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Metabolic Bone Disease Flashcards

Learning outcomes for MCQ (76 cards)

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1
Q

What are the 2 classifications of bone?

A

Cortical and Trabecular bone

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2
Q

What dose cortical bone consist of?

A

Dense calcified tissue, providing structure and protection

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3
Q

What does trabecular bone consist of?

A

Horizontal and vertical interconnecting plates called trabeculae.

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4
Q

What does trabecular bone permit?

A

Bone marrow, blood vessels, connective tissue to be in contact with the endosteum

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5
Q

What are osteoblasts?

A

bone cells which produce bone matrix & initiate bone mineralisation

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6
Q

What are osteoblast function influenced by?

A

Parathyroid hormone, calcitonin, Vit D3, growth hormone, glucocorticoid hormones, gonadal steroids - oestrogen & testosterone

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7
Q

What are Osteoclasts?

A

Bones cells responsible for bone reabsorption

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8
Q

Name the 3 bone cells?

A

Osteoclasts, Osteoblasts, Osteocytes

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9
Q

What is the function of osteocytes?

A

Derive from osteoblasts, mature cells which transport calcium in the bone

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10
Q

How much of the body’s total calcium exists in bone?

A

98%

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11
Q

How is VitD synthesised in the body?

A

Via the skin during UV light exposure. Acting on bone, the intestine and kidneys

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12
Q

What hormone requires the presence of VitD and why?

A

Parathyroid hormone. It stimulates bone reabsorption enhances renal reabsorption of calcium and renal resynthesis of Vit D

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13
Q

What are the 6 functions of bone?

A

Provide vital function, 1. protection of internal organs, 2. storage and release of fat. 3. Production of blood cells. 4. storage and release of minerals e.g. Calcium. 5. Facilitates movement. 6. Supports the body

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14
Q

What is mechanotransduction?

A

The process whereby the skeleton responds to imposed demands and adjusts it’s structure accordingly.

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15
Q

Why does bone disease come under endocrinology?

A

Because of metabolism of bone being controlled by hormones

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16
Q

What is the bone turnover cycle?

A

A process where bone is removed by osteoclast cells then osteoblasts form new bone scaffold, calcium and other minerals finish the cycle. Continuous process

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17
Q

What is the percentage of our annual bone turnover cycle throughout our lives?

A

10%

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18
Q

In healthy adults what is the balance of the bone turnover cycle?

A

In healthy adults the amount of bone being removed is equal to the amount of new bone matrix being produced

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19
Q

What is osteopenia or osteoporosis?

A

Where the resorption/removal of bone is greater than bone formation

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20
Q

What is increased bone loss a risk factor for?

A

Fracture

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21
Q

Name a side effect of long term corticosteroid usage?

A

Osteoporosis

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22
Q

Is obesity a risk factor for osteoporosis?

A

no, low BMI is a greater risk factor for osteoporosis

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23
Q

Name secondary causes for osteoporosis…

A

Anorexia nervosa, male hypogonadism, chronic liver disease, renal disease, coeliac disease, RA, hyperthyroidism, IBD, Vit D deficiency

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24
Q

Who are at risk groups for osteoporosis?

A

People aged over 70

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25
Osteocalstic activity is increased by Corticosteroids (7.5mg a day or more) causing osteoporosis over what time frame?
First 6 months
26
What is Type I primary osteoporosis?
females, hormonal related. post menopausal, in vertebra
27
What is Type II primary osteoporosis?
Male + Female gender, age related (O70yrs) decreased osteoblast activity, reduction in exposure to sunshine, reduction in calcium and VitD, reduced Vit D synthesis & an increase in parathyroid hormones and increased bone resorption.
28
What is Secondary Osteoporosis?
Predisposed reduced bone density - nutritional, hormonal, drugs, disease, Rheumatological conditions.
29
What investigations are used in diagnosing osteoporosis?
DEXA, Ultrasound, Bone scans, Blood Tests (to rule out other pathology, CA etc)
30
What T score is indicative of osteoporosis?
< -2.5 SD
31
What are clinical features of Osteoporosis?
Pain, Kyphosis, Mid-Thoracic #, Low Thoracic #, Upper Lumbar #, NOF # Distal radius/ulnar #
32
What are clinical features of osteoporosis?
Loss of height, long legs, kyphosis.
33
What are clinical features of osteoporosis?
Resp tract infection secondary to rib #
34
What are clinical features of osteoporosis?
Increased abdominal skin creases
35
What loss of height is indicative of osteoporosis?
A loss of 4-16cm in height
36
What are the risks of # in over 50 age catagory?
50% of women and 1/8th of men
37
Can osteoporosis be cured?
No
38
What is the aim of treatment for osteoporosis?
The slow the rate of bone loss, reduce fracture risks/falls
39
What are forms of osteoporosis prevention?
Education, smoking cessation, HRT, Ca/VitD diet, Medication & WB exercises
40
What medications are used to treat osteoporosis?
Fosamax, Bonviva, Actonel
41
What age does peak bone mass occur?
Late teens - early 20's
42
By what age does bone consolidation complete?
at 30 years of age
43
After the age of 30, what percentage of bone loss occurs annually thereafter?
1% loss per year (accelerated post-menopause in women)
44
What medications are prescribed for osteoporosis?
Romosozumab, VitD & Calcium & HRT
45
What functional test is used in the physical examination of osteoporosis?
TUG
46
What measure of aerobic fitness is used in osteoporosis?
6 metre walk test & 2 minuet walk test
47
What are elements of physiotherapy management for osteoporosis?
Education, pain relief options, postural correction, WB exercise, Hydrotherapy, Mobility and Balance for falls prevention
48
Define WB exercise as treatment for osteoporosis?
Low impact WB activity, characterised by having 1 foot on the floor. (high impact training is not suitable for patients with osteoporosis, e.g. jumping both feet on floor
49
Why is weight baring activity preferred over non WB exercise?
Because swimming, cycling do not stimulate bone adaptation as you need load to cause bone adaptation.
50
How often should people with osteoporosis perform resistance training exercsie?
Weights three times per week for 30 minuets
51
What precautions should be considered before commencing exercise?
GP sign-off & Screening questionnaire
52
What does BMD stand for?
bone mineral density
53
What physiotherapy interventions are contraindicated for osteoporosis?
Manual therapy techniques & Manual Chest clearance techniques (lung disease)
54
What exercise's are to be avoided for osteoporotic patients?
Excessive spinal flexion e.g. dynamic abdominal exercises. Abrupt or explosive movements. High-impact loading. Twisting movements.
55
How are vertebral fractures managed during the initial 6-8 week healing phase?
Bed rest & pain relief, spinal brace mobilising.
56
How are vertebral fractures managed during the initial post 8 weeks?
Ax, posture/taylor brace, exercise & HEP
57
What is a fragility fracture?
A pathological fracture resulting from normal every day activities, such as a fall from standing height or less.
58
Hip fracture is one of the most serious consequences of falls in the elderly. What is the mortality rate associated with hip fractures?
10% at 1 month and 30% at 12 months
59
What complications do 20% of post op hip fracture patients experience?
9% contract chest infections & 5% suffer heart failure
60
What percentage of elderly people who sustain a hip fracture are unable to take care of themselves afterwards?
50%
61
What less common disease affects the pelvis, skull and lower limbs?
Paget's Disease
62
What less common VitaminD deficiency related disease affects the bones & why?
Osteomalacia is a softening of the bones which occurs do to lack of uptake of Calcium do to a lack of Vitamin D in the bones
63
What is another name for osteomalacia?
Rickets / Soft Bones
64
How dose a deficiency in Vit D cause Osteomalacia?
Inadequate mineralisation of osteoid framework in the bone matrix.
65
What are clinical features of Osteomalacia? (Rickets)
Bone deformity, diffuse bone + muscle pain, fatigue, proximal myopathy (weakness) in the hips/spine region, observed "waddling gait"
66
How is osteomalacia diagnosed?
Bone biopsy / biochemistry / x-ray
67
How is osteomalacia treated?
Oral Vit D supplements & sunlight
68
How do you prevent osteomalacia?
Education, diet, vit d
69
How does Paget's Disease affect bone?
it effects bone renewal by disrupting the normal cycle of bone renewal replacing hard bone with soft bone increasing the risk of fracture
70
How common is Paget's?
2-3% of over 55's and 10% of over 85's - Aetiology is unknown
71
Where in the body is Paget's disease most common?
Pelvis 71%, Lumbar Spine 50%, Femur49%, Humerus 40%, Skull 28%, Tibia 8%
72
What are clinical features of Paget's?
Dull bone pain, night pain, deformity of long bones & skull, degenerative joint changes, spinal kyphosis, headache
73
What are complications of Paget's?
Pathological fracture, non-union, stress-fracture, paraplegia
74
What medications are used in Paget's?
Calcitonin & Bisphosphonates
75
What readiness for exercise questionnaire would you use in osteoporosis patients?
The ParQ questionnaire
76

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