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Metabolic Bone Conditions Flashcards

1
Q

Which bone disease has normal serum Ca, PO4, alkaline phosphatase, PTH, and 1,25 OH2 vitamin D

A

Osteoporosis

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2
Q

Which bone disease has low serum Ca, low PO4, high alkaline phosphatase, high PTH, and low 1,25 OH2 vitamin D

A

Osteomalacia

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3
Q

Which bone disease has normal serum Ca, PO4,, PTH, and 1,25 OH2 vitamin D, and very high alkaline phosphatase

A

Pagets

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4
Q

Which bone disease has low serum Ca, high PO4, normal or high alkaline phosphatase, high PTH, and low 1,25 OH2 vitamin D

A

Renal failure

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5
Q

Which bone disease has high serum Ca, low PO4, normal or high alkaline phosphatase, high PTH, and normal 1,25 OH2 vitamin D

A

Primary hyperparathyroidism

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6
Q

Why is 25 vit d often measured instead of 1,25 vit d

A

More long lived

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7
Q

Why does renal failure cause low serum 1,25 vit d but normal serum 25 vit d

A

1,25 synthesised in kidney

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8
Q

How does osteoporosis affect bone amount and mineralisation

A

Decr amount
Normal mineralisation

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9
Q

How does osteomalacia affect bone amount and mineralisation

A

Normal amount
Decr mineralisation

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10
Q

Why are women more affected by osteoporosis than men

A

Men start with more bone
Women have faster bone mass decline
Decline speeds up at menopause

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11
Q

How can bone mineral density be expressed

A

T score
Z score

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12
Q

T score

A

Number of standards deviations from the mean bone density for 30 year old of same gender and ethnicity

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13
Q

Z score

A

Number of standards deviations from the mean bone density for same age, gender and ethnicity

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14
Q

When is z score used

A

Young people w osteoporosis

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15
Q

What t score indicates osteoporosis

A

<2.5

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16
Q

What t score indicates osteopenia

A

-1- -2.4

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17
Q

What type of bone is more susceptible to osteoporotic bone loss

A

Trabecular

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18
Q

Why are vertebral bodies and femoral neck susceptible to osteoporotic bone loss

A

High proportion of trabecular bone

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19
Q

Osteoporosis

A

Relative incr in bone resorption not matched by formation

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20
Q

Osteoporosis treatments

A

Bisphosphonates
Calcium
Vitamin D
HRT - oestrogen
Raloxifene - Selective oestrogen receptor modulator
Teriparatide
Denosumab
BCD TROD

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21
Q

What is raloxifene

A

Selective oestrogen receptor modulator

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22
Q

What is teriparatide

A

Recombinant PTH

23
Q

What is denosumab

A

Monoclonal antibody for RANKL that mimics OPG receptor

24
Q

When is a selective oestrogen receptor modulator used instead of HRT

A

Women at risk of breast or uterine cancer

25
Primary osteoporosis treatment
Bisphosphonates
26
How do Bisphosphonates inhibit bone resorption
Deposited into hydroxyapatite making clasts less likely to degrade Causes apoptosis in clasts that uptake bisphosphonate containing hydroxyapatite bone Decr RANKL expression and decr OPG production by blasts -> mod blast to Clast signalling
27
Bisphosphonate complications
Less bone renewal leading to Giant osteoclasts Osteonecrosis of jaw Atypical fractures
28
How are Bisphosphonate complications managed
Give pt Bisphosphonate holiday to allow bone renewal
29
What is osteopotegrin OPG
decoy receptor for RANKL
30
Why does teriparatide treatment give intermittent PTH exposure rather than continual OTH exposure
Intermittent exposure causes blasts proliferation Chronic exposure causes clast differentiation
31
Romosozumab
Monoclonal antibody against sclerostin
32
Why does bone resorption decrease during lutealphase of menstrual cycle
High progesterone
33
Osteomalacia
Impaired mineralisation of bone matrix causing softening of bones
34
What causes osteomalacia
Insufficient calcium and phosphate to mineralise new bone osteoid
35
What is osteomalacia called in children
Rickets
36
Why does osteomalacia cause more deformity in children
Epiphyseal growth plate still open More woven bone
37
How are serum calcium, phosphorus, and alkaline phosphatase levels in osteomalacia
calcium and phosphorus low Alkaline phosphatase High
38
Pseudofractures/loosers lines
Areas of unmineralised bone that look like fractures of x ray Common in osteomalacia
39
How much osteoid is unmineralised in normal bone
<20%
40
Why are Clast numbers increased in osteomalacia
Incr ca reabsorbtion
41
What subtpstance is used to label mineralising bone and asses bone mineralisation
Tetracycline
42
Osteomalacia treatment
Vitamin d supp Calcium supp
43
Paget’s disease
Chronic Condition causing increased bone breakdown and growth
44
Dysfunction in What cell causes Paget’s
Osteoclasts - genetic + viral infection
45
3 phases of Paget’s
Incr rate of bone resorption Compensatory/proliferative phase Burnt out/sclerotic phase
46
What happens in the compensatory phase of Paget’s
Incr woven bone formation with disorganised deposition Blast proliferation
47
Pagetic bone
Dense bone with little cellularity
48
Features of bone in Paget’s burnt out phase
Irregular thickened Trabeculae Prominent cement line Bone marrow replaced by fibrovascukar CT Pagetic bone
49
Which bones are most commonly effected in Paget’s
Pelvis Femur Vertebrae Skull tibia
50
How can Paget’s cause CN palsies
Bone growth closes foramena and compresses nerves
51
What type of cancer is a rare complication of Paget’s
Osteosarcoma
52
Which bones do osteosarcomas most commonly affect
Long bones Often near knee
53
Paget’s treatment
Bisphosphonates Calcium Vit d Pain management Surgery Calcitonin (used less)

LOCO2 (26 decks)

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