Calcium and Bone Disorders

Question 1

what is osteoporosis

Answer 1

progressive skeletal disease characterised by low bone mass and deterioration of bone tissue

Question 2

what causes osteoporosis to occur

Answer 2

increased bone turnover with increased osteoclast activity/increased bone resorption

Question 3

list the risk factors for developing osteoporosis

Answer 3

age
family history 
low BMI
rheumatoid arthritis 
liver or renal failure 
early menopause
steroid use
coeliac disease

Question 4

does osteoporosis present with symptoms

Answer 4

typically asymptomatic unless have pathological fracture

Question 5

where are the common site of fractures seen in osteoporosis

Answer 5

colles
hip
vertebral wedge

Question 6

what is the best investigation for diagnosing osteoporosis

Answer 6

dexa bone scan

Question 7

how is a dexa bone scan interpreted

Answer 7

T score shows the number of standard deviations away from a young persons bone density

• 1 to -2.5 is osteopenia
• 2.5 or more is osteoporosis

Question 8

outline the lifestyle management for osteoporosis

Answer 8

smoking cessation
alcohol reduction
resistance training
calcium supplements

Question 9

what classes of drugs are used to treat osteoporosis

Answer 9

bisphosphonates
strontium ranelate
teriparatide - s/c injection only indicated if patient doesnt respond to other therapies

Question 10

list examples of bisphosphonates

Answer 10

alendronate

risedronate

Question 11

how do bisphosphonates work

Answer 11

kill off osteoclasts which reduces bone reasorption

one tablet taken once a week

Question 12

what are the side effects of bisphosphonates

Answer 12

photosensitivity
GI upset
osteonecrosis of the jaw

Question 13

what is Pagets disease of the bone

Answer 13

metabolic disease causing increased bone turnover, osteoblast and osteoclast activity increased and bone is deposited in a disorganised manner

Question 14

how does Pagets disease present

Answer 14

deep bone pain that is worse at night and weight bearing

pathological fracture - commonly tibia, femur, skull and pelvis

Question 15

state the complications of Pagets disease

Answer 15

pathological fractures
hypercalcaemia
nerve compression

Question 16

describe alkaline phos, calcium and phosphate levels in Pagets disease

Answer 16

raised alk phos

normal calcium and phosphate

Question 17

other than bloods tests, what investigations are done for Pagets disease

Answer 17

x-ray
early disease shows lytic lesions
late disese shows cortical thickening and deformity

Question 18

how is Pagets disease managed

Answer 18

analgesia

bisphosphonates

Question 19

describe the pathophysiology of osteomalacia and rickets

Answer 19

normal amount of bone but the mineral content of the bone is low

Question 20

what is the difference between rickets and osteomalacia

Answer 20

rickets occurs during active periods of bone growth before growth plates have fused
osteomalacia occurs once the epiphyseal growth plates have fused

Question 21

what causes osteomalacia and rickets

Answer 21

vitamin D deficiency
renal bone disease in context of CKD
cirrhosis - vitamin D cannot be activated
anti-convulsants

Question 22

how does Rickets present

Answer 22

growth retardation
bow legged/knock knees
hypotonia
apathy

Question 23

how does osteomalacia present

Answer 23

bone pain
fractures - neck of femur
proximal myopathy
waddling gait

Question 24

outline the investigations done for osteomalacia and rickets

Answer 24

bloods showing hypocalcaemia

x-ray showing reduced cortical bone and scleritic lines

Question 25

how is osteomalacia and rickets managed

Answer 25

calcium and vitamin D supplements | if renal disease - restrict fluids, phosphate binders

Question 26

what causes primary hyperparathyroidism and how does it present

Answer 26

usually parathyroid adenoma or hyperplasia of all 4 glands | presents with hypertension, increased bone resorption and hypercalcaemia

Question 27

what are the main symptoms of hypercalcaemia

Answer 27

``` fatigue thirst renal stones abdo pain depression ```

Question 28

state the blood test findings for primary hyperparathyroidism

Answer 28

PTH and calcium high | phosphate low

Question 29

what is the best investigation to diagnose hyperparathyroidism

Answer 29

sesatimbi scan to visualise the glands

Question 30

how is primary hyperparathyroidism managed

Answer 30

watchful waiting | removal or adenoma or glands

Question 31

what is the difference between secondary and tertiary hyperparathyroidism

Answer 31

secondary - physiological response in response to hypocalcaemia tertiary - hyperplastic change due to prolonged hypercalcaemia, not a normal response

Question 32

outline the biochemical profile of secondary and tertiary hyperparathyroidism

Answer 32

secondary - low calcium, raised phosphate and PTH | tertiary - raised calcium and PTH, low phosphate

Question 33

how is secondary/tertiary hyperparathyroidism managed

Answer 33

treat underling cause with Vit D supplements | diet restriction if renal disease

Question 34

what is hypoparathyroidism

Answer 34

low PTH hormone due to gland failure

Question 35

what causes hypoparathyroidism

Answer 35

decreased Mg Di George syndrome haemochromatosis/Wilsons disease thyroid surgery

Question 36

how does hypoparathyroidism present (symptoms of hypocalcaemia)

Answer 36

``` numbness muscle cramps spasms wheeze anxiety ```

Question 37

what is the biochemical profile of hypoparathyroidism

Answer 37

low calcium low PTH high phosphate