Bone And Joint Disorders

Question 1

Osteoporosis vs osteomalacia

Answer 1

Osteoporosis

• Weakening of bones- more likely to fracture- caused by reduced bone density
• Diagnosis made with DEXA scanning for bone density with T score < -2.5 is osteoporosis
• Treatment with bisphosphonates that increase bone density, PTH/Calcium + vit D supplements, selective oestrogen receptor modulators (SERMS) like raloxifebe that maintain bone density similar to oestrogen, HRT that replaces loss of oestrogen after menopause (but increased risk of breast cancer, stroke, CVD so not often used)

Osteomalacia

• Inadequate mineralisation of bone causing soft bones
• caused by vit D deficiency so insufficient Ca2+ absorption or insufficient dietary intake, chronic kidney failure, bone-tumour induced, coeliac disease
• Diagnosis made with v low vit D conc measure, pseudo fractures on radiographs
• Treatment for nutritional deficiency is increased dietary intake, increased outdoor time and supplementation of vit D
• ## Treatment for malabsorption is injection/daily oral vit D

Question 2

Causes of limping child

Answer 2

• Inflammation
• Infection- may have had UTI and the inflammation has spread to hip joint (transient synovitis)
• Trauma- accidents or non-accidental injury (abuse)
• Others e.g. tumour

Question 3

• What tests would we do?

Answer 3

• Bloods: FBS (Fasting blood sugar), Esr (erthyrocyte sedimentation rate- how long it takes RBCs to fall to bottom of test tube- quicker they fall, the more likely there’s high inflammation), CRP, renal function
• Autoantibodies perhaps
• MRI perhaps
• Xray leg or hip

Question 4

How will bacteria change the joint fluid and blood?

Answer 4

The clear straw-coloured joint lubricating fluid would have changed its colour and consistency.

In the presence of infection, it would look turbid or cloudy, perhaps darker, presence of pus, increased viscosity and large volume of effusions from swellings