Pathphysiology: Metabolic Bone Disorders: Okatai

Question 1

What Vit D do you order to see if PTH is working?

Answer 1

1,25 Vit D (not 25…)

Question 2

Osteo fibrosis cystica is due to what?

Answer 2

Too much PTH

Question 3

What is the major contributor to fracture risk?

Answer 3

Age
Gender
BMI
High salt intake
Thinness
No activity
Smoking
Alcohol
GI disease

Question 4

Hormonal causes of osteoporosis?

Answer 4

HyperPTH
Low T, androgen insensitivity
Low E
Cortisol
Thyrotoxicosis
DM1 and 2
Adrenal insufficiency
Hyper prolactinemia
Hypopituitary

Question 5

High calcium makes you check for what leukemia?

Answer 5

MMyeloma

Monoclonal gammopathy

Question 6

Blood tests for low bone density?

Answer 6

PTH
25 Vit D
CMP, PO4, Mg
TSH
T
CBC
24 hour urine

Question 7

Why order a 24 hour urine Ca when blood Ca is normal?

Answer 7

If losing Ca in urine, blood is only normal because bone is being degraded to fill the gap

Question 8

What is the DEXA Z score compared to?

Answer 8

Age, sex, ethinicty of matched population

Question 9

What is the DEXA T score compared to?

Answer 9

Young adult reference population

Question 10

Who needs bone density testing?

Answer 10

F>65
M>70
Younger postmenopausal women with risk
Men 50-69 with risk 
Any adult with fracture after 50
Cortisol drug pts.

Question 11

What are 3 markers of bone FORMATION?

Answer 11

Bone Alk Phos
Osteocalcin
Aminoterminal propeptide of Type I procollagen

Question 12

What are markers of bone RESORPTION?

Answer 12

Serum C telopeptide

Urinary N-telopeptide

Question 13

What is FRAX?

Answer 13

calculation for 10 year probability of fracture

Question 14

Drugs for osteoporosis?

Answer 14

Calcitonin
Bisphosphonates
Estrogen
SERMs
RANK-L
Teriperidide (PTH)