Bones

Question 1

Osteoclast

Answer 1

Break bone down

Question 2

Osteoblast

Answer 2

Bone formation

Question 3

Name some regulating factors of bone density

Answer 3

Genetics 70-80%
Body weight- Low BMI is bad
Sex hormones
Diet and Exercise

Question 4

What causes bone density loss?

Answer 4

Sex hormone deficiency e.g menopause
Low BMI
Diet low in Vitamins C and D

Question 5

Where are the common sites of osteoporotic bone fractures?

Answer 5

Neck of the femur
Vertebral body
Distal Radiu
Humeral Neck

Question 6

What is DXA

Answer 6

A scan used to measure bone density

Question 7

What sites are used in a DXA scan?

Answer 7

Lower Lumbar spine

Hip

Question 8

What is normal in DXA?

Answer 8

Bone density within 1 SD of young adults

Question 9

What scale is used in in deterring whether someone is osteoporotic?

Answer 9

Standard deviation SD from the norm of peak bone density

Question 10

What is classed as Osteopenia?

Answer 10

BMD >1 SD below mean but <2.5SD

Question 11

What is classes as osteoporosis?

Answer 11

BMD >2.5 SD below mean

Question 12

What is classed as severe osteoporosis ?

Answer 12

BMD >2,5 SD below mean and a fragility fracture

Question 13

What are modifiable risk factors for fractures?

Answer 13

Alcohol
Weight
Smoking
Physical inactivity

Question 14

What are non modifiable risk factors for fractures?

Answer 14

Gender and menopause

Question 15

What are secondary causes of fragility fractures?

Answer 15

Hypothyroidism
Coeliac disease
IBD
Cushings

Question 16

What is the lifestyle advice given to those at risk of fractures?

Answer 16

High intensity strength training
Low impact weight bearing
Avoid excess alcohol and smoking
Fall prevention

Question 17

What dietary supplements should be taken by those at risk of fractures?

Answer 17

700Mg calcium

1000Mg post menopausal

Question 18

What treatment should be started on menopausal women before 45 years of age?

Answer 18

HRT

Question 19

When is testosterone replacement used?

Answer 19

Hypogonadal men

Question 20

How do bisphosphonates work?

Answer 20

Taken up by osteoclasts and cause cell death, resulting in reduced bone breakdown
Reduce risk of fractures at all sites

Question 21

Name a bisphosphonate

Answer 21

Alendronate

Risendronate

Question 22

What is the main risk with bisphosphonates?

Answer 22

Osteonecrosis of the Jaw

Question 23

What other bisphosphanate can be used?

Answer 23

Zoledronic acid - IV infusion once yearly

Question 24

What is Denosumab?

Answer 24

Monoclonal antibody for RANKL

Question 25

What is the function of RANKL in osteoclasts?

Answer 25

Prevents activation of RANK which inhibits osteoclast activation

Question 26

What is the monoclonal antibody used in osteoporosis?

Answer 26

Denosumab

Question 27

What is the effect of Corticosteroids on bone?

Answer 27

Reduction of osteoblast activity and lifespan Suppression of osteoblast precursor Reduction of Ca2+ absorption

Question 28

What is usual age of Pagets?

Answer 28

<40 increased incidence in age

Question 29

What is the cause of Pagets?

Answer 29

Environmental trigger in a genetically predisposed individual

Question 30

Where does pages affect?

Answer 30

Long Bones Pelvis Lumbar spine Skull

Question 31

Pagets Presentation

Answer 31

Bone Pain and deformity Deafness Compression neuropathies Raised alkaline phosphates

Question 32

What scan shows the distribution of Pagets?

Answer 32

Isotope scan

Question 33

Treatments in Pagets?

Answer 33

Analgesics and Bisphosphonates

Question 34

What is pathology of Pagets?

Answer 34

Abnormal osteoclast activity followed by abnormal osteoblast activity resulting in abnormal bone -reduced strength and increased fracture risk

Question 35

What is Osteogenesis imperfecta?

Answer 35

Rare group of genetic disorders of Type 1 Collagen

Question 36

What genes are affected?

Answer 36

COLIA1 and COLIA2I

Question 37

What is osteogenesis imperfecta type 1?

Answer 37

Mild

Question 38

What is osteogenesis imperfecta type 2?

Answer 38

Presents in neonates | Incompatible with life

Question 39

What is osteogenesis imperfecta type 3 and 4

Answer 39

Very severe

Question 40

What is the treatment in osteogenesis imperfecta?

Answer 40

No cure Fracture fixation Consider bisphosphonates

Question 41

In a young child presenting with fractures what should always be considered?

Answer 41

Non accidental injury

Question 42

What mode of inheritance is osteogenesis imperfecta?

Answer 42

Autosomal dominant