R/O - Metabolic bone disease Flashcards Preview

Year 2 Specialty Medicine > R/O - Metabolic bone disease > Flashcards

Flashcards in R/O - Metabolic bone disease Deck (37):
1

definition: osteoporosis

bone deterioration with:
- reduced bone mass
- disruption of micro architecture of bone

2

what is the T score cut off for osteoporosis?

-2.5 (-2.5 or less means osteoporosis diagnosis)

3

what type of fracture has the highest mortality?

hip fracture

4

what is the most common reason for nursing home admittance?

hip fractures

5

what is the gold standard screening for diagnosing and monitoring osteoporosis?

DXA

6

what is a Z score?

age matched control

7

low bone density (osteopenia) is a T score in what range?

- 1.0 down to -2.5

8

what is a normal T score?

-1.0 to 1.0

9

anyone with a fragility fracture by definition has:

osteoporosis

10

when should a T score be used?

- comparing BMD to a person of same age
- younger than peak bone mass
- pre-menopausal women
- men under 50 yo
- evaluating for secondary causes of osteoporosis

11

recommend BMD testing in women over ____ and men over ____

- women: 65
- men: 75

12

in postmenopausal women and men 50-70, recommend BMD testing when there is concern based on ______________________

risk factor profile

13

the WHO FRAX algorithm was developed to calculate:

- 10 yr probability of a hip fracture
- 10 yr probability of any major osteoporotic fracture (defined as hip, forearm, humerus)

14

consider initiating treatment in postmenopausal women and men over 50 with T score of ______ AND _________

- 1 to -2.5
- 10 yr hip fracture probability 3% or more

15

how often is BMD testing recommended?

every 2 years

16

what are limitations of FRAX?

- patients naive to treatment
- only uses T score from hip and does not accomodate peripheral sites or spine T score

17

what are the anticatabolic drug therapies for osteoporosis?

- bisphosphonates
- SERM
- denosumab

18

what is the anabolic drug therapy for osteoporosis?

teriparitide

19

what is the MOA of bisphosphonates?

- bind to bone mineral
- concentrate at sites of bone resorption
- release and intracellular uptake during resorption
- loss of resorptive function

20

bisphosphonate action depend on what two factors?

- mineral binding
- effects of osteoclasts

21

what is the MOA of denosumab?

- binds RANK-L and inhibits osteoclast-mediated bone destruction
- osteoclast formation, function, and survival inhibited
- bone resorption inhibited

22

what factors determine PTH effects on bone?

- administration
- dose

23

high dose (continuous) PTH has what effect on bone?

catabolic

24

low dose (daily) PTH has what effect on bone?

anabolic

25

paget disease of bone is characterized by abnormalities of the ______________ (cell type) and there is _______________ (accelerated / decreased) bone turnover and abnormal bone remodeling

- osteoclast
- accelerated

26

what is the inheritance of PDB?

AD

27

what are the labs in PDB?

- increased alk phos (bone specific AP)
- bone turnover markers increased
- calcium and phosphate typically NORMAL

28

what test should be done in patients with PDB?

baseline bone scan

29

what do you monitor in PDB?

alk phos

30

what is the medication of choice for PDB?

- bisphosphonates (zoledronic acid)

31

definition: rickets

deficient mineralization at the growth plate, as well as architectural disruption of this structure

32

definition: osteomalacia

impaired mineralization of the bone matrix

33

rickets and osteomalacia occur together as long as:

growth plates are open (only osteomalacia occurs once the growth plates close)

34

calcipenic rickets is usually caused by:

dietary deficiency of vitamin D and/or calcium (most common form)

35

phosphopenic rickets in children and adolescents is almost always caused by:

- renal phosphate wasting (usually isolated)
- generalized tubular disorder (e.g. Fanconi)
- inadequate dietary phosphate / intestinal malabsorption (rare)

36

- delayed closure of fontanelles
- parietal and frontal bossing
- enlargment of costochondral junction
- widening of wrist
- lateral bowing of femur and tibia

rickets

37

- elevated alk phos
- reduced serum calcium and phosphorus
- low urinary calcium
- low 25-OH vitamin D
- elevated PTH

osteomalacia