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CORTEX biochemistry Flashcards

1
Q

What is osteoporosis?

A

Reduced bone mineral density and increased porosity

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2
Q

Osteoporosis can be described as a quantitive defect, what does this mean?

A

The bone is normal but there’s not enough of it

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3
Q

What does osteoporosis increase your risk of?

A

Fractures (i.e fragility fractures)

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4
Q

Define osteopenia and osteoporosis

A

Osteopenia - 1-2.5 SDs below mean

Osteoporosis - >2.5 SDs below mean

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5
Q

When does loss of bone density begin?

A

30 y/o

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6
Q

Describe physiological loss of bone density and mention the relevance of menopause

A

Slowdown of osteoblast activity with age

Increased osteoclastic bone reabsorption post-menopause due to reduced oestrogen

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7
Q

List the two types of primary bone osteoporosis

A

Type 1 post menopausal

Type 2 osteoporosis of old age

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8
Q

What are the risk factors for post menopausal osteoporosis?

A 
Early menopause
White people
Smoking
Alcohol 
Lack of exercise
Poor diet
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9
Q

Which types of fractures tend to occur in post menopausal osteoporosis?

A

Colles fractures

Vertebral insufficiency

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10
Q

What are the risk factors for osteoporosis of old age?

A 
Chronic disease
Inactivity 
Reduced sunlight exposure (low vit D)
Smoking
Alcohol
Poor diet 
White people
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11
Q

Which types of fractures tend to occur in osteoporosis of old age?

A

Femoral neck fractures

Vertebral fractures

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12
Q

List the causes of secondary osteoporosis

A

Corticosteroid use
Alcohol abuse
Malnutrition
Chronic disease (CKD, malignancy, rheumatoid arthritis)
Endocrine disease (cushing’s, hyperthyroidism, hyperparathyroidism)

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13
Q

How is osteoporosis diagnosed?

A

DEXA scanning
Normal serum calcium
Normal serum phosphate

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14
Q

How is osteoporosis managed?

A 
Calcium supplements
Vitamin D supplements 
Biphosphonates 
Monoclonal antibody (desunomab)
Strontium
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15
Q

How is osteoporosis managed?

A

Exercise
Diet
Sunlight exposure

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16
Q

List some biphosphonates

A

Alendronate
Risedronate
Etdronate
IV zoledronic acid (once per year)

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17
Q

How do biphosphonates work?

A

Reduce osteoclast reabsorption

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18
Q

How does desunomab work?

A

Reduces osteoclast activity

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19
Q

How does strontium work?

A

Increases osteoblast replication and reduces absorption

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20
Q

Why is intranasal calcitonin not used to treat osteoporosis?

A

Increased cancer risk with no benefit over other treatments

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21
Q

HRT is recommended as first line treatment of osteoporosis in post menopausal women. T/F

A

False - considered if side effects with other medications

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22
Q

What are the risks of HRT?

A

Breast cancer
Endometrial cancer
DVT

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23
Q

What is raloxifene? What is the risk of it?

A

Oestrogen receptor modulator

DVT

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24
Q

Osteomalacia is a qualitative bone defect, what does this mean?

A

Bone quantity is normal but the quality is sub-par

25
What is osteomalacia?
Abnormal soft bones that have not been mineralised due to deficiencies in calcium and phosphorus
26
What is Rickets?
Abnormal soft bones that have not been mineralised due to deficiencies in calcium and phosphorus occuring in CHILDREN
27
What are the causes of osteomalacia and ricket's?
Lack of dietary calcium Deficiency of vitamin D Resistance to vitamin D Phosphate deficiency (increased renal loses)
28
What are the specific pathologies which lead to osteomalacia and ricket's?
``` Malnutrition Malabsorption Lack of sunlight exposure Hydrophosphateamia Long term anti-convulsant use Chronic kidney disease ```
29
What are the causes of hydrophosphateamia?
Re-feeding syndrome Alcohol abuse Malabsorption Renal tubular acidosis
30
Which inherited renal diseases can be the cause of osteomalacia and rickets?
X-linked hydrophosphateamia | Vitamin D resistant ricket's
31
How does osteomalacia/ricket's present?
Bone pain (pelvis, spine, femur) Bony deformity Pathological fractures Hypocalcaemia
32
Is bony deformity more common in osteomalacia or ricket's?
Ricket's
33
How does hypocalcaemia present?
``` Paraesthesia Muscle cramps Irritability Fatigue Seizures Brittle nails ```
34
What may be typically seen on a radiograph of someone with osteomalacia or ricket's?
Pseudofractures (looser's zones) of pubic rami, proximal femur, ulna or ribs
35
How does osteomalacia/ricket's present biochemically?
Low calcium Low serum phosphate High serum alk phosphatase
36
How is osteomalacia/ricket's treated?
Vitamin D therapy Calcium supplements Phosphate supplements
37
What is hyperparathyroidism?
Over activity of parathyroid glands (i.e high parathyroid hormone)
38
What causes primary hyperparathyroidism?
Adenoma Hyperplasia Neoplasia
39
What is the result of primary hyperparathyroidism?
High PTH --> hypercalcaemia
40
How does primary hyperparathyroidism present biochemically?
High calcium High PTH Phosphate low/normal
41
How does hypercalcaemia present?
``` Bones (pain) Stones (renal) Groans (fatigue, depression) Myalgia Nausea Thirst Polyuria Osteoporosis ```
42
What is secondary hyperparathyroidism?
Overproduction of PTH secondary to hypocalcaemia caused by CKD or vit D deficiency
43
What is tertiary hyperparathyroidism?
Patients with chronic secondary hyperparathyroidism develop a parathyroid adenoma producing ectopic PTH
44
What is usually the cause of chronic secondary hyperparathyroidism?
CKD
45
What bone problems can hyperparathyroidism cause? How are they treated?
Fragility fractures Brown's tumours/osteitis fibrosa cystica (lytic bone lesions) Stabilisation
46
How is hyperparathyroidism treated?
Removal of cause (e.g adenoma, cancer, etc) | Treatment of cause (e.g vit D deficiency, etc)
47
How is hypercalcaemia treated?
IV fluids Biphosphonates Calcitonin
48
What type of bone changes are caused by CKD? Why?
Secondary hyperparathyroidism causes osteomalacia, bone sclerosis and soft tissue calcification Reduced phosphate excretion and inability to activate vit D
49
What is Paget's disease?
Chronic bone disease causing thick, brittle and deformed bones
50
How many bones does paget's disease affect? Which bones?
One or two | Pelvis, femur, skull, tibia
51
Which age groups are typically affected by Paget's?
> 55 (increasing age)
52
Which two factors may increase incidence of Paget's?
Viruses (paramyxoviruses) | Genetic defects
53
Describe the pathogenesis of Paget's disease
Increased osteoclast activity (exaggerated vit D response) --> Increased bone turnover --> Osteoblasts become more active in a bid to compensate --> New bone does not remodel correctly --> Brittle, easily fractured bone
54
What happens if Paget's occurs in ear ossicles?
Conductive deafness
55
How does Paget's disease present?
``` Asymptomatic until picked up on x-ray Arthritis Pathological fractures Deformity Pain High output cardiac failure ```
56
How does Paget's disease present biochemically?
High alk phosphatase Normal calcium Normal phosphate
57
How does Paget's appear on an x-ray?
Enlarged bone with thickened cortices Thickened trabeculae Mixed lysis and sclerosis
58
How does Paget's appear on bone scans?
Increased uptake in affected bones
59
How is Paget's treated?
Biphosphonates Calcitonin (extensive lysis) Joint replacement Femoral shaft fractures stabilised with IM nails

Year 2 (72 decks)

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