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Flashcards in clinical aspects of bone disease Deck (45):
1

what is the definition of osteoporosis?

a systemic skeletal disease with low bone mass increasing fragility and susceptibility to fracture

2

what are the types of osteoporosis?

type 1: post menopausal
Type II: senile
secondary

3

who tends to get type I osteoporosis?

Post menopausal women around 10 years after

4

what causes type I osteoporosis?

Low levels of oestrogen after post menopause

5

what bone is affected in type I osteoporosis?

trabecular bone and there is accelerated loss

6

who tends to get type II osteoporosis?

equally men and women over 70

7

what are the causes of type II osteoporosis?

nutrition and delayed physical activity

8

what bone is lost in type II osteoporosis?

both trabeculae and corticol

9

what bone is lost in secondary osteoporosis?

both trabecular and cortical

10

what are the main 'ACCESS' risk factors for osteoporosis ?

A- alcohol use
C- corticosteroid use
C- calcium low
E- estrogen low
S- smoking
S- sedentary lfiestyle

11

other than the 'ACCESS' risk factors for osteoporosis?

- family history
- rheumatoid arthritis
- thyroid or liver disease
- spinal cord injury
- nutrition
- thyroid replacement
- ant acids
- long term anti convulsant use

12

what is the normal presentation of osteoporosis?

often silent but get kyphosis and fractures

13

what are DEXA T scores?

SD is to the young normal mean bone density from a population of 20-30 year olds Caucasian women

14

what is Z score in DEXA?

the age matched mineral bone density

15

when is a patient referred for a DEXA scan?

- low trauma fracture
- osteopenia/ vertebral fracture seen on XRAY
- steroid therapy
- early menopause
- secondary causes
- strong family history

16

what is FRAX?

a calculator to work out 10 year fracture possibility

17

what does FRAX consider?

T score
Alcohol
R.A
glucocorticoids
smoking
previous fractured hip
previous fracture
afe
BMI

18

what is the conservative management of osteoporosis?

weight bearing exercise
calcium rich diet
vitamin D supplements
avoid alcohol and smoking

19

what anti-resorptive medications is given for osteoporosis?

- oestrogen
-- bisphosphonates (alendronate, risedronate, etidronate)
selective oestrogen receptor modulators
calcitonin

20

what bone forming agents can be given for osteoporosis?

- PTH (teriparatide fluoride)
anti rank ligand (denosumab)

21

what are CI to bisphosphonates?

oesophagitis

22

what is an alternative for bisphosphonates in osteoporosis?

strontium ranelate

23

what is the definition of osteomalacia?

- loss of bone mineralisation related to vitamin D deficiency

24

what is the different in bone amount in osteoporosis vs osteomalacia?

reduced in osteoporosis
normal in osteomalacia

25

what is the different in bone mineralisation in osteoporosis vs osteomalacia?

Normal is osteoporosis
reduced in osteomalacia

26

what are causes of osteomalacia?

- vitamin D deficiency
- lose of vit D through the gut
- defect in production of vit D

27

what can cause Vitamin D loss in the gut contributing to osteomalacia?

- coeliac disease
- pancreatic insufficiency
- cholestatic liver disease
- chapattis

28

what are causes of defective Vit D production?

- familial hypophosphaetaemic rickets
CKD
fanconis syndrome

29

what is the presentation of osteomalacia?

- bone pain
- proximal weakness
- malaise
- symptoms of hypocalcaemia
- deformity
- fractures
- rickets (hypotonia, growth retardation, skeletal deformities)

30

what blood results suggest osteomalacia?

- low calcium
- low phosphate
- low vit D
- raised PTH (due to low calcium)
- increased serum alkaline phosphatase

31

what can be seen in osteomalacia Xrays?

- normal or osteopenia
- looser zones
- pseudo fractures often in ribs, scapula, pubic rami and upper femur

32

what is seen in Xray of someone with rickets?

Cupping and fraying of metaphyses
widened epiphyseal plates

33

what is a definition of pagets disease of the bone?

- a condition of abnormal bone remodelling

34

what genes are involved with pagets disease?

5q35 QTER

35

what are the phases of pagets disease?

1. lytic phase
2. mixed phase
3. sclerotic phase

36

what is the lytic phase of pagets?

intense osteoclastic resorption

37

what is the sclerotic phase of pagets disease?

osteoblast bone formation dominates

38

what is the presentation of pagets disease?

pain
deformity
osteoarthritis
fractures
neurological symptoms (deafness and conductive defects)
sarcomatous transformation
cardiac failure

39

what are differentials of raised alkaline phosphatase?

- metastatic bone disease
- osteomalacia
- pagets disease
- lliver disease
- hyperparathyroidism

40

what is seen on XRay in pagets?

marked areas of sclerotic and lytic lesions

41

what are complications of pagets disease?

- stress fractures
- increased OA
- skull enlargement can cause deafness, hydrocephalus
- high output cardiac failure
- osteosarcoma

42

what is osteopetrosis?

increased bone density due to decreased osteoclast action

43

what is the treatment of osteopetrosis?

bone marrow transplant
calcitriol

44

what is osteopoikilosis?

- spotted bone disease
- islands of deep cortical bone appear within the medullary cavity and the cancellous bone of the long bones

45

what is a bisphosphonate fracture?

An atypical femoral fracture is a diagnosis of exclusion:
- not spiral or comminuted
- not to the femoral neck or intertrochaneric
- no evidence of malignant bone tumour
- not periprosthetic