Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

45 Cards in this Set

  • Front
  • Back
What is Osteoporosis?
-Metabolic bone disease
-Rate of bone REABSORPTION ACCELERATES whil rate of bone formation slows done(or normal)
-increased osteoclasts, decreased osteoblasts
-bone loses calcium and phosphate and becomes porous and brittle
2 types of Osteoporosis?
Type 1 = due to ovarian failure and low estrogen-manopause-only in women

Type 2 = age associated>75 years old
men and women affected equally
Osteoporosis is a big problem:
-major public health threat
-associated with increasing aging
-1 out of 2 women and on in eight men over 50 will have OP related fractures in their lifetime.
Colles fracture?
Very common with Osteoporosis-fall on outstretched hands (type 1)
Many risk factors for OP
-female gender
-Increased age
-post men women
etc see page 2 of notes**
Signs & Symptoms of Osteporois?
* Usually no symptoms 'till fractures occur
*Loss of Height
* Backache
Fatalities due to Fractures?(osteoporosis)
* Fat/pulmonary embolism
* Hemorrhage and schock
* Corrective surgical complications.
Labs for osteoporisis?
Primary osteoporosis = labs will be normal
Ca++, Mg++, phosphate, vitamin D
But need to get:
TSH, Vitamin D levels (25 hydroxyvitamin D)
Imaging for osteoporosis?
Quantitative X-ray Bone Densitometry – DEXA Scan
What is seen:
demineralization of spine and pelvis (femoral neck and head)
Compression of vertebrae
* No longer 1st line of therapy
* Bisphosphonates -inhibit bone resorption (Fosamax, Actonel, Boniva)
* Evista – Selective Estrogen Receptor Modulator (SERM)
* Calcitonin
Treatment (cont)
* Diet: Calcium (1.5g/d), vit. D (400u/d), Mg++
* Weight bearing exercise
* Weight training and physical therapy
* Smoking cessation
* Testosterone (men and women) will increase bone density
No rope jumping or jogging
Sources of calcium?
* Caltrate
* Tums, Rolaids
* Milk, Yogurt
* Sardines
* Other products like Viactiv
DDX of Osteoporous?
Osteomalacia and Rickets
* Metabolic bone diseases
* Deficiency in Vitamin D (prohormone)
- Results in decreased Ca++ and phosphate absorption
* Osteomalacia = Adults
* Rickets = children
Anticonvulsants may induce osteomalacia
Osteomalacia and Rickets
Symptoms (presentation)?
* Bone pain and muscle weakness
* Low back pain
* Children develop skeletal deformities
* Bone fractures
* Vertebral collapse with minimal trauma
What are the Lab studies for Osteomalacia and Rickets?
* Radiography:
(Diffused decrease bone density, Bone biopsy)
* Hypocalcemia, pocalciuria, hypophosphatemia
* Increased alkaline phosphatase
* Decreased 25-hydroxyvitamin D
What are the treatments for Osteomalacia and Rickets?
* Prevention: sun light exposure and adequate vitamin D

* Ergocalciferol 50,000 1-2x weekly 6-12 months, then daily
* Phosphate supplementation
Oral calcium
* Treat patients on phenytoin prophylactically
What is Paget’s Bone Disease (Osteitis Deformans)?
Increased osteoclastic activity with insufficient osteoblastic response—resulting in bone replaced by abnormal fibrotic tissue and irregular bone formation
General info of Paget’s Bone Disease?
* Manifested by bony lesions

* Prevalence in the elderly
2nd to osteoporosis as a common cause of bone disorder

* Family history is usually positive

* Chronic lesions in 1-3% of patients transform into osteosarcoma
What are the Symptoms of Paget’s Bone Disease (Osteitis Deformans)?
1. Most are asymptomatic
2. Bone and joint pain
3. Pathological fractures
4.Back pain, head pain, increased hat size
5. Bowed tibias, kyphosis
6. Deafness
What are the Lab studies for Paget’s Disease?
* Normal Ca++ and Phosphate
* High alkaline phosphatase
* Hypercalcemia in bed bound patients with Paget’s
* Radiographic and bone scan findings:
Dense, expanded bone, fissures in long bones
What are the complications of Paget's Disease?
- Fractures with minimal trauma
- Hypercalcemia and renal stones in bed bound patients
- Vertebral collapse & spinal cord compression
- Osteosarcoma
- Cranial nerve palsies from extensive skull involvement
What is the treatment?
- Cyclic administration of Biphosphonates
- Nasal Calcitonin-salmon (alternative)
What is the purpose of Parathyroid Glands?
To regulate calcium
What is the Parathyroid function?
* Breakdown of bone to deliver calcium and phosphorus into circulation via the Parathyroid Hormone (PTH)
* Activates the action of vitamin D in the kidney
-Vit. D bioactive form (skin—GI—liver—kidney)
* Vit D increases GI absorption of Ca++, Mg++ and Phosphorous
What is necessary for PTH function?
Magnesium and Vitamin D
What is the net effect of the Parathyroid function?
Calcium Metabolism
* Under PTH control
* Kidneys control excretion of Ca++
* GI controls absorption of Ca++
* Calcium binds to albumin
- To correct serum Ca++: serum Ca + (0.8 x [4.0-albumin]) 7.2 (0.8 x 4-2.8) = 8.16
* Counter-regulation with calcitonin
Inhibits bone resorption
* Most common after thyroid removal (loss of active parathyroid tissue)
* Very RARE
* Result is low serum Calcium
What are the Symptoms of Hypoparathyroidism?
* Tetany with muscle cramps
* Lethargy, Irritability
* Carpopedal spasm
* Convulsions
* Circumoral tingling, tingling of hands and feet – almost always present in hypo- parathyroidism
* Cataracts
* Teeth, hair and nail (dry/brittle) changes
* Loss of eyebrow hair
* Dry skin
What are the Signs of Hypoparathyroidism?
1. Chvostek’s sign
-Facial muscle contraction on tapping facial nerve in front of ear
2.Trousseau’s phenomenon
-Carpal spasm after application of a cuff
Lab for Hypoparathyroidism
- Low Serum Calcium And High Phosphorus
- Urine calcium low
- Alkaline phosphatase normal
- PTH low
- Check serum magnesium – may exacerbate low Ca++
Imaging for Hypoparathyroidsm
Ct scan or x-ray may show bones more dense than normal
Physical exam for Hypoparathyroidism
Cutaneous calcifications may be present
Treatment for Hypoparathyroidism
* Acute Treatment
If tetany is present:
Airway maintenance and slow Ca++ intravenous infusion
IV and oral Calcium, Vitamin D, +/- Mg

Maintain serum Calcium 8-8.6; patient should be asymptomatic
Vitamin D
Mg++ might be required
Avoid or minimize calcium depleting drugs (furosemide)
Prognosis – Good
Continue checking periodic serum calcium levels
Maintenance treatment for Hypoparathyroidism
* Maintain serum Calcium 8-8.6; patient should be asymptomatic
Vitamin D
Mg++ might be required
Causes of Hyperparathyroidism
* The most common cause is a benign tumor (adenoma) in one of the parathyroid glands
* Less Common Causes
- Parathyroid multi-glandular hyperplasia
- Carcinoma
* Hypersecretion of parathyroid hormone
-Increased osteoclastic activity
* Causes excessive renal excretion of calcium and phosphate
Hypercalcemia, hypercalciuria
Signs and Symptoms
Summary of symptoms:
“bones, stones, abdominal groans, psychic moans, with fatigue overtones"
Hyperparathyroidism Labs
* Hypercalcemia >10.5 mg/dL
* Serum Phosphate low <2.5 mg/dL
* Parathyroid hormone elevation is essential for diagnosis
Hyperparathyroidism Imaging
* Might see osteopenia on x-ray
* Bone density scan—osteopenia /osteoporosis if present
Hyperparathyroidism Treatment for symptomatic disease
* Kidney stones or bone disease
* Removal of parathyroid glands
Hyperparathyroidism Treatment for mild disease
* Keep active
* Drink adequate fluids
*Avoid large doses of vitamin D and A, and calcium
* Treat with medications (Biphosphonates ea.
Hypercalcemic Crisis Signs
* Labs
[Ca++] > 17.5 mg/ dL
PTH 20 x the upper limit of normal
* Clinical presentation
Neurological (Confused, coma, death)
* GU - Nephrolithiasis
Hypercalcemic Crisis treatment
* Isotonic normal saline intravenous infusion
* Calcitonin
* Zolendronate (Zolendroic acid, Zometa)
Hypercalcemic Crisis treament if comatose or [Ca++] 18-20 mg/dL
Urgent hemodialysis is indicated in addition to the aforementioned treatment for hypercalcemia