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Metabolic bone conditions Flashcards

1
Q

Describe the blood serum results in osteoporosis

A

All normal

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2
Q

Describe the blood serum results in osteomalacia

A

Calcium low
Potassium low
Alkaline phosphatase high
PTH and vit D normal

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3
Q

Describe the blood serum results in Pagets

A

All normal except alkaline phosphatase

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4
Q

Describe the blood serum results in renal failure

A 
Calcium low
Potassium high
Alkaline phosphatase either normal or high
PTH high
Vit D low
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5
Q

Describe the blood serum results in primary hyperparathyroidism

A 
Calcium high
Phosphate low
Alkaline phosphatase either normal or high
PTH high
normal vit D
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6
Q

What is alkaline phosphatase produced from

A

Osteoblasts (bone) and the liver

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7
Q

At what rate is bone lost at the age of 40 onwards

A

0.7% a year

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8
Q

What speed is bone mass lost after menopause

A

2-9% a year

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9
Q

What 2 scores can bone mineral density expressed as

A

T or Z score

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10
Q

What is a T score

A

Number of standard deviations from the mean young (30y) same gender and ethnicity

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11
Q

What is a Z score

A

Number of standard deviations from mean aged, same gender and ethnicity

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12
Q

In terms of T score, when and how is a diagnosis of osteoporosis made

A

t score below 2.5

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13
Q

What does DEXA stand for

A

Dual energy X-ray absorptiometry

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14
Q

What is the prevalence of osteoporosis at

a) 50 and
b) 80

A

a) 2%

b) >25%

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15
Q

In terms of T score, when is a diagnosis of osteopenia made

A

between 1 and 2.4

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16
Q

What kind of bones are more susceptable to osteoporotic bone loss

A

High proportion of trabecular bone

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17
Q

Give 2 examples of bone susceptible to osteoporosis

A

Vertebral bodies

Femoral neck

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18
Q

Briefly describe/ define osteoporosis

A

Relative increase in resorption is not matched by formation. Bone is normally mineralised so there is less bone

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19
Q

Is loss evenly distributed in osteoporosis

A

No- trabeculae bone is more at risk

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20
Q

Why is trabeculae bone more at risk of osteoporosis

A

Because it has a greater surface area, and is in areas that respond to new stresses

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21
Q

How does osteoporotic bone differ to normal bone

A

Cortices and trabeculae are thinned

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22
Q

How would you treat an osteoporosis patient who is over 75 and has low trauma fracture

A

Bisphosphonate calcium and vit D

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23
Q

How would you treat an osteoporosis patient aged 50-75 and low trauma fracture

A

DEXA scan

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24
Q

Why are calcium supplements given to people with osteoporosis

A

Reduce negative calcium balance

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25
Why are vitamin D supplements given to people with osteoporosis
Significant numbers of elderly are deficient
26
Name 5 non supplemental treatments for osteoporosis
``` HRT Selective oestrogen receptor modulator Bisphosphonates Teriparatide Denosumab ```
27
How does denosumab work
Monoclonal antibody that binds to RANKL | Inhibits osteoclast formation
28
Name a selective oestrogen receptor modulator
Raloxifene
29
Why are bisphosphonates given to treat osteoporosis
Potent inhibitors of bone resoprtion | Reduce fracture risk by 50%
30
Name 3 complications of bisphosphonates
Giant osteoclasts Osteonecrosis of the jaw Atypical fractures
31
Why is teriparatide used to treat osteoporosis
Intermittent exposure to PTH will activate osteoblasts more than osteoclasts
32
How is denosumab administered
Subcutaneous injection every 6 months
33
What is the colloquial name for ostemalacia
Rickets
34
Briefly describe the underlying pathophysiology of osteomalacia
- Insufficient calcium and phosphate to mineralise new bone osteoid - Bones softer and more liable to bend/ fracture
35
What does osteomalacia usually result from
Vit D deficiency
36
Is osteomalacia more or less deforming in adults than children and why
Less deforming because the epiphyseal growth plates are closed
37
What can looser lines on an x-ray suggest
Pseudofractures
38
What are pseudofractures
Areas of unmineralised bone which can progress to insufficiency fractures.
39
Where do pseudofractures most commonly form
At areas of higher bone turnover
40
What % of osteroid is unmineralised in normal bone
<20%
41
Describe the bone biopsy of an osteomalcia patient
Wide seams of unmineralised osteroid Mineralised bone green in severe cases Up to 100% covered by unmineralised osteoid
42
What must osteoid thickness be greater than
14um
43
3 treatments for osteomalacia
Vit D supplements Dietary- calcium Sun or UV
44
What foods may be recommended to increase calcium
Milk, bread, beans, pulses, dried fruit, green + leafy veg
45
What % of the population have Pagets disease when aged a) >50 b) >80
a) 3% | b) 10%
46
State the 3 phases of Pagets disease
1) Initially increased rate of bone resorption 2) Compensatory phase/ proliferative 3) Burnt out phase/ sclerotic
47
What happens in the first phase of Pagets
Large number of giant osteoclasts
48
What happens in the second phase of Pagets
Increased bone formation | Accelerated deposition in disorganised manner
49
What happens in the sclerotic phase of Pagets
Hypercellularity may diminish Bone is dense Hyper-vascular bone marrow
50
How does the bone appear in the final stage of Pagets
Prominent cement lines | Bone marrow replaced by fibrovascular CT
51
Name 5 bones commonly affected by pagets
``` Pelvis Femur Vertebrae Skull Tibia ```
52
Name a rare, late complication of Pagets disease
Osteosarcoma
53
In what % of paget cases does osteosarcoma occur
1|%
54
What is osteosarcoma
Among the most malignant of cancers Usually in a long bone, near the knee Can spread rapidly usually to lungs
55
5 treatment options for Pagets disease
``` Bisphosphonates Calcium and vit D supplements Pain management Surgery Calcitonin ```
56
How do bisphosphonates work to treat Pagets
Work directly on osteoclasts to slow bone resorption
57
What is the duration of bisphosphonates for pagets
- oral 2-6 months | - IV single infusion to 3 infusions
58
What is the other name for sclerostosis
Van Buchem Syndrome
59
Genetic inheritence of sclerostosis
Autosomal recessive
60
Clinical signs of sclerostosis
Endosteal hyperotosis Resistant to fracture Excessive heigh
61
What is sclerostin secreted by and what does it do
Osteocytes | Inhibits osteoblasts and thus bone formation
62
How is sclerostosis treated
By an antibody to sclerostini (romosozumab)

LOCO 2 (25 decks)

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