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MSK disease (🦴 & 🦵 (Metabolic disorder ((Calcium (Osteoporosis 👴🏻…

- - - - Vitamin D
        
        Role:
        Bone mobilizes Ca & P
        GI ← Ca & P
        Kidney ← Ca, → P
        
        Deficiency?
        
        diet/sun
        
        malabsorption (GI+kidney)
        
        metabolism (liver+kidney; travels via binding protein)
        
        end organ R
        
        P def - aluminium bound meds, renal malabsorption
        
        Rickets 👧🏻 - x calcification, abN growth, poor ossification, affect skull, vertebrae, ribs, lower limb
        
        Osteomalacia 👩🏻 (mineral) - finished growth, ↑ osteoid, osteopenia, fracture
      - Parathyroid hormone
        
        PTH Role in Ca
        
        ✔️ osteoclast → Ca
        
        ↑ renal reabsorption ← Ca
        
        ↑ GI ← Ca
        
        ↑ conv. vit D to 2OH in kidney
        
        ↑ urinary P excretion
        
        Excess?
        1º HYPERPARATHYROIDISM
        or 2º to renal disease (to keep up Ca)
        
        more osteoclasts resorbs bone;
        
        Hypercalcemia
        
        Subperiosteal resorption (hand Xray)
        
        dissecting osteitis
        
        brown tumour (Von Recklinghausen)
      - Phosphate
        
        Deficiency?
        Renal Osteodytrophy
        
        A?
        
        RF → ↓ P, PTH retention
        
        Worsened by ↑ Al and amyloid
        
        Consequence?
        
        2º hyperparathyroidism
        
        osteomalacia/ osteoporosis
        
        ↓ growth
      - Calcium
        
        Osteoporosis 👴🏻 (protein) - porous bones, density >2.5 SD below the mean peak bone mass, measured by DXA
        
        A?
        Senile: ↓ effective osteoblast, diet, exercise → ↑ cortical bone loss
        Post-menopaus: ↓ oestrogen ↑ cytokines → mobilize osteoclast/ blast → ↑ bone loss turnover
        osteoclast (resorption) ≠ osteoblast (form)
        
        Consequence?
        Microfracture → pain, height loss, pelvic fracture, fatal, pneumonia, PE
        
        Types
        1º ie juvenile, idiopathic (Type I post menopausal, Type II age-related)
        
        Osteoarthritis