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Pathology 3 > metaboolic bone disease > Flashcards

metaboolic bone disease Flashcards

(52 cards)

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1
Q

too much osteoclast

A

bone wasting diseases

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2
Q

too much osteoblast

A

sclerosing bone disease

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3
Q

osteoperosis

A

porous bone
bone wasting disease
a skeletal disorder characterised by compromised bone strength predisposing to an increased risk of fracture

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4
Q

bone wasting disease example

A

osteoperosis

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5
Q

example sclerosing bone disease

A

osteopetrosis (stone bone)

sclerosteosis

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6
Q

bone strength

A

bone density + bone quality

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7
Q

bone density

A

grams of mineral per volume (BMD, bone mineral density)

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8
Q

bone quality

A

architecture, turnover, damage

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9
Q

osteoporosis incidence

A

most common metabolic bone disease

endemic in wester society

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10
Q

a fracture resulting from a fall of standing height or less due to osteoporosis

A

osteoperotic-related fragility fracture
1 in 2 women and 1 n 3 men will suffer this sort of fracture
usually wrist, vertebrae or hip

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11
Q

mortality of osteoporosis

A

hip and vertebral fracture mortality
risk of death is greatest immediately after fracture
death is not directly attributed to the fracture but rather other chronic diseases that lead to the fracture

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12
Q

morbidity of osteoporosis

A

7% of survivors of fracture have some sort of permanent disability
hip fractures most often associated with osteoporosis-disabilities
eg. pressure sores, UTIs etc, 50% unable to independently walk after fracture

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13
Q

pathophysiology of osteoporosis

A

remodelling - imblanace in processes whch are responsble for acquision and maintenance of bone mass
increase in resorption of bone

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14
Q

type 1 osteoporosis

A

post menopausal
only effects trabecular bone
forearm and spinal fractures most common

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15
Q

type 2 osteoporosis

A

age related
cortical and trabecular bone
hip fracture more common

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16
Q

secondary osteoporossis

A

arises from other causes: usually endocrine diseases (cushings, hypogonadism, hyperparathyroidsm), drugs (anti-retrovirals), glucocorticoids, malabsorbtion, and rheumatological diseases

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17
Q

histology og osteoperosis

A

trabecular and cortical thinning
increased adiposity in marrow
smaller osteoid seams
normal bone width

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18
Q

clinical features of oosteoporosis

A 
mostly asymptomatic 
- pain 
- microfactures 
- fractures
hip, vertebral bodies, radius
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19
Q

clinical diagnoss of osteopoross

A 
serum biochemistry - typically with normal limits 
alkaline phosphatase (ALP - osteoblast marker) 
carboxy terminal telopeptide of type 1 collagen (CTX, bone resorption osteoclast marker)
- serum calcium and serum phosphate
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20
Q

if CTX is raised this may indicate

A

Carboxy terminal telopeptide of type 1 collagen

could ndicate secondary osteoporoosis

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21
Q

clinicall diagnosis of osteoporosis using X ray

Study These Flashcards
A

insensitve means of detection
decreased bone density
cortical thinning
fracture

22
Q

gold standard clinical diagnosis of osteoporosis

23
Q

densitometry

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A

DEXA-T scores
bone mineral density as assessed by Dual-Energy X ray Absorptiometry
difference nbetween measures and mean ‘healthy’ (based on matched gender and ethnic group)

24
Q

T score > -1

25
T score -1 ro -2.5
ostopaenia
26
T score < -2.5
osteoporosis
27
T score < -2.5 and H. of fracture
severe osteoporosis
28
T score represents
T score represents the number SD a patient is above or below the mean BMD of a young adult
29
osteomalacia
defective minelarlisation of organic matrix bone softening rickets (children) osteomalaca (adults)
30
pathophysiology of osteomalacia
impaired metabolism most commonly caused by severe vit D deficency lack of mineralisation effects both quality and quantity of bone reduced stifness and stength, susceptibe to compressive forces deformities of weight bearing bones pathological fractures
31
dietary deficiencies of osteomalacia
vit D, calcium, phosphate
32
vitamine D lack may be caused by
``` endogenous synthesis reduced (lack of sunlight) dietary lack (malabsorbtion) chronic renal failure, hepatic disease ```
33
aetiology of rickets
- vit D lack or resistance - hypophosohatamia - drugs: phenytoiin, aluminium, heavy metals - neoplasia - oncogenic osteomalacia
34
clinical features of osteomalacia
- bone is soft (deformity) and fragile - bone pain/tenderness proximal muscle weakness (hypocalcaemia) general low bone mass on radiology multiple bilateral cortical lucensies (pseudofractures)
35
biochemistry of osteomalacia
alterations in the serum concentrations of calcium, phosphorous, vitamin D vary according to the underlying disorder but tend to show: low/normal serum calcium, low phosphate, high ALP
36
rickets in children
shortened heght due to disruption of metaphysis | warping of femurs
37
primary hyperparathyroidism
parathyroid adenoma, parathyroid hyperplasia | parathyroid carcinoma
38
secondary hyperparathyroidism
chronic hypocalcaemia lack of negative feedback hypersecretion of PTH
39
pathophysiology of primary hyperparathyroidism
primary excessive uncontrolled production of parathyroid hormone (PTH) from neoplastic of hyperplastic parathyroid tissue parathyroid hyperplasia/adenoma/carcinoma excessive PTH stimulates osteoclastic resorpton results in marked hyperclacemia
40
effects of excessive PTH
increased bone resorption by osteoclasts mobilisation of Ca/PO4 osteoclastic > osteoblastic activity diffuse osteopaenia cysts (macro or micro) marrow fibrosis brown tumours (rare) large localised areas of resorpton (jaw, skull, long bones)
41
clinical presentation of hyperparathyroidsim
asymptomatic (biochemical abnormality detected incidentally) signs and symptoms of hypercalcaemia - abnormal cramps, constipation, muscle fatigue, peptic ulceration, renal calculi bone related disease
42
diagnosis hyperparathyroidism
primary/secondary bone changes are identical on radiology dissecting/tunnelling bone resorption thinnng cortical and trabecular bone irregularr new bone formation x-rays = diffuse osteopaenia and/or circumscribed lucencies subperiosteal eg. phalanges - erosion of tufts
43
hyperparathyroidism microscopically
increased osteoclast number and activity wth increased bone resorpton, which a characteristic tunneling or dissecting pattern mesenchymal cells proliferate in the marrow space and fibrous tissue replaces lost bone
44
paget's disease
osteitis deformans | characterised by disordered bone remodelling
45
3 phases of paget's disease
1. osetolytic (hyperactivated/large and hypernucleated osteoclasts) 2. mixed (lytic and blastic) 3. osteoblastic/sclerotic phases results in thick, soft, porous bone, prone to compression and deformity
46
aetiology of paget's disease
``` idiopathic disorder relatively common late adult life virus (paramyxovirus inclusions) genetic ```
47
paget's disease my involve
one bone - monostotic multiple bone - polyostotic most commonly pelvis and skull but virtually any bone
48
paget's disease sites/symptoms
skull - sskull enlargement, cranial nerve compression thoraco-lumbar spine - pain, neurological cord compression pelvis sacrum - pain, joint involvement - arthritis femur, tibia - pain, deformity, pathological fracture also associates with high ooutput congestive heart failure due to increased shunting of blood to bones bones are hypervascular and hot
49
paget's disease - diagnosis
often asymptomatic x ray elevated serum ALP and urinary hydroxyproline normal serum calcium and phosphorous rradiology description
50
earrly signs of pagets
radiolucency
51
late signs of pagets
increased bone density increased microfractures loss of distinction between cortex and medulla may have sharp demarcation between normal and affected bone may extend into soft tissue if florid disease
52
histology of pagets
increased osteoclastic and oosteoblastic activty acute - primarily women bone, focal mosaic pattern of lamellar bone, resembled jigsaw puzzle with prominent irregular cement lne - osteoclasts present at surface of bone but dont tunnel, in osteollytic phase, hypernucleated osteoclasts may have up to 100 nuclei chronic - thick trabeculae and thicker bones, highly vascullar fibrocellular marrow replacing the haematopoietic marrow

Pathology 3 (11 decks)

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