Metabolic bone disease

Question 1

What are some drugs to treat osteoporosis?

Answer 1

ANTI-RESPORPTIVE
bisphosphonates 
denosumab - monoclonal antibody
HRT
ANABOLIC
teriparatide - PTH analogue

Question 2

What are some risk factors for fractures?

Answer 2

low trauma fracture 
inflammatory disease 
endocrine disease
malabsorption 
low BMI 
immobility 
medication 
family history of hip fracture 
alcohol 
vit D deficiency

Question 3

What is the T score?

Answer 3

standard deviation relating to normal young adult of same gender
under -2.5 = osteoporosis

Question 4

What are some tests to find underlying causes of osteoporosis?

Answer 4

Ca, PTH, vit D 
serum and urine electrophoresis 
TSH
coeliac antibody 
FBC, ESR
sex hormones

Question 5

What are some examples of bisphosphonates?

Answer 5

alendronate, risedonate, ibandronate, zoledronate

Question 6

What are the triad of symptoms for Paget’s?

Answer 6

pain, deformity, fracture

Question 7

What are the tests for paget’s?

Answer 7

XR, isotope scan, alkaline phsphatase

Question 8

How would you treat Pagets?

Answer 8

Only if symptomatic
- bisphosphonates, alendronate
analgesia

Question 9

What is osteomalacia?

Answer 9

softening of bones caused by impaired bone metabolism - normally caused by inadequate levels of phosphate, calcium and vit D

Question 10

What are the symptoms of osteomalacia?

Answer 10

weakness, fatigue
bone pain
fractures

Question 11

How would you treat osteomalacia?

Answer 11

high dose Vit D and calcium

Question 12

What are the normal and abnormal levels of Vit D?

Answer 12

> 50 nmol/l
<25 deficient
- we all need 10 micrograms per day

Question 13

Who is at risk of vit D deficiency?

Answer 13

no sunlight - housebound, dark skin, clothing
renal failure
anticonvulsants

Question 14

What are some symptoms of hypercalcaemia?

Answer 14

polyuria, thirst, constipation, confusion

Question 15

What tests would you do in hypercalcaemia and what would results mean?

Answer 15

U&E
PTH
- high = primary hyperparathyroidism
-low = hypercalcaemia

Question 16

What is the emergency level of hypercalcaemia?

Answer 16

> 3 mmol/l

Question 17

How would you treat hypercalcaemia?

Answer 17

0.9% Saline - 4-6l in 24 hr

IV bisphosphonates or steroids in extreme cases

Question 18

How would you treat dangerous hypocalcaemia? What level is that?

Answer 18

<2
10mls 10% calcium gluconate
calcium gluconate infusion

Question 19

What are causes of low magnesium?

Answer 19

High alcohol
diabetes
diuretics
chemo

Question 20

What T score indicates osteopenia?

Answer 20

between -1 and -2.5

Question 21

At what age is HRT no longer desirable as osteoporosis treatment?

Answer 21

over 60s

Question 22

What age do you go onto bisphosphonate if on a steroid, regardless of bone density?

Answer 22

65 years old

Question 23

What is a treatment for severe osteoporosis?

Answer 23

teraperitide

Question 24

What happens to PTH when serum calcium starts to fall?

Answer 24

PTH goes up

Question 25

What does PTH do?

Answer 25

increased bone turnover increased renal absorption increase calcium absorption in gut

Question 26

How would you monitor osteoporosis?

Answer 26

BMD T score: -1 normal Z score FRAX score - risk of serious fracture in next 10 years

Question 27

Which 3 factors contribute to bone strength?

Answer 27

bone density bone size bone quality (turnover, mineralisation, architecture)

Question 28

What happens in ankylosing spondylitis?

Answer 28

calcium line down spine can lead ot severe kyphosis of thoracic and cervical spine inflammation - erosive damage - repair - new bone formation

Question 29

What is Paget's disease?

Answer 29

increased bone turnover resulting in bone remodelling, enlargement, deformity and weakness formation >resorption

Question 30

What is hyperphosphataemic rickets?

Answer 30

X linked defect to phosphate transport in proximal tubule = low serum phosphate, high urine phosphate growth retardation, bowing of long bones, dental abscesses

Question 31

What is fibrous dysplasia?

Answer 31

can be part of mcCune-Albright syndrome fibrous tissue development = swelling in jaw, gaps in teeth, weak fibrous bone tissue

Question 32

What is osteopetrosis?

Answer 32

osteoclasts cannot resorb bone | = skeletal fragility with high bone density

Question 33

What is tumoral calcinosis?

Answer 33

massive periarticular soft tissue deposition of calcium and phosphate (esp. upper body), causes chronic renal failure

Question 34

What is osteogenic/tumour induced osteomalacia?

Answer 34

small bony or soft tissue tumours secrete FGF23 and cause hypophsophataemia

Question 35

What is Beal's arachnodactyly?

Answer 35

mutation in gene that builds fibrillin-2 = aortic enlargement, unable to extend joints, joints can be deformed (similar to Marfan's)

Question 36

What is a pneumonic to remember the risk factors for osteoporosis?

Answer 36

SHATTERED steroids, hyperparathyroid/hyperthyroid, age, thin, testosterone deficient, early menopause rheumatology/renal disease, eating poorly, vitamin D deficient