Bone and joint disorders Flashcards
Can you list all the possible causes for a 78 yr old lady (tripped and fell + had a fall one year ago and sustained wrist fracture)?
High risk of fracture (still important to rule out other causes)
Osteoarthritis (Was it painful prior to her fall)
Hernia (can you see a lump)
Lymph nodes (can you FEEL for lumps)
Any change in sensation (nerve impingement)
Deformity of lower limb ( e.g. short and externally rotated (think hip fracture))
List some lifestyle factors that can increase the risk of osteoporosis.
Excess alchohol, smoking, physical activity, physical inactivity, low body weight
List some drugs that can increase the risk of osteoporosis.
Glucocorticoids
Antiepileptic
Anticoagulant (heparin)
List some endocrine diseases that can increase the risk of osteoporosis.
Hypogonadsim, Hyperthyroidism, Cushing’s Disease, Growth hormone deficiency, Hyperparathyroidism
List some medical disorders that can increase the risk of osteoporosis.
Malnutrition or malabsorption. Anorexia nervosa Inflammatory intestinal disease Intestinal resection Chronic inflammatory diseases (RA) Transplant patients (solid organs and bone marrow) Systemic mastocytosis
Give some info on osteoporosis.
Weakening of bone: More likely to fracture and break.
Stooped back is one of the first signs.
Develops slowly over several years.
Caused by reduced bone density.
Women have ^ risk - particularly after menopause.
Oestrogen slows bone loss and improves bodies absorption/retention of calcium.
What are the causes of osteoporosis?
Long term high dose corticosteroids use. Certain medications for inflammatory, endocrine or malabsorption problems. Family Hx Low BMI Drinking/smoking
What can be done to diagnose OP?
Use risk assessment tools to predict the likelihood of a fracture.
DEXA scanning can look at bone density. Compared against a peer and a young, healthy adult.
Score >-1 = Normal
Score -1 to -2.5 = Osteopenia
Score
List the treatments for OP.
Bisphosphonates - 1st line; Act as anti-bone resorption agents. Leads to increased bone density.
Ca2+ and VD supplements - Recommended daily intake of Ca2+ is 700mg/day. VD is available from sun exposure and certain foods.
PTH (Not 1st line) - Releasing when Ca2+ levels are low. Slows down bone thinning in those with very low bone density.
Selective oestrogen receptor modulators (SERMS) e.g. raloxifene - Similar effects to oestrogen. Helps maintain bone density and decrease fracture risk.
HRT - Replaces oestrogen after menopause. Helps to maintain BD. Has an ^ risk of breast cancer, stroke and CVD so not commonly used.
Give some info on osteomalacia.
Inadequate mineralisation of bone, causing softening of the bone.
Due to insufficient Ca2+ absorption or dietary intake of vitamin D.
Phosphate deficiency caused by ^ed renal losses.
Causes of osteomalacia.
Insufficient dietary intake Faulty vitamin D metabolism Renal tubular acidosis Malnutrition during pregnancy Chronic kidney failure Bone tumour-induced Coeliac disease
How can you diagnose osteomalacia?
Very low VD concentration.
Pseudo-fractures and protrusion acetabula on radiographic images.
Generally measure 25-hydroxycholecalciferol
List treatments of osteomalacia.
Nutritional osteomalacia:
^ dietary intake
^ outdoor time
Supplementation of VD
Malabsorption osteomalacia:
Injected or daily oral dosing of VD.
Can be easily treated if caught early.
Osteomalacia due to other conditions:
Other conditions need to be treated :)
List the causes of limping in children (Hip pain in children).
<4 years old: Transient synovitis Osteomyelitis/ SA Juvenile idiopathic arthritis Non-accidental injury Referred pain from limb Uncommon - Leukaemia, eosinophilic, metastases neuroblastoma.
4-10 years: Transient synovitis Perthes disease Osteomyelitis/ SA Uncommon - Leukaemia, Ewing
10-16 years: Slipped femoral epiphysis Avulsion fractures Osteomyelitis/ SA Uncommon - Leukaemia, osteoid osteoma, Ewing, osteosarcoma
