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Metabolic Bone Diseases

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General Orthopaedics and Basic Science

Part of the book series: Orthopaedic Study Guide Series ((ORTHSTUDY))

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Abstract

Under the spectrum of metabolic bone disease we can find multiple diseases characterized by disorders of bone strength, usually caused by abnormalities of minerals (such as calcium or phosphorus), vitamin D, bone mass, or bone structure. Osteoporosis is the most common metabolic bone disease in the developed world. It is responsible for a large impact on the society due to the consequences of low mineral density: pain and fractures in the elderly are common in an ageing population. However in children, osteopenia may overlap with many hereditary and acquired conditions of diverse etiology that lead to disturbed metabolism of the bone tissue.

Some of these processes primarily affect bone; others are secondary to nutritional deficiencies, a variety of chronic disorders, and/or treatment with some drugs.

It is fundamental for the resident in training to be familiar with the different diseases causing osteopenia since only a careful diagnosis will prevent further complications. In the next pages the most common pathologies are presented in a succinct but practical way to make it easier to recognize some diseases that are not part of the daily life of an orthopedic surgeon.

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References

  1. Tachdjian pediatric orthopaedics, 5th ed. Saunders. Chapter 42. Elsevier; 2014.

    Google Scholar 

  2. Canale T, Beaty J. Campbell’s operative orthopaedics. 12th ed. Mosby; 2012.

    Google Scholar 

  3. Glorieux FH. Pediatric bone. Elsevier; 2012.

    Google Scholar 

  4. Prentice A. Nutritional rickets around the World. The Journal of Steroid Biochemistry and Molecular Biology. 2013;136:201–6.

    Article  CAS  Google Scholar 

  5. Elder CJ, et al. Rickets. The Lancet. 2014;383(9929):1665–76.

    Article  Google Scholar 

  6. Mornet E. Hypophosphatasia. Best Pract Res Clin Rheumatol. 2008;22:113.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Centro Hospitalar Lisboa Norte, Lisbon, Portugal

    Miguel Botton

  2. Department of Orthopaedic Surgery, Hospital José Joaquim Fernandes, Beja, Portugal

    António Robalo Correia

  3. Hospital CUF Descobertas, Lisbon, Portugal

    Manuel Cassiano Neves

Authors
  1. Miguel Botton
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  2. António Robalo Correia
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  3. Manuel Cassiano Neves
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Corresponding author

Correspondence to Manuel Cassiano Neves .

Editor information

Editors and Affiliations

  1. Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA

    Nikolaos K. Paschos

  2. Royal National Orthopaedic Hospital, Institute of Orthopaedics and Musculo-Skeletal Science, U.C.London, Stanmore, Middlesex, UK

    George Bentley

Review Questions

Review Questions

  1. 1.

    The BLOOD CALCIUM LEVEL is normal or low in all the conditions below except:

    1. (A)

      Vitamin D-deficiency rickets

    2. (B)

      Vitamin D-resistant rickets

    3. (C)

      Renal osteodystrophy

    4. (D)

      Hyperparathyroidism

    5. (E)

      Hypoparathyroidism

  2. 2.

    The most common radiographic findings in HYPOTHYROIDISM are the following except:

    1. (A)

      Immature skeleton for infant’s chronologic age

    2. (B)

      Epiphyseal dysgenesis

    3. (C)

      Narrow physis

    4. (D)

      Thoracolumbar kyphosis

    5. (E)

      Transverse radiopaque bands in metaphyseal areas and thickened cortices

  3. 3.

    In RENAL OSTEODYSTROPHY the pathological findings are characterized by the following except:

    1. (A)

      Failure to replace physeal chondrocytes by endochondral ossification

    2. (B)

      Widened physis

    3. (C)

      Provisional calcification zone irregular

    4. (D)

      Bony trabeculae with abundant osteoid and widened osteoid seams

    5. (E)

      Bone sclerosis

  4. 4.

    In a patient with SCFE secondary to hypothyroidism:

    1. (A)

      The “in situ” fixation should be performed with Kirschner wires.

    2. (B)

      If the slip angle is > 45° it should be corrected by surgical dislocation of the hip

    3. (C)

      AVN is observed in 73% of the cases

    4. (D)

      Prophylactic pinning of the contralateral hip is mandatory

    5. (E)

      All the above

  5. 5.

    Regarding VITAMIN D-RESISTANT RICKETS which below sentence is appropriate:

    1. (A)

      The orthotic treatment should be the initial treatment.

    2. (B)

      Surgical correction of angular deformities is fundamental.

    3. (C)

      Multilevel osteotomy with undercorrection of mechanical axis is the rule.

    4. (D)

      Recurrent deformity is a rare sequel.

    5. (E)

      Younger patients have lower risk.

  6. 6.

    Which of the following is NOT a known risk factor for NUTRITIONAL RICKETS?

    1. (A)

      Premature infant

    2. (B)

      Celiac disease

    3. (C)

      Prolonged breastfeeding

    4. (D)

      Hypocaloric diet

    5. (E)

      Hepatobiliary disease

  7. 7.

    Which symptom is NOT a typical RICKETS physical finding?

    1. (A)

      Rachitic rosary

    2. (B)

      Harrison’s groove

    3. (C)

      Pectus excavatum

    4. (D)

      Short stature

    5. (E)

      Periarticular swelling

  8. 8.

    Regarding VITAMIN D DEFICIENCY,

    1. (A)

      Serum calcium is usually above normal levels.

    2. (B)

      Serum phosphorus is above normal levels.

    3. (C)

      Alkaline phosphatase is below normal levels.

    4. (D)

      25(OH) vitamin D is below normal levels.

    5. (E)

      Serum PTH is below normal levels.

  9. 9.

    Which of the following are radiographic findings of RICKETS?

    1. (A)

      Widened growth plate

    2. (B)

      Cupped metaphysis

    3. (C)

      Looser’s lines

    4. (D)

      Angular deformities

    5. (E)

      Thickening of cortices

  10. 10.

    Which is the most frequent inherited form of VITAMIN D-RESISTANT RICKETS?

    1. (A)

      X-linked dominant

    2. (B)

      Autosomal dominant mutations in FGF23

    3. (C)

      Autosomal recessive mutations

    4. (D)

      Autosomal recessive mutations in SLC34A3

    5. (E)

      Autosomal recessive mutations in SLC34A1

  11. 11.

    Which sentence below does not apply to IDIOPATHIC JUVENILE OSTEOPOROSIS?

    1. (A)

      Characterized by increased remodeling activity

    2. (B)

      Onset before puberty

    3. (C)

      Compression fractures of the vertebrae and long bones

    4. (D)

      Formation of new but osteoporotic bone

    5. (E)

      Spontaneous recovery after skeletal maturity

  12. 12.

    Which of the following diseases has SCFE as a clinical manifestation?

    1. (A)

      Renal osteodystrophy

    2. (B)

      Nutritional rickets

    3. (C)

      Drug-induced rickets

    4. (D)

      Vitamin D-resistant rickets

    5. (E)

      Scurvy

  13. 13.

    In a child with osteopenia, jaundice, lethargy, sleepiness feeding difficulties, and constipation the most probable diagnosis is:

    1. (A)

      Growth hormone deficiency

    2. (B)

      Idiopathic hyperphosphatasia

    3. (C)

      Hypervitaminosis D

    4. (D)

      Hypothyroidism

    5. (E)

      Hypoparathyroidism

  14. 14.

    Which of the following radiograph signs are not common in HYPOTHYROIDISM?

    1. (A)

      Skeleton immature for infant’s chronologic age

    2. (B)

      Epiphyseal dysgenesis

    3. (C)

      Narrow and irregular physis

    4. (D)

      Thoracolumbar kyphosis

    5. (E)

      Transverse radiopaque bands in metaphyseal areas and thickened cortices

  15. 15.

    In a child with loss of appetite, irritability, hemorrhage, impaired wound healing, fractures, osteopenia, and thinning of cortices all the above should be considered except:

    1. (A)

      Scurvy

    2. (B)

      Osteomyelitis

    3. (C)

      Leukemia

    4. (D)

      Purpuric diseases

    5. (E)

      Pseudohypoparathyroidism

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Botton, M., Correia, A.R., Neves, M.C. (2019). Metabolic Bone Diseases. In: Paschos, N., Bentley, G. (eds) General Orthopaedics and Basic Science. Orthopaedic Study Guide Series. Springer, Cham. https://doi.org/10.1007/978-3-319-92193-8_10

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  • DOI: https://doi.org/10.1007/978-3-319-92193-8_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92191-4

  • Online ISBN: 978-3-319-92193-8

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