Bone Disease

Question 1

What is the definition of Osteoporosis?

Answer 1

Metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone leading to increased risk of fractures, the bone is 2.5 SD away from being healthy

Question 2

What are the secondary causes of osteoporosis?

Answer 2

Hyperparathyroidism 
Gh deficiency 
Malabsorption 
Malignanc 
Rheumatic drugs 
Amenorrhea
Oestrogen Deficiency

Question 3

What is the pathogenesis of osteoporosis?

Answer 3

Increased breakdown by osteoclasts and decreased production by osteoblasts

Question 4

What is the presentation of Osteoporosis?

Answer 4

Fractures on low impact
Asymptomatic
Crushed vertebra Colles’s fractures

Question 5

What is the GOLD standard investigation on osteoporosis? What does this scan look at?

Answer 5

Dexa Bone Scan

Bone mineral density

Question 6

What are some other investigations to do in osteoporosis?

Answer 6

Plain radiograph

FBC’s

Question 7

What are the prophylactic measures in OP?

Answer 7

HRT
Physiotherapy
Stop smoking and alcohol
Calcium and vitamin D for those on steroids

Question 8

What are the 4 medical management options for osteoporosis?

Answer 8

Biphosphonates
Vitamin D/ calcium 
Raloxifene
Strotium ranelate
Risk factor assessment

Question 9

What is Rickets?

Answer 9

Severe vitamin D or calcium nutritional deficiency in children
Before the epiphyseal plates have closed

Question 10

What is osteomalacia?

Answer 10

Severe vitamin D or calcium nutritional deficiency in Adults
After the epiphyseal plates have closed

Question 11

What is the most common cause of rickets?

Answer 11

Lack of phosphate or vitamin D deficiency

Question 12

What are the clinical features of rickets?

Answer 12

Stunted growth, curve in the spine, wide bones

Bowed legs

Question 13

What are the clinical features of Osteomalacia?

Answer 13

Joint and bone pain, muscle weakness, abnormal gait, low calcium features = irregular heart, numbness and muscle spasms

Question 14

what are your investigations for these 2?

Answer 14

Serum Vit D, Calcium, phosphate, PTH
X-ray
Bone biopsy

Question 15

What are the managements?

Answer 15

Oral calcium and vitamin D

Bone correction surgery

Question 16

What is Pagets Disease?

Answer 16

This is a disorder of bone remodelling after an initial event of excessive reabsorption, this leads to disorganised bone with more vascualtoyt and less compact meaning it can be fractures more easily

Question 17

What are the causes of Paget’s disease?

Answer 17

This is familial in 30%

Can be caused by an environmental trigger

Question 18

What bones are most commonly involved?

Answer 18

Femoral, pelvis and skull

Question 19

What is the presentation of Paget’s disease

Answer 19

This is a condition in the over 40's, who have:
Bone pain and deformity 
Excessive heat over the bone 
Neurological complications 
Can be complicated by osteosarcoma
FH of pagers disease

Question 20

What is THE diagnostic test in pagets disease?

Answer 20

Raised SERUM ALKALINE PHOSPHATASE
Bone Scan
X-ray/ bon biopsy

Question 21

What is the management of Paget’s bone disease?

Answer 21

Minimal unless skull involvement

IV biphosphonate

Question 22

What is osteogenesis Imperfecta

Answer 22

This is genetic connective tissue disorder where there is very fragile bones form mild trauma and daily living

Question 23

What are the 4 types of OI?

Answer 23

1 = mild, presents in adults
Type 2 = can be lethal by age 1
3 = more severe and progressive
4 = adults but very severe very quickly

Question 24

What re the clinical features of OI?

Answer 24

Growth deficiency 
Defective tooth formation 
Hearing loss
Blue sclera
Barrel chest
Easy bruising 
OI

Question 25

What is the clinical diagnosis and management of OI?

Answer 25

Skin biopsy and genetic testing | IV biphosphonates and that the fractures surgically

Question 26

What is Marfan's syndrome?

Answer 26

This is an autosomal DOMINANT condition in which there is loss of the elastic tissue

Question 27

What is the cause of Marfan's syndrome?

Answer 27

This is due to a defect in the fibrillar gene

Question 28

What are the 3 diagnostic areas that are affected in Marfan's syndrome?

Answer 28

MSK Cardio Occular

Question 29

What MSK symptoms are seen in Marfan's syndrome?

Answer 29

``` Caved chest Long and Thin limbs Scoliosis Thumb sign Back ache ```

Question 30

What ocular symptoms are seen in Marfan's syndrome?

Answer 30

Myopia and retinal detachment

Question 31

What Cardio symptoms are seen in Marfan's syndrome?

Answer 31

Aortic aneurysm - Dilatation/ dissection Aortic/mitral valve murmur Pneumothorax

Question 32

What are the managements for Marfan's Syndrome?

Answer 32

``` Antihypertensives Aortic root Sx Mechanical valve insertion Surgery for ocular symtoms Myopia = corrective lens Physio and analgesia ```