Metabolic bone dz

Question 1

Osteoporosis

Answer 1

Most common metabolic bone dz in the US.

Imbalance of bone homeostasis

Question 2

PTH Causes…

Answer 2

Increased Ca resorption in tubules
Increased osteoclast activity
Conversion of Vitamin D to active form
Increased Ca abs in GI

Question 3

Thyroid and Bone

Answer 3

Hyperthyroid stimulates clastic activity

Question 4

What does the thyroid release with high serum calcium?

Answer 4

Calcitonin

Inhibits clasts

Question 5

Osteoporosis Pneumonic

Answer 5

Low calcium intake

Question 6

oSteoporosis Pneumonic

Answer 6

Seizure meds

Question 7

osTeoporosis

Answer 7

Thin build

Question 8

ostEoporosis

Answer 8

ETOH

Question 9

osteOporosis

Answer 9

Hypogonadism

Question 10

osteoPorosis

Answer 10

Previous fracture

Question 11

osteopOrosis

Answer 11

Thyroid excess

Question 12

osteopoRosis

Answer 12

Race (white, asian)

Question 13

osteoporOsis

Answer 13

Other relatives (genetics)

Question 14

osteoporoSis

Answer 14

Steroids

Question 15

osteoporosIs

Answer 15

Inactivity

Question 16

osteopososiS

Answer 16

Smoking

Question 17

DEXA scan

Answer 17

Dual-energy x-ray absorptiometry

Test to eval bone mineral density

Question 18

Osteoporosis medical tx

Answer 18

Calcium
VItamin D
Exercise

Question 19

Calcium dose

Answer 19

1200 mg daily

Citrate is better absorbed if concominant use of acid blocking agents

Question 20

Vitamin D dose

Answer 20

800 IU DR daily

Question 21

Bisphosphonate MOA

Answer 21

Inhibit bone resorption by decreasing number and fxn of osteoclasts

Question 22

Bisphosphonate CI

Answer 22

Barrett’s esophagus
Active upper GI dz
If GFR not greater than 30-35

Question 23

Bisphosphonate types

Answer 23

Alendronate (Fosamax)
Risedronate (Actonel)
Zoledronic acid (Reclast)
Ibandronate (Boniva)

Question 24

What must patient do post bisphosphonate dose?

Answer 24

Remain upright for 30 - 60 mins

Question 25

Bisphosphonate SE

Answer 25

``` Reflux, esophagitis Ulcers Esophageal CA? Hypocalcemia MS Pain Eye pain, blurred vision Osteonecrosis of the jaw ```

Question 26

Estrogen agonists

Answer 26

Less effective that estrogen and bisphosphonates. | SE: DVT, hot flashes, cancer

Question 27

Calcitonin

Answer 27

Reduces risk for vertebral body fxs Antagonizes PTH Miacalcin or fortical

Question 28

Hormone therapy

Answer 28

Initiate if other tx options have failed Prempro SE: MI, CVA, Breast CA, PE, DVT

Question 29

Parathyroid hormone replacement

Answer 29

Forteo Actually builds bone Use if bisphosphonates fail

Question 30

Pagets dz of the bone

Answer 30

2nd most common metabolic bone dz | Lesions can occur at various sites

Question 31

Common paget sites in descending order

Answer 31

``` Skull Thoracolumbar spine Pelvis long bones LE ```

Question 32

Pagets patho

Answer 32

``` Dz of osteoclasts Increased bone remodeling Genetic, onset after 55 Mostly men Associated w/ osteosarcoma ```

Question 33

T-score of -1.0 to -2.5 =

Answer 33

Osteopenia

Question 34

T-score of less than -2.5

Answer 34

Osteoporosis

Question 35

Pagets s/s

Answer 35

``` Arthritis, pain Bone deformity/ fractures Hearing loss, HA, vertigo, tinnitus High output heart failure Hypercalciuria Increased incidence of stones ```

Question 36

Pagets labs

Answer 36

Increased alkaline phosphatase

Question 37

Pagets imaging

Answer 37

Mixed lytic and sclerotic lesions Long bone bowing Bone thickening and enlargement

Question 38

Pagets tx

Answer 38

Vitamin D, Calcium | Bisphosphonates

Question 39

Osteomalacia

Answer 39

Decreased mineralization of newly formed bone | Bone is soft, but no matrix loss

Question 40

2 main causes of osteomalacia

Answer 40

``` Insufficient Ca abs in intestine Phosphate deficiency (celiac sprue, kidney, hepatic dz) ```

Question 41

Osteomalacia s/s

Answer 41

Bone pain and muscle weakness Bone tenderness Fracture Difficulty walking

Question 42

Osteomalacia imaging

Answer 42

Reduced bone density w/ thinning of cortex | Fissures, pseudofractures

Question 43

Looser's lines

Answer 43

Fractures from osteomalacia

Question 44

Osteomalacia tx

Answer 44

Tx underlying condition | Vitamin D supplementation

Question 45

Most common fx sites in osteomalacia

Answer 45

Distal radius and prox femur | NOT significant cause of hip fxs

Question 46

Rickets

Answer 46

Deficient mineralization at growth plate | Usually occurs w/ osteomalacia if growth plates have not fused.

Question 47

Rickets cause

Answer 47

Vitamin D and calcium deficiency

Question 48

Rickets Imaging

Answer 48

Bow legs

Question 49

Renal osteodystrophy

Answer 49

Bone dz secondary to kidney dz

Question 50

Osteitis fibrosis

Answer 50

High turnover secondary to hyperPTH

Question 51

Adynamic bone dz

Answer 51

Low turnover. Most common CKD bone dz PTH suppression

Question 52

Is osteomalacia common in CKD?

Answer 52

not really