Rheumatology/bone Disease

Front 1

what treatment if DEXA T score > -1.5 according to NICE?

Back 1

bisphosphonate (Alendronate)

Front 2

osteomalacia def

Back 2

disease resulting from inadquate mineralization of bone caused by defect in vitamin D availability or metabolism

Front 3

osteomalacia - aetiology
(common causes, medication interfering with vit D)

Back 3

vitamin D deficiency (dietary, lack of sunlight, malabsorption)
renal disease (CKD, RTA, fanconi syndrome)
phenytoin/phenobarbital

Front 4

osteomalacia - clinical features

Back 4

asian women
vague symptoms of muscle pain and tenderness
"waddling gait"
biochemical abnormalities

Front 5

osteomalacia - biochemical profile
(Ca, PO4-, PTH, Alk Phos, Vit D)

Back 5

Ca normal or low
Phosphate normal or low (with PTH elevated)
Alk Phos elevated
Vit D low (except Vit D resistent rickets)

Front 6

osteomalacia - characteristic xray appearance, which bones usually?

Back 6

"looser zones" (linear areas of low density surrounded by sclerotic bone)
femur, pelvis, ribs

Front 7

osteomalacia - treatment
(how does treatment differ in nutrional deficiency, in kidney disease, in malabsorption?)

Back 7

mainstay: correction of cause
nutritional: VitD supplement
malabsorption: parenteral doses
kidney disease: calcitriol, alfacalcidiol (due to defective 1alfa hydroxylase unable to hydroxylate Vit D!)

Front 8

Osteoporosis def

Back 8

Disease characterized by low bone mass and micro-architectural deterioration of bone tissue leading to increased fracture risk.

Front 9

Osteoporsis diagnosis
(diagnostic test, other investigations needed for assessment)

Back 9

diagnostic: DEXA scan T < -2.5 (less than 2 standard deviations)
exclude secondary causes

Front 10

Osteoporosis management
(who to treat)

Back 10

select patient at risk
exclude secondary cause
perform DEXA scan

lifestyle advice, Ca+VitD, bisphosponate first line

Front 11

Osteoporosis indications for DEXA scan?

Back 11

loss of height/kyphosis
previous fragility fracture
radiographic osteopenia
on glucocorticoids
BMI <19
diseases associated with osteoporosis (e.g. coeliac, renal...)

Front 12

Osteoporosis in younger patient without fracture

Back 12

assess need for treatment according to risk factors

Front 13

Osteoporosis in elderly frail

Back 13

lifestyle advice
fall risk assessment
Ca+VitD
hip protectors NOT effective

Front 14

Osteoporosis in >65 with previous fracture

Back 14

lifestyle advice
Ca+VitD supplement if depleted
first line treatment: bisphosphonates or strontium

Front 15

Osteoporosis in men

Back 15

bisphosphonates
testosterone if hypogonadism

Front 16

Osteoporosis in glucocorticoid therapy
(who should receive primary prophylaxis, who needs treatment, what treatment)

Back 16

>65 or have had fracture - primary prevention, other should be considered if therapy >3months
treatment: Ca+VitD and bisphosphonates

Front 17

osteoporosis - what lifestyle advice

Back 17

exercise
smoking and alcohol cessation
reduce falls (physio/OT)

Front 18

treatment osteoporotic spinal fracture

Back 18

mainstay: conservative
1-2 weeks bed rest
pain relief (simple analgesics, TENS, pamidronate)
diazepam as muscle relaxant
physiotherapy

Front 19

Paget's disase (of the bone) def

Back 19

Osteitis deformans is a focal disorder of bone remodelling where ultimately formation exceeds reabsorption but the new bone is structurally abnormal.

Front 20

Paget's disease clinical presentation

Back 20

* >40 yr
* asymptomatic finding: xray or Alk phos
* bone pain
* deformities (tibia, skull)
* with complications:
- CN compression (most CNVIII)
- hydrocephalus (spinal stenosis)
- high output CCF (bone perfusion)
pathological fracture

Front 21

Paget's investigations
(diagnostic, biochemical bone profile)

Back 21

diagnostic: Xray appearance (skeletal survey)
Alk phos high with normal Ca/PO4-

Front 22

Paget's management
(treatment, monitoring)

Back 22

bisphosphonates
monitor with AlkPhos +/- urinary hydroxyproline.
surgery for severe deformities