Bone Disorders

Question 1

what destroys bone?

Answer 1

osteoclasts

Question 2

what rebuilds bone?

Answer 2

osteoblasts

Question 3

female bone mass significantly reduces at what age/stage?

Answer 3

menopause

50s/60

Question 4

what 2 classes of drug results in bone loss?

Answer 4

glucocorticoids and aromatase inhibitors

Question 5

name the 4 common fracture sites

Answer 5

neck of femur
vertebral body
distal radius
humeral neck

Question 6

those with osteoporosis often have thoracic ______sis

Answer 6

those with osteoporosis often have thoracic KYPHOSIS

Question 7

what scan is performed to measure bone mass?

Answer 7

DEXA scan

Question 8

normal
osteopenia
osteoporosis
severe osteoporosis

BMD ≥ 2.5 SD below the young adult mean

Answer 8

osteoporosis

Question 9

normal
osteopenia
osteoporosis
severe osteoporosis

BMD within 1 SD of the young adult reference mean

Answer 9

normal

Question 10

normal
osteopenia
osteoporosis
severe osteoporosis

BMD >1 SD below the young adult mean but <2.5 SD below this value

Answer 10

osteopenia

Question 11

normal
osteopenia
osteoporosis
severe osteoporosis

BMD ≥2.5 SD below the young adult mean with fragility fracture

Answer 11

severe osteoporosis

Question 12

if younger than 20, what is the only thing reported?

Answer 12

z score

Question 13

who should be referred for DEXA?

Answer 13

patients over 50
low trauma fracture

10 year risk assessment for any OP fracture of at least 10%

Question 14

name the risk assessment tool for increased risk of fracture

Answer 14

FRAX or Qfracture

Question 15

WHO fracture risk calculator allows prediction of __ year fracture risk of major osteoporotic fracture or hip fracture

Answer 15

WHO fracture risk calculator allows prediction of 10 year fracture risk of major osteoporotic fracture or hip fracture

Question 16

those under the age of 50 that have undergone early ________ or on _______________ should be assessed

Answer 16

those under the age of 50 that have undergone early MENOPAUSE or on GLUCOCORTICOIDS should be assessed

Question 17

lifestyle advice for management of osteoporosis?

Answer 17

strength training
avoidance of alcohol
avoidance of smoking
fall prevention

Question 18

how much calcium in those with osteoporosis should they get?

Answer 18

700mg calcium (2-3 portions)

postmenopausal women - 1000mg calcium

Question 19

what 2 supplements should those with osteoporosis receive?

Answer 19

calcium and vitamin D

Question 20

name the drug class prescribed in osteoporosis that prevent bone loss at all sites vulnerable to osteoporosis

Answer 20

biphosphonates - alendronate and risedronate

target osteoclast activity

reduce risk of hip and spine fractures

Question 21

long term concern of biphosphonate therapy?

Answer 21

osteonecrosis of the jaw

GI upset

Question 22

what is an alternative to biphosphonates due to GI upset?

Answer 22

zoledronic acid

once yearly IV infusion for 3 years

Question 23

name the monoclonal antibody that inhibits development and activity of osteoclasts

Answer 23

denosumab

SC injection 6 monthly

Question 24

adverse effects of densomab?

Answer 24

hypocalcaemia
eczema
cellulitis

Question 25

name the recombinant hormone that stimulates bone growth rather than reduce bone loss

Answer 25

teriparatide used in those who can't tolerate oral treatment

Question 26

corticosteroids ______ osteoblast activity and calcium absorption

Answer 26

corticosteroids REDUCE osteoblast activity and calcium absorption also inhibit gonadal and adrenal steroid production

Question 27

name the following disease: abnormal osteoclastic activity followed by increased osteoblastic activity

Answer 27

paget's disease abnormal bone structure with reduced strength and increased fracture risk

Question 28

what type of bones does pagets affect?

Answer 28

long bones also pelvis, lumbar spine and skull

Question 29

what causes pagets?

Answer 29

viral/environmental/biochemical trigger in genetically predisposed individuals

Question 30

what does pagets present with?

Answer 30

bone pain, deformity, deafness, compression neuropathies

Question 31

biochemistry of pagets: high what?

Answer 31

ALP - alkaline phosphatase

Question 32

how do you diagnose pagets?

Answer 32

high ALP and XR

Question 33

pagets treatment?

Answer 33

biphosphonates

Question 34

``` rare children fracture blue sclera dentinogenesis imperfecta ``` diagnosis?

Answer 34

Osteogenesis Imperfecta autosomal dominant mutations in collagen genes

Question 35

Osteogenesis Imperfecta cure?

Answer 35

no cure fracture fixation, surgery and biphosphonates DHx for suspected non-accidental injury