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22 Cards in this Set

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what treatment if DEXA T score > -1.5 according to NICE?
bisphosphonate (Alendronate)
osteomalacia def
disease resulting from inadquate mineralization of bone caused by defect in vitamin D availability or metabolism
osteomalacia - aetiology
(common causes, medication interfering with vit D)
vitamin D deficiency (dietary, lack of sunlight, malabsorption)
renal disease (CKD, RTA, fanconi syndrome)
phenytoin/phenobarbital
osteomalacia - clinical features
asian women
vague symptoms of muscle pain and tenderness
"waddling gait"
biochemical abnormalities
osteomalacia - biochemical profile
(Ca, PO4-, PTH, Alk Phos, Vit D)
Ca normal or low
Phosphate normal or low (with PTH elevated)
Alk Phos elevated
Vit D low (except Vit D resistent rickets)
osteomalacia - characteristic xray appearance, which bones usually?
"looser zones" (linear areas of low density surrounded by sclerotic bone)
femur, pelvis, ribs
osteomalacia - treatment
(how does treatment differ in nutrional deficiency, in kidney disease, in malabsorption?)
mainstay: correction of cause
nutritional: VitD supplement
malabsorption: parenteral doses
kidney disease: calcitriol, alfacalcidiol (due to defective 1alfa hydroxylase unable to hydroxylate Vit D!)
Osteoporosis def
Disease characterized by low bone mass and micro-architectural deterioration of bone tissue leading to increased fracture risk.
Osteoporsis diagnosis
(diagnostic test, other investigations needed for assessment)
diagnostic: DEXA scan T < -2.5 (less than 2 standard deviations)
exclude secondary causes
Osteoporosis management
(who to treat)
select patient at risk
exclude secondary cause
perform DEXA scan

lifestyle advice, Ca+VitD, bisphosponate first line
Osteoporosis indications for DEXA scan?
loss of height/kyphosis
previous fragility fracture
radiographic osteopenia
on glucocorticoids
BMI <19
diseases associated with osteoporosis (e.g. coeliac, renal...)
Osteoporosis in younger patient without fracture
assess need for treatment according to risk factors
Osteoporosis in elderly frail
lifestyle advice
fall risk assessment
Ca+VitD
hip protectors NOT effective
Osteoporosis in >65 with previous fracture
lifestyle advice
Ca+VitD supplement if depleted
first line treatment: bisphosphonates or strontium
Osteoporosis in men
bisphosphonates
testosterone if hypogonadism
Osteoporosis in glucocorticoid therapy
(who should receive primary prophylaxis, who needs treatment, what treatment)
>65 or have had fracture - primary prevention, other should be considered if therapy >3months
treatment: Ca+VitD and bisphosphonates
osteoporosis - what lifestyle advice
exercise
smoking and alcohol cessation
reduce falls (physio/OT)
treatment osteoporotic spinal fracture
mainstay: conservative
1-2 weeks bed rest
pain relief (simple analgesics, TENS, pamidronate)
diazepam as muscle relaxant
physiotherapy
Paget's disase (of the bone) def
Osteitis deformans is a focal disorder of bone remodelling where ultimately formation exceeds reabsorption but the new bone is structurally abnormal.
Paget's disease clinical presentation
* >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
Paget's investigations
(diagnostic, biochemical bone profile)
diagnostic: Xray appearance (skeletal survey)
Alk phos high with normal Ca/PO4-
Paget's management
(treatment, monitoring)
bisphosphonates
monitor with AlkPhos +/- urinary hydroxyproline.
surgery for severe deformities