clinical aspects of bone disease

Question 1

what is the definition of osteoporosis?

Answer 1

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

Question 2

what are the types of osteoporosis?

Answer 2

type 1: post menopausal
Type II: senile
secondary

Question 3

who tends to get type I osteoporosis?

Answer 3

Post menopausal women around 10 years after

Question 4

what causes type I osteoporosis?

Answer 4

Low levels of oestrogen after post menopause

Question 5

what bone is affected in type I osteoporosis?

Answer 5

trabecular bone and there is accelerated loss

Question 6

who tends to get type II osteoporosis?

Answer 6

equally men and women over 70

Question 7

what are the causes of type II osteoporosis?

Answer 7

nutrition and delayed physical activity

Question 8

what bone is lost in type II osteoporosis?

Answer 8

both trabeculae and corticol

Question 9

what bone is lost in secondary osteoporosis?

Answer 9

both trabecular and cortical

Question 10

what are the main ‘ACCESS’ risk factors for osteoporosis ?

Answer 10

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

Question 11

other than the ‘ACCESS’ risk factors for osteoporosis?

Answer 11

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

Question 12

what is the normal presentation of osteoporosis?

Answer 12

often silent but get kyphosis and fractures

Question 13

what are DEXA T scores?

Answer 13

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

Question 14

what is Z score in DEXA?

Answer 14

the age matched mineral bone density

Question 15

when is a patient referred for a DEXA scan?

Answer 15

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

Question 16

what is FRAX?

Answer 16

a calculator to work out 10 year fracture possibility

Question 17

what does FRAX consider?

Answer 17

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

Question 18

what is the conservative management of osteoporosis?

Answer 18

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

Question 19

what anti-resorptive medications is given for osteoporosis?

Answer 19

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

Question 20

what bone forming agents can be given for osteoporosis?

Answer 20

• PTH (teriparatide fluoride)

anti rank ligand (denosumab)

Question 21

what are CI to bisphosphonates?

Answer 21

oesophagitis

Question 22

what is an alternative for bisphosphonates in osteoporosis?

Answer 22

strontium ranelate

Question 23

what is the definition of osteomalacia?

Answer 23

• loss of bone mineralisation related to vitamin D deficiency

Question 24

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

Answer 24

reduced in osteoporosis

normal in osteomalacia

Question 25

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

Answer 25

Normal is osteoporosis | reduced in osteomalacia

Question 26

what are causes of osteomalacia?

Answer 26

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

Question 27

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

Answer 27

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

Question 28

what are causes of defective Vit D production?

Answer 28

- familial hypophosphaetaemic rickets CKD fanconis syndrome

Question 29

what is the presentation of osteomalacia?

Answer 29

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

Question 30

what blood results suggest osteomalacia?

Answer 30

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

Question 31

what can be seen in osteomalacia Xrays?

Answer 31

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

Question 32

what is seen in Xray of someone with rickets?

Answer 32

Cupping and fraying of metaphyses | widened epiphyseal plates

Question 33

what is a definition of pagets disease of the bone?

Answer 33

- a condition of abnormal bone remodelling

Question 34

what genes are involved with pagets disease?

Answer 34

5q35 QTER

Question 35

what are the phases of pagets disease?

Answer 35

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

Question 36

what is the lytic phase of pagets?

Answer 36

intense osteoclastic resorption

Question 37

what is the sclerotic phase of pagets disease?

Answer 37

osteoblast bone formation dominates

Question 38

what is the presentation of pagets disease?

Answer 38

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

Question 39

what are differentials of raised alkaline phosphatase?

Answer 39

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

Question 40

what is seen on XRay in pagets?

Answer 40

marked areas of sclerotic and lytic lesions

Question 41

what are complications of pagets disease?

Answer 41

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

Question 42

what is osteopetrosis?

Answer 42

increased bone density due to decreased osteoclast action

Question 43

what is the treatment of osteopetrosis?

Answer 43

bone marrow transplant | calcitriol

Question 44

what is osteopoikilosis?

Answer 44

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

Question 45

what is a bisphosphonate fracture?

Answer 45

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