Osteomalacia, Pagets, Osteoporosis Flashcards Preview

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Flashcards in Osteomalacia, Pagets, Osteoporosis Deck (29):
1

what is osteomalacia

severe prolonged vitamin D deficiency (rickets in children)

2

what happens in osteomalacia to the amount of bone and mineralisation

normal amount of bone, decr mineral content- have excess uncalcified osteoid and cartilage

3

what are the causes of vitamin D deficiency

diet, poor sunlight, Asian, anti convulsant therapy, malabsorption, renal failure, vitamin D resistance

4

what is the difference between rickets and osteomalacia

rickets- if process occurs during period of bone growth. osteomalacia- after fusion of epiphyses

5

signs of rickets

growth retardation, hypotonia, apathy, knock kneed, bow legged

6

signs of osteomalacia

bone pain, tender, fractures (typically femoral neck), proximal myopathy, osteoporosis

7

causes of osteomalacia

vit D deficiency, renal osteodystrophy, drug induced, vit D resistance, liver disease, tumour induced

8

investigations in osteomalacia

plasma- decr Ca, decr PO4, incr ALP, incr PTH, decr vit D. biopsy- incomplete mineralisation of bone, muscle normal. x ray- loss of cortical bone, partial fractures without displacement especially- lateral border scapula, inferior femoral neck, medial femoral shaft

9

treatment osteomalacia

vit D. dietary- calcium D3 Forte. malabsorption- ergocalciferol or parenteral calcitriol. renal or vit D resistance- alfacalcidol or calcitriol

10

what is another term for Pagets

osteitis deformans

11

what is Pagets

increased bone turnover, incr number of osteoclasts and osteoblasts- with remodelling, bone enlargement, deformity, weakness. woven bone

12

clinical features Pagets

asymptomatic in >70%. deep boring pain, bony deformity and enlargement- pelvis, lumbar spine, skull, femur, tibia- bowed sabre tibia.

13

complications Pagets

fractures, OA, incr Ca, nerve compression due to bony enlargement,osteosarcoma

14

diagnosis Pagets

x ray- localised enlargement bone, patchy cortical thickening- sclerosis, osteolysis, deformity. bloods- incr ALP, Ca and PO4 normal. isotope bone scan- incr uptake.

15

treatment Pagets

analgesia, bisphosphonates- zoledronate, pamidronate, risedronate, alendronate

16

what is osteoporosis

low bone mass. deterioration of bone mass.

17

where are the common sites of fracture osteoporosis

spine, neck of femur, wrist

18

what happens in bone remodelling osteoporosis

bone resorption is greater than bone formation- osteoclasts resorb greater amount of bone, osteoblasts lay down smaller amount of bone than was resorbed

19

what are the primary and secondary causes osteoporosis

primary- age related. secondary- another condition or drugs

20

what happens if trabecular bone is affected osteoporosis

crush fractures of vertebrae common

21

why is osteoporosis more common in women

oestrogen low after menopause

22

risk factors osteoporosis

SHATTERED- Steroids; Hyperthyroidism, hyperparathyroidism, hypercalciuria; Alcohol and tobacco; Thin; Testosterone decr; Early menopause; Renal/liver failure; Erosive; Dietary

23

what are the complications of osteoporosis over time

kyphosis, loss of height, indigestion/reflux, pain, neck weak and head falls forward, breathing difficulties, stress incontinence

24

investigations osteoporosis

x ray, DEXA (dual energy x ray absorptiometry). bloods- ca, po4, alp normal

25

what is measures from DEXA

T score- number of standard deviations the BMD is from youthful average -2.5 or worse is osteoporosis. -1 to -2.5 is osteopenia

26

indications for DEXA

prev low trauma fracture, FH, early menopause, prior to long term prednisolone, osteopenia, bone and remodelling disordera

27

how do steroids predispose to osteoporosis

promote osteoclast bone resorption, decr muscle mass, decr Ca absorption from gut

28

management osteoporosis lifestyle

stop smoking, weight bearing exercise, good calcium intake, HRT women early menopause.

29

management osteoporosis pharmacological

bisphosphonates (alendronate 10mg/day SE photosensitivity, GI upset); calcium and vit D; strontium ranelate (decr fracture rates); HRT (prevent not treat); raloxifene (oestrogen receptor modulator); teriparatide; calcitonin; testosterone; denosumab