Bones - Acquired Disorders

Question 1

Osteopenia

Answer 1

Decreased bone mass

Question 2

With Osteopenia, how many SD’s below the mean must be present?

Answer 2

1-2.5 SD below mean

Question 3

Osteoporosis

Answer 3

Very decreased bone mass with fracture risk

Question 4

With Osteoporosis, how many SD’s below the mean must be present?

Answer 4

More than 2.5 SD below the mean

Question 5

What are the signs of Osteoporosis?

Answer 5

Vertebral compression fractures or atraumatic fractures

Loss of height

Question 6

What are the signs of Osteoporosis?

Answer 6

Vertebral compression fractures or atraumatic fractures

Loss of height

Question 7

The magnitude of bone deficits that accumulate each year of life are determined by?

Answer 7

Hereditary factors

Question 8

What treatment can often increase bone loss?

Answer 8

Breast cancer treatment (tamoxifen)

Question 9

What are some risk factors for Osteoporosis?

Answer 9

Caucasian
Low calcium
High phosphorus
Smoke exposure

Question 10

Age-related Osteoporosis

Answer 10

Decreased capacity to make bone (low turnover variant)

Question 11

Decreased physical activity correlates with?

Answer 11

Increased rate of bone loss

Question 12

Between load magnitude and load cycles, which physical activity is better for decreasing rate of bone loss?

Answer 12

Load magnitude – resistance exercises are better

Question 13

Adolescent girls have insufficient ____ intake during growth that causes a decreased peak bone mass to be achieved

Answer 13

Insufficient calcium intake

Question 14

Hormones can play a major role in the pathogenesis of Osteoporosis. Especially when?

Answer 14

Post-menopause = accelerated bone loss

Question 15

_____ Estrogen can cause Osteoporosis

Answer 15

DECREASED

Question 16

Decreased Estrogen causes _____ resorption&raquo_space; formation

Answer 16

Increased resorption (high turnover variant)

Question 17

Decreased Estrogen can also activate what things to cause bone resorption?

Answer 17

RANKL
Cytokines
==> (+) osteoclasts

Question 18

How does Osteoporosis look on histo?

Answer 18

NORMAL – just decreased bone in quantity

Question 19

Post-menopausal Osteoporosis involves increased Osteoclast activity. What changes can be seen on the bone?

Answer 19

Trabeculae thinned and loss of the horizontal trabeculae

– microfractures and vertebral collapse

Question 20

Post-menopausal Osteoporosis involves thinned trabeculae. Senile Osteoporosis involves thinned ____

Answer 20

Thinned cortex = senile

Question 21

What causes Rickets and Osteomalacia?

Answer 21

Vitamin D Deficiency –> impairs mineralization

Question 22

What causes Rickets and Osteomalacia?

Answer 22

Vitamin D Deficiency –> impairs mineralization

Question 23

Rickets occurs in ____ and interferes with bone deposition where?

Answer 23

Kids - interferes with deposition of bone at growth plate

Question 24

What are the signs of Rickets?

Answer 24

Frontal bossing of head
Rachitic Rosary of ribs
Bowed legs
Pigeon breast deformity of chest

Question 25

A kid presents with frontal bossing, bowed legs, rachitic rosary of the ribs and pigeon chest. What do they have?

Answer 25

Rickets

Question 26

Osteomalacia occurs in?

Answer 26

Adults | -- prone to fractures

Question 27

Hyperparathyroidism involves Increased PTH which = ___

Answer 27

Increased PTH = Increased Calcium

Question 28

Describe the cascade seen with Hyperparathyroidism

Answer 28

- PTH increases RANKL to (+) osteoclasts - Calcium is resorbed by renal tubules - Urinary excretion of phosphates - Increased vitamin D synthesis increases RANKL

Question 29

Hyperparathyroidism involves ___ bone mass along with fractures, deformities, etc.

Answer 29

Decreased bone mass

Question 30

What 3 things can be seen morphologically with untreated Hyperparathyroidism?

Answer 30

1. Osteoporosis 2. Brown tumor - secondary hemorrhage mass lesion 3. Von Recklinghausen - clasts tunnel to form "railroad tracks"

Question 31

Renal Osteodystrophy

Answer 31

Skeletal changes that occur with chronic renal disease

Question 32

What molecule is increased in the blood with Renal Osteodystrophy?

Answer 32

Hyperphosphatemia

Question 33

Paget Disease

Answer 33

INCREASED bone mass -- disorganized

Question 34

With disease involves increased bone mass?

Answer 34

Paget Disease

Question 35

Paget Disease usually affects 1 or multiple bones?

Answer 35

Multiple

Question 36

What bones are usually involved with Paget Disease?

Answer 36

Axial skeleton | Femur

Question 37

Some cases of Paget disease are asscociated with mutations in what gene?

Answer 37

SQSTM1

Question 38

How does the bone look with Paget Disease?

Answer 38

Mosaic pattern of lamellar bone | == jigsaw appearance with prominent cement lines

Question 39

How does the bone look with Paget Disease?

Answer 39

Mosaic pattern of lamellar bone | == jigsaw appearance with prominent cement lines

Question 40

What are the 3 stages of Paget Disease?

Answer 40

1. Osteolytic = Osteoclasts with 100 nuclei 2. Mixed = clasts and blasts 3. Burned out quiescent osteosclerotic = Osteoblasts

Question 41

What are the 3 stages of Paget Disease?

Answer 41

1. Osteolytic = Osteoclasts with 100 nuclei 2. Mixed = clasts and blasts 3. Burned out quiescent osteosclerotic = Osteoblasts

Question 42

What types of fractures are seen with Paget Disease?

Answer 42

Chalk stick fractures of long bones | Spinal compression fractures

Question 43

With Paget Disease, the leg bones will ____. What types of fractures are seen too?

Answer 43

Legs will bow - Chalk stick fractures of long bones - Spinal compression fractures

Question 44

How will the skin feel over the affected bone and why with Paget Disease?

Answer 44

Warm due to hypervascularity

Question 45

Hypervascularity of the affected bones with Paget Disease can result in?

Answer 45

AV shunt ==> High output Heart Failure

Question 46

What will be elevated with Paget Disease?

Answer 46

Alk Phosphatase

Question 47

What are 2 treatment options for Paget Disease

Answer 47

Calcitonin | Bisphosphonates