Metabolic bone disorders
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This document discusses three cases of metabolic bone diseases: 1) A 72-year-old woman with severe thoracic pain was found to have osteoporosis based on imaging and lab results. 2) A 33-year-old woman with generalized bone pain for 3 months had low calcium and phosphate levels, indicating she had osteomalacia likely caused by medication-induced vitamin D deficiency. 3) Gout was briefly discussed regarding its acute attack management and long-term prevention.
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Metabolic bone disorders
- 1. Metabolic Bone Disease AB Govindaraj, FRCS Consultant Orthopedic Surgeon, Fortis Malar Hospital
- 2. Aims & Objectives • Aim: • Create Awareness about Common Metabolic disorders • Objective: • Demonstrate understanding of Epidemiology, Aetiology, Clinical features and Management of Osteoporosis, Osteomalacia & Gout.
- 3. Case 1 • 72 year old lady • Acute onset severe thoracic pain • Keeping her awake at night • Radiates around ribs • No history of trauma • PMH – COPD • DH - Inhalers
- 4. Case 1 • On examination: • Frail lady • Afebrile • Thoracic kyphosis • Tender over spinous processes T10 area • No neurological deficit
- 5. Diff. Diag. of Back Pain • Simple strain • Degenerative disease • Metabolic – Osteoporosis, Osteomalacia, Pagets • Inflammatory – Ankylosing spondylitis • Infective – TB • Neoplastic • Others, Fracture • Visceral
- 6. Case 1- Investigations • HB 12.9 • WCC 9.0 • Plts 245 • Na 139, K 4.4 • Urea 7.3, Cr 0.96 • SAP 297 • Ca 6.5 mg% • CRP 1
- 7. Imaging
- 8. Osteoporosis Reduction in bone mass leading to increase risk of fracture Ratio of mineralised bone: matrix is normal Imbalance of bone remodelling
- 11. DEXA
- 15. Osteoporosis - Treatment • Lifestyle factors: Falls prevention • Ca and Vit D • Bisphosphonates • Salmon Calcitonin - SC/Nasal • Teriparatide- PTH • SERMs • Monoclonal antibodies (MAbs) (Denosumab) • Strontium
- 17. Case 2 • 33 year old lady • Generalised bony pain 3 months • PMH – Depression • DH – Sertraline • O/E – Generalised bony tenderness • Joints – Normal ROM, No inflammation
- 18. Investigations • Hb- 12.9 Calcium- 2.18 (2.2-2.6) • WCC- 4.7 Phosphate- 0.79 (0.85-1.45) • Plt- 253 Albumin- 39 (35-50) • ESR- 12 Alk Phos- 172 (25-96) • Urea- 15 LFTs normal • Creat- 0.8 1,25, Dihydroxy Levels - <5
- 19. Osteomalacia • Deficiency or Resistance to Vit D or Phosphate handling problem • Defective Mineralization of bone • Proximal Myopathy, Bony pain, Malaise • SAP raised, Ca and Vit D low or normal • PO4 low or normal
- 20. osteomalacia - Causes • Reduced availability of Vitamin D • Diet: Oily fish, Eggs, Breakfast cereals • Minimal sun exposure • Dark skin, skin covering when outside • Kidney failure • Malabsorption • Epilepsy: Phenytoin, Phenobarbitones • Genetic disease
- 21. • Defective metabolism of Vitamin D • Chronic renal failure, Vit D dependent rickets, • Liver failure, anticonvulsants • Receptor Defects • Altered phosphate homeostasis • Malabsorption, RTA, hypophosphatasia
- 22. Loosers zones
- 23. Treatment • Diet rich in Sea foods/ Fortified Milk • Exposure to Sunlight • Vitamin D Supplements- IM/Oral • Calcium supplements
- 25. Case 3
- 26. Gout - Management • Acute attack- • NSAID’s: Indomethacin/Diclofenac/Ketorolac • Steroids: Prednisolone • Colchicine: • Prevention- • Allopurinol: Zyloric • Febuxostat: Febutaz, Uricostat • Probenecid: Benemid • Diet: Low Purine Diet. No Alcohol
- 28. 28 Thank You