Locomotor: Aging Bones

Question 1

Second most common metabolic bone disease?

Answer 1

Paget’s disease of the bone

Question 2

What is Paget’s disease of the bone and what are the 3 phases?

Answer 2

It is an unusual remodelling of the bone

The phases are:
1. Osteolytic phase, predominantly resorption by osteoclasts
2. Mixed phase, resorption with compensatory formation
3. Osteosclerotic phase, predominantly formatoin by osteoblasts

Question 3

Paget’s disease of the bone clinical symptoms

Answer 3

• Enlarged skull
• Bowing of long bones
• Large joint OA
• Fractures
• Nerve compression leading to deafness

Question 4

What is the bad prognosis in 1% of Paget’s disease patients

Answer 4

Paget’s sarcoma

Question 5

Paget’s disease of the bone investigations and treatments

Answer 5

Insetigations:

• Imaging
• Lab results elevated ALP

Treatments:

• Osteoclast inhibition
• Arthroplastly

Question 6

What is hyperparathyroidism

Answer 6

Increasing level of PTH as a results of excessive production from one or more parathyroid glands

Question 7

Main effects of PTH

Answer 7

• Incourages OBs to release mroe RANKL
• Increases renal uptake of vit d which also increases RANKL

Question 8

Hyperparathyroidism symptoms and signs

Answer 8

Bones, stones, abdominal groans, thrones, psychic moans

Question 9

Primary hyperparathyroidism

Answer 9

This is due to an abnormality in the parathyroid glands

This is treated with a parathyroidectomy (removal)

Question 10

Secondary hyperparathyroidism

Answer 10

This where the PT is simply releasing too much PTH and is usually a result of vit d deficiency

This is treated by treating vit d deficiency

Question 11

What is rickets?

Answer 11

Insufficient calcium or phosphate prior to physeal closure

Question 12

What is congenital rickets?

Answer 12

Inherited inability of kidneys ot absord phosphate

Question 13

What is acquired rickets?

Answer 13

Rickets due to vitamin d deficiency

Question 14

Rickets presentation

Answer 14

• Bowing of long bones
• Brittle bones
• Flattening of skull
• Kyphosis

Question 15

Rickets treatment

Answer 15

• Aquired: Vit d and calcium
• Congenital: Calcitriol

Can perform surgery to correct deformaties

Question 16

What is osteomalacia

Answer 16

Rickets but after physeal closure

Question 17

Osteomalacia presentation

Answer 17

• Atypical fractures
• Loose areas of bone
• Femoral/ femoral neck fractures
• Hip arthritis with protrusio (femoral head goes too far into acetabulum)

Question 18

Osteomalacia treatment

Answer 18

Phatty amounts of vit d

Question 19

Why are post menopausal women more prone to osteoporosis?

Answer 19

Without estrogen osteoblast release more RANK-L

Question 20

What are compression wedge fractures and what are the knock-on effects

Answer 20

These are acumalated stress or low energy trauma fractures which usually only happen with weakened bone from osteoporosis

Results in:

• Height loss
• Reduced pulmonary volume
• Protruding abdomen
• Constipation
• Early satiety

Question 21

The two classifications of wrist fracturs

Answer 21

• Smith’s - volar
• Colles’ - dorsal

Question 22

Treatment of an intracapsular hip fracture

Answer 22

Screw or Arthroplasty depending on blood supply to femoral head

“pin it or bin it”

Question 23

What is arthroplasty

Answer 23

Replacement of a joint

Question 24

Treatment of an extracapsular hip fracture

Answer 24

Pin it

If intertrochanteric sliding hip screw

If subtrochanteric intramedullary nail