osteoporosis, osteomalacia, pagets

Question 1

what is osteomalacia

Answer 1

softening of bone from low Vit D – > low mineral content

Question 2

what is osteomalacia referred to in children

Answer 2

rickett’s

Question 3

what can cause osteomalacia secondary to vit D deficiency

Answer 3

malabosrption, lack of sunlight, diet

Question 4

what can cause phosphate deficiency –> osteoamalacia

Answer 4

CKD or alcohol abuse + cirhosis

Question 5

what can cause ca deficiency –> osteoamalacia

Answer 5

malbsorption eg coliac

Question 6

what drugs can cause osteomalacia

Answer 6

anti-convulsants

Question 7

symptoms osteomalacia

Answer 7

bone pain, tenderness, fractures (femur), proximal myopathy

Question 8

how does Vit D stimulate bone health

Answer 8

stimulates absorption of calcium and phosphorus

Question 9

bloods in malacia

Answer 9

low vit D, low Ca, low phosphate // high ALP, high PTH

Question 10

mx osteomalacia

Answer 10

Vit D (+ ca or phosphorus)

Question 11

what SD defines osteoporosis

Answer 11

-2.5

Question 12

what SD defines osteopenia

Answer 12

-1 –> -2.5

Question 13

RF osteoporosis (6)

Answer 13

steroids, smoking, alcohol, low BMI, post menopause, RA

Question 14

endocrine disorders that increase risk of osteoporosis

Answer 14

hyperthyroid, hyperparathyroid, hypogonad testosterone def (Turners), GH deficiency

Question 15

chronic ___ disease increases risk of osteoporosis

Answer 15

CKD

Question 16

drugs that increase risk of osteoporosis

Answer 16

SSRI, AED, PPI, glitazone, heparin, aromatase inhibitors eg anastrozole, steroids

Question 17

primary care invx osteoporosis

Answer 17

FBC, U+E, LFT, bone profile, CRP, TFT

Question 18

gold standard invx osteoporosis

Answer 18

DEXA scan

Question 19

T + Z score osteoporosis

Answer 19

T score = bone mass of referencfe pop // Z = adjust for age, gender, race

Question 20

when would a diagnosis of osteoporosis be assumed and no scan needed

Answer 20

75+ and had a fragility fracture –> start mx

Question 21

what fractures are common in osteoporosis

Answer 21

colle’s

Question 22

1st line mx osteoporosis

Answer 22

bisphosphonate eg alendronate

Question 23

what SE to alendronate would indicate change in mx and to what to

Answer 23

GI symptoms, give risedronate

Question 24

2nd line mx osteoporosis

Answer 24

desunomab

Question 25

3rd line mx osteoporosis

Answer 25

stronium ranelate or raloxifine

Question 26

what supplements should people with osteoporosis be offered

Answer 26

ca and Vit D

Question 27

when would HRT be indicated in osteoporosis

Answer 27

post-menipausal women - suffering from vasomotor symptoms (not often used)

Question 28

what screening score can assess risk of fragility fracture

Answer 28

FRAX or Qfracture

Question 29

what is Paget’s disease

Answer 29

increased and uncontrolled bone turnover

Question 30

what cells are overactive in Paget’s

Answer 30

osteoclats

Question 31

bones affected in Paget’s

Answer 31

skull, spine, pelvis, long bones

Question 32

RF pagets

Answer 32

age, male, white, FH

Question 33

presentation pagets

Answer 33

(mostly aysmptomatuc), male with bone pain + raised ALP, bowing of tibia and deformed skull

Question 34

what happens to cortical bone in Pagets

Answer 34

thickens but becomes more brittle

Question 35

bloods in pagets

Answer 35

raised ALP!! normal ca and phosphate // PINP, CTx, NTx

Question 36

imaging in pagets

Answer 36

Xray: osteolysis + thick skull // bone scintohraphy

Question 37

mx pagets

Answer 37

bisphosphonate (+/- calcitonin)

Question 38

bone protection patients on long term steroids

Answer 38

3+ months –> bisphosphonate

Question 39

bone scan results from steroid induced osteoporosis

Answer 39

65+ with fracture –> bisphosponate // <65 + fracture –> DEXA scan –> 0 - -1.5 = repeat 3 years // <-1.5 = bisphosphonates

Question 40

complications pagets

Answer 40

deafness, sarcoma, skull thickening, HF