Bone Disorders

Question 1

Define osteoporosis

Answer 1

Progressive decrease in bone mass and deterioration of bone tissue, causing increased fragility and susceptibility of fracture

Question 2

Osteoporosis is more common in men than women. True/False?

Answer 2

False

Women

Question 3

List common fracture sites due to osteoporosis

Answer 3

Neck of femur
Vertebral body
Distal radius
Humeral neck

Question 4

Describe the bone remodelling cycle that occurs in bone remodelling units

Answer 4

Osteoclasts act on an inactive surface and resorbs bone; these are then replaced by osteoblasts that fill the cavity by laying osteoid; osteoid is then mineralised to form new bone

Question 5

What is the abnormal process occurring in osteoporosis?

Answer 5

Relative/absolute increase in bone resorption compared to formation

Question 6

In women, what is the major determinant of bone loss following menopause?

Answer 6

Oestrogen deficiency

Question 7

What is the most widely used method of assessing bone mineral density and fracture risk respectively?

Answer 7

DEXA scan

Q fracture

Question 8

Define normal BMD

Answer 8

Within 1 standard deviation of young adult reference mean

Question 9

Define osteopenic BMD

Answer 9

BMD between 1 and 2.5 standard deviations below young adult reference

Question 10

Define osteoporotic BMD

Answer 10

BMD of 2.5 or more standard deviations below young adult reference

Question 11

Low BMD is proportional with increased risk of fracture. True/False?

Answer 11

True

Question 12

List lifestyle advice for osteoporosis

Answer 12

High intensity strength training
Low impact weight-bearing exercise
Avoid smoking and alcohol
Diet management

Question 13

List drug treatment for osteoporosis

Answer 13

Calcium and vitamin D supplements
Biphosphonates
Denosumab
Teriparatide
Strontium ranelate
HRT
SERMs
Testosterone

Question 14

How do bisphosphonates work?

Answer 14

Antiresorptive agents to prevent bone loss at vulnerable sites; absorb onto bone and ingested by osteoclasts, leading to cell death

Question 15

Give examples of biphosphonates

Answer 15

Alendronate

Risedronate

Question 16

When would antiresorptive therapy be started in patients?

Answer 16

T score less than -2.5

Question 17

List some long term concerns/complications of biphosphonates

Answer 17

Osteonecrosis of jaw
Oesophageal cancer
Atypical fractures

Question 18

Which complication of osteoporosis is zoledronic acid particularly useful for?

Answer 18

Reduces risk + incidence of fractures

Question 19

What is denosumab and why is it useful for osteoporosis?

Answer 19

Monoclonal antibody treatment that antagonises RANK to inhibit development of osteoclasts, resulting in increased bone density

Question 20

Strontium renelate is the 3rd line treatment for osteoporosis - why?

Answer 20

Antiresorptive capacity is lower than bisphosphonate

Has more contraindications

Question 21

What is teriparatide?

Answer 21

Recombinant PTH that helps stimulate bone growth

Question 22

What is Paget’s disease? What are the two types?

Answer 22

Abnormal osteoclast activity resulting in increased osteoblast activity
Mono- or polystatic

Question 23

Which bones does Paget’s disease typically affect?

Answer 23

Long bones
Pelvis
Lumbar spine
Skull

Question 24

List clinical features of Paget’s disease

Answer 24

Bone pain
Deformity
Deafness
Compression neuropathy

Question 25

What is the main treatment for Paget's disease?

Answer 25

Analgesia | Biphosphonates if pain not responding

Question 26

List investigations used to diagnose osteoporosis

Answer 26

``` U+Es/LFTs/FBC/PV/TSH Bone biochemistry Protein electrophoresis/ Bence Jones proteins Coeliac Igs Testosterone Vitamin D PTH ```

Question 27

List some secondary causes of osteoporosis

Answer 27

Endocrine (hyperthyroidism, hyperparathyroidism, cushings disease) GI (coeliac disease, IBD, CLD, chronic pancreatitis) Respiratory (CF, COPD) CKD

Question 28

What type of malignancy is associated with Paget's disease?

Answer 28

Osteosarcoma

Question 29

List investigations for Paget's disease

Answer 29

XR (incidental) | Isotope bone scan

Question 30

What bone biochemistry would you expect in Paget's disease?

Answer 30

Increased Alk Phos with normal LFTs

Question 31

Osteogenesis imperfecta affects type __ collagen

Answer 31

1

Question 32

List clinical features of osteogenesis imperfecta

Answer 32

Blue sclerae Dentinogenesis imperfecta Severe fracture in childhood

Question 33

Name a differential diagnosis for osteogenesis imperfecta

Answer 33

NAI

Question 34

Outline management of osteogenesis imperfecta

Answer 34

Fracture fixation Surgery to correct deformity Biphosphonates