Bone and Joint Disorders Flashcards
What are potential differential diagnosis for groin pain following a fall?
- High chance of hip fracture
- Was it painful prior to the fall? Could be osteoarthritis
- Can you see a lump? Could be inguinal hernia
- Can you feel for lumps? Lymph node condition
- Change in sensation? Nerve impingement
- Kidney stones
- Lumbar radiculopathy
- Groin strain
What factors increase risk of osteoporosis?
Lifestyle factors, certain drugs, endocrine diseases and medical disorders. Lifestyle factors include excess alchohol, smoking, physical inactivity and low body weight. Drugs include glucocorticoids, antiepileptic drugs and anticoagulants like heparin. Endocrine diseases include hypogonadism, hyperthyroidism, Cushing’s disease, GH deficiency and hyperparathyroidism.
What medical disorders increase risk of osteoporosis?
Malnutrition and malabsorption. Anorexia nervosa. Inflammatory intestinal disease. Intestinal resection. Chronic inflammatory disease (rheumatoid arthritis). Transplant patients and systemic mastocytosis.
What is the difference between osteoporosis and osteomalacia?
Osteoporosis is the weakening of bone and reduced bone mineral density while osteomalacia is due to lack of mineralisation which causes a softening of bone.
What is osteoporosis characterised by?
More likely to fracture and break. Stooped back one of the first signs. Develops slowly over several years. Women have an increased risk especially after menopause as oestrogen slows bone loss and improves body absorption and retention of calcium.
What is osteomalacia caused by?
Caused by insufficient dietary calcium/vitamin D intake or absorption. Phosphate deficiency caused by renal losses.
What are causes of osteoporosis?
- Long term high corticosteroid use
- Certain medications for inflammatory, endocrine or malabsorption problems
- Family history
- Low BMI
- Drinking/smoking
What are 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 is osteoporosis diagnosed?
Risk assessment tools predict likelihood of fracture. DEXA scanning looks at bone mineral density and this is compared against a peer and a young, healthy adult. >-1 is normal, -1 to -2.5 is osteopenia while below that is osteoporosis.
How is osteomalacia diagnosed?
Very low vitamin D concentration, psuedo fractures and protrusion acetabula on radiographic images.
How is osteoporosis treated?
- Biphosphonates used - act as anti-bone resorption agents leading to increased bone density
- Calcium and Vitamin D supplements -
- PTH - released when calcium levels are low. Slows down bone thinning in those with very low bone density.
- SERMS (Selective Oestrogen Receptor Modulator) - Similar effects to oestrogen and helps maintain bone denisty + reduce risk of fracture.
- HRT - replaces loss of oestrogen after menopause and helps to maintain bone density. Has an increased risk of breast cancer, stroke and CVD so not commonly used.
How is osteomalacia treated?
Nutritional changes such as increasing dietary intake of calcium and vitamin D, increasing outdoor time and taking supplements. For malabsorption, oral or injected daily dose of vitamin D and can be easily treated if caught early. If other conditions causing it, they need to be treated.
What are the most common causes of hip pain in a child under 4?
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- Juvenile idiopathic arthritis
- Non-accidental injury
- Referred pain from limb
Uncommon causes: - Leukaemia 2. Eosinophilic granuloma
- Metastases neuroblastoma
What are the most common causes of hip pain in a child between 4 and 10?
- Transient synovitis
- Perthes disease
- Osteomyelitis/septic arthritis
Uncommon causes: - Leukaemia 2. Ewing’s
What are the most common causes of hip pain in a child aged between 10 and 16?
- Slipped femoral epiphysis
- Avulsion fracture
- Osteomyelitis/septic arthritis
Uncommon: - Leukaemia 2. Osteoid osteoma 3. Ewing
- Osteosarcoma
