
Most common metabolic bone disease

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2
Q

What is the consequence of osteoporosis?

A

Enhanced bone fragility and more prone to fractures

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3
Q

What are the risk factors for osteoporosis?

A

Old age
Female
Reduced mobility and activity
Low BMI
RA
Alcohol and smoking
Long term steroids
SSRIs, PPIs, anti-oestrogens

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4
Q

What is a key group to consider in osteoporosis?

A

Post- menopausal women
Oestrogen is protective against osteoporosis
Postmenopausal women have less oestrogen

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5
Q

What is FRAX tool?

A

Prediction of the risk of a fragility fracture over the next 10 years

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6
Q

What are the components of FRAX?

A

Age
BMI
Comorbidities
Smoking
Alcohol
FH

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7
Q

What is a DEXA scan?

A

Dual- energy X ray absorptiometry
Measure bone mineral density (BMD)

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8
Q

What is the first step in assessing osteoporosis?

A

Perform a FRAX assessment on at risk patients

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9
Q

What lifestyle changes are used for osteoporosis management?

A

Activity and exercise
Maintain a healthy weight
Adequate calcium intake
Adequate vitamin D
Avoiding falls
Stop smoking
Reduce alcohol consumption

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10
Q

What medical options are used for osteoporosis?

A

Vitamin D and Calcium
Bisphosphonates
Denosumab
Raloxifene
HRT

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11
Q

Describe bisphosphonates

A

First line treatment
Interfere with osteoclasts preventing bone resorption

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12
Q

Describe bisphosphonates

A

First line treatment
Interfere with osteoclasts preventing bone resorption
E.g. Alendronate

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13
Q

What are the side effects of bisphosphonates?

A

Reflux and oesophageal erosions
Atypical fractures
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal

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14
Q

Describe denosumab

A

Monoclonal antibody that blocks osteoclast activity

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15
Q

Describe raloxifene

A

Selective oestrogen receptor modulator- stimulates oestrogen receptors on bone
Secondary prevention only

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16
Q

Describe HRT

A

Use din early menopause women

17
Q

What is osteomalacia?

A

Condition where there is defective bone mineralisation causing ‘soft’ bones

18
Q

What causes osteomalacia?

A

Insufficient Vitamin D

19
Q

What is the role of vitamin D in normal physiology?

A

Vitamin D is essential in calcium and phosphate absorption from the intestines and kidneys.
It is also responsible for regulating bone turnover

20
Q

What is the pathophysiology of osteomalacia?

A

Inadequate vitamin D leads to a lack of calcium and phosphate
Results in defective bone mineralisation
Low calcium causes hyperparathyroidism leading to increased bone reabsorption

21
Q

What patients are at risk of osteomalacia?

A

Darker skin- require a longer period of sun exposure to generate the same quantity of Vitamin D
Malabsorption disorders- reduced Vitamin D from diet
Chronic kidney disease- reduced Vitamin D metabolism

22
Q

What is the presentation of osteomalacia?

A

Fatigue
Bone pain
Muscle weakness
Muscle aches
Pathological fractures

23
Q

What investigation results are seen in osteomalacia?

A

Low serum 25-hydroxyvitamin D (<25nmol/L)
Low serum calcium
Low serum phosphate
High serum ALP
High PTH
DEXA shows low BMD
X rays show osteopenia

24
Q

What is the treatment of osteomalacia?

A

Supplementary Vitamin D (colecalciferol)

25
Q

What is the name for osteomalacia in children?

A

Rickets

26
Q

What is Paget’s disease?

A

Disorder of bone turnover
Excessive activity of osteoblasts and osteoclasts
Leads to patchy areas of high density (sclerosis) and low density (lysis)

27
Q

What part of the skeleton is particularly affected in Paget’s?

A

Axial skeleton

28
Q

What is the result of Paget’s disease on bone?

A

Enlarged and deformed bones
Increased risk of pathological fractures

29
Q

What is the presentation of Paget’s?

A

Bone pain
Bone deformity
Fractures
Hearing loss- bones in ear

30
Q

What age group is affected by Paget’s?

A

Older adults

31
Q

What are the x ray findings for Paget’s?

A

Bone enlargement and deformity
Osteoporosis circumscripta- well defined osteolytic lesions
Cotton wool appearance- patchy skull
V shaped defects- long bone

32
Q

What are the biochemical reuslts for Paget’s?

A

Raised ALP
Normal calcium and phosphate

33
Q

What is the management of Paget’s?

A

Bisphosphonates- main treatment. Restore normal bone metabolism
NSAIDs- bone pain
Calcium and Vit D supplements

34
Q

Why is surgery rare in Paget’s?

A

Pagetic bone is very vascular

35
Q

What are the complications of Paget’s?

A

Osteosarcoma
Spinal stenosis and spinal cord compression

MSK (20 decks)

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