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Year 3: Block 1: MSK system > Metabolic bone disease > Flashcards

Metabolic bone disease Flashcards

(57 cards)

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1
Q

Bone consists of (3)

A

Osteoblasts
Osteoclasts
Bone remodelling
cycles

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2
Q

What cell controls turnover

A

osteoblasts

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3
Q

How do we get VIT D

A

sunshine and diet

UV radiation - skin - chemical reaction

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4
Q

Chemical reactions of VIT D

A

7DHC

25 OH vit D (stored in lier fat and muscle)

kidney 1,25 Oh2 vit D

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5
Q

Where is calcium absorbed

A

gut under influence of vit d

maintaining extracellluar fluid calcium in a tight level for body functions

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6
Q

What is Paget’s disease of bone

  • what does this cause and lead to?
A

Localised disorder of bone turnover

Increased bone resorption followed by increased bone formation

Leads to disorganised bone: bigger, less compact, more vascular and more susceptible to deformity and fracture

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7
Q

does Paget’s disease have a genetic component?

believe there is a?

A

YES- strong
15-30% are familial

environmental trigger

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8
Q

what is the major viral trigger for Paget’s

A

Possibility of chronic viral infection within Osteoclast

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9
Q

paget’s - symptoms (4)

A

always over 40, often over 60 in presentation

  • deep seated bone pain all the time, often at night
  • bone deformity

excessive heat over the Pagetic bone
- or by neurological complications such as nerve deafness

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10
Q

Common bones for Paget’s disease

A

long bone,

femur , tibia, fibia and humerus
pelvis , skull , forearm

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11
Q

Diagnostic tests for Paget’s

A

X-ray

isotope bone scan

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12
Q

Features of tests that may show Paget’s disease (5) (more rarely)

A

Isolated elevation of serum alkaline phosphatase-is the commonest presentation in the 21st centuary - liver test

  • Bone pain and local heat
  • Bone deformity or fracture
  • Hearing loss
  • Rarely the development of osteosarcoma in affected bone
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13
Q

Treatment of Paget’s Disease - what should you not treat on alone?

what therapy would yo use? - how is it given? is it repeated?

A

raised alkaline phosphatase

Intravenous Bisphosphonate therapy-One off zoledronic acid infusion

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14
Q

Paget’s is often a cause of ?

effectively managed by?

A

isolated elevation of serum alkaline phosphatase.

intravenous Bisphosphonates

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15
Q

What causes ricket’s in a growing child?

A

Severe nutritional vitamin D or Calcium deficiency causes insufficient mineralisation

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16
Q

What Is caused in the adult after severe insufficient mineralisation

A

Osteomalacia in the adult when the epiphyseal lines are closed

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17
Q

What is impaired in low Vit D states

A

Muscle function

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18
Q

what does vit D - STIMULATE

A

absorption of calcium and phosphate from the gut and calcium and phosphate then become available for bone mineralisation

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19
Q

Features of a child with rickets

A
  • Abnormal bony shape
  • stunted growth
  • large skull - frontal bossing
  • rib shape - rickety rosary
  • protruded abdomen
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20
Q

how is rickets treated in children

A

vitamin D and calcium supplements

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21
Q

Osteomalacia in adult common in?
symptoms? (3)
- seen more common in?

A

elderly - house bound

bone pain, muscle weakness, increased falls risk

asian

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22
Q

Where can you see micro fractures in osteomalacia?

A

pelvis, ribs and long bones - looser bones

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23
Q

treatment of osteomalacia

Study These Flashcards
A

calcium and vit d supplements

24
Q

What is Osteogenesis Imperfecta - what is it characterised by?

Study These Flashcards
A

Genetic disorder of connective tissue characterised by fragile bones from mild trauma and even acts of daily life

25
How many types of genetic Osteogenesis Imperfecta
28
26
Osteogenesis Imperfecta - type 1 , type 11, type 111, type 4 - describe them and the features what types are they?
1: milder form-when child starts to walk and can present in adults Type 11: lethal by age 1 Type 111: progressive deforming with severe bone dysplasia and poor growth Type 4 : similar to type 1 but more severe collagen defects
27
Osteogenesis Imperfecta-other features (7)
Growth deficiency Defective tooth formation (dentigenesis imperfecta) - baby teeth Hearing loss Blue sclera Scoliosis / Barrel Chest Ligamentous laxity Easy bruising
28
management of OI surgical medical social genetic
surgical - to treat fractures Medical - to prevent fracture intravenous Bisphosphonates Social-educational and social adaptions Genetic - genetic counselling for parents and next generation
29
osteoporosis characterised by | - what does this lead to ?
low bone mass and micro architectural deterioration of bone tissue, - leading to enhanced bone fragility and a consequent increase in fracture risk
30
DXA bone scanning for osteoporosis ? menopause ?
31
The relevance of of osteoporosis is? risk of fracture is related to?
risk of fracture Age; BMD; Falls; and Bone Turnover
32
what tool used in osteoporosis
FRAX - risk fracture assessment tool Q fracture - aged 30-85, men and women
33
Osteoporosis scanner when Q or FRAX is greater than?? what interferes with scan result?
10% - Prodigy Scanner DEXTER - L1-L4 in spine - DXA scan of spine - aorta calcification - degeneration
34
What else is scanned with DXA for osteoporosis
HIP scan - t scores and z scores are generated for the bone density lateral DXA scan total body often scanned in children and those who are underweight
35
significant risk of osteoporosis fracture numbers?
a >10% risk of osteoporotic fracture over 10 years) the individual should be referred for a DXA scan ( Dual energy X-ray Absorptiometry)
36
who should be referred for a DXA scan regardless of their Fracture risk percentage?
All who are on oral steroids or suffer a low trauma fracture
37
How common is Osteoporosis?
I in 2 women over 50 | I in 5 men over 50
38
If you suffer 1 vertebral fracture you are?
are 5 times more likely to have another and twice as likely to have hip fracture than if you had no vertebral fractures.
39
Endocrine causes of osteoporosis (6)
Thyrotoxicosis Hyper and Hypoparathyroidim Cushings Hyperprolactinaemia Hypopituitarism Low sex hormone levels in pregnancy and breast feeding bone can be lost
40
Rheumatic causes of osteoporosis (3)
Rheumatoid arthritis Ankylosing Spondylitis Polymyalgia Rheumatica
41
Gastroenterological causes of osteoporosis? (3) ones in the liver and malabsorption
Inflammatory diseases: UC and crohns Liver diseases: PBC, CAH, Alcoholic cirrhosis, Viral cirrhosis (Hep C) Malabsorption: Cystic Fibrosis, chronic pancreatitis, coeliac disease, whipples disease, short gut syndromes and ischaemic bowel
42
Medications which cause osteoporosis (6)
Steroids PPI Enzyme inducting antiepileptic medications Aromatase inhibitors GnRH inhibitors Warfarin
43
Peak bone mass age around- when does accelerated loss occur?
30 years old - menopause
44
How to we prevent osteoporotic fractures?
Minimise risk factors - non smokers, alcohol intake - Ensure good calcium and Vitamin D status Falls prevention strategies Medications
45
Medications that help prevent fractures what are the side effects? (3)
Hormone replacement therapy Increased risks of blood clots Increased risk of breast cancer with extended use into late 50s/early 60s Increased risk of Heart disease and stroke if used after large gap from menopause
46
What are SERMS
Selective oEstrogen Receptor Modulator-Raloxifene
47
Raloxifene reduces risk of ?
vertebral fractures
48
Negative Effects of SERMS? (3)
Hot flushes if taken close to menopause Increased clotting risks Lack of protection at hip site - help reduce the risk of breast cancer
49
Bisphosphonates are? features required to use this mediation?
Oral Bisphosphonates generally the first line of treatment ``` Adequate Renal function required Adequate Calcium and Vitamin D status Good Dental Health and Hygiene advised Notify dentist on Bisphosphonates Encourage regular check ups / well fitting dentures ```
50
EGFR for Bisphosphonates
oral - less than 30 | IV - less than 45
51
Side effects of Bisphosphonates?
- Oesophagitis - Iritis/uveitis - heartburn Not safe when eGFR<30 mls/min ONJ - osteonecrosis of jaw Atypical femoral shaft fractures
52
What is Denosumab what does it reduce? how is it given?
Monoclonal antibody against RANKL Reduces osteoclastic bone resorption Subcutaneous injection every 6 months - reduces bone break down but closer to recovery
53
Denosumab is after in patients with?
significant renal impairment then bisphosphonates
54
Denosumab blocks????
Osteoclast Formation, Function, and Survival Inhibited
55
Side effects of Denosumab? reserve it for?
Allergy/rash Symptomatic hypocalcaemia if given when vitamin D deplete ONJ Atypical femoral shaft fractures - rebound fracture - older individuals
56
only licensed anabolic therapy for bone? how is it given?
TERIPARATIDE: Intermittent Human Parathyroid Hormone single daily injection
57
Side effects of Teriparatide? (3)
minor - Injection site irritation - Rarely hypercalcaemia - Allergy not suitable for children

Year 3: Block 1: MSK system (22 decks)

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