bone and joint pathology Flashcards
how does osteoporosis occur?
it is due to a decrease in bone mass
the decrease of bone mass seen in osteoporosis leads to what?
- bone reabsorption and destruction (occurs due to the osteoclast activity)
- bone formation (osteoblast activity)
the decrease in bone mass often leads to an increase in what?
the risk for fractures
what is a primary disorder
the diagnosis
what is a secondary disorder
due to another diagnosis
think metapause can cause osteoporosis
what is the epidemiology of osteoporosis
incidence of osteoporosis increases with age
what vitamins/ molecules are associated with osteoporosis?
calcium phosphate and collagen
The WHO criteria for osteoporosis is?
bone mineral density (BMD) at hip or spine > 2.5 SD bellow young normal mean reference population
The WHO criteria for osteopenia is ?
BMD 1.0 - 2.5 SD below young normal mean reference population
what are the stats associated with osteoporosis
-10 million in the USA with osteoporosis
33.6 million in the USA with osteopenia
At what ages is bone loss from osteoporosis seen in men and women?
women 1% per year after 30-35
50-55 for men
what is the correlation seen in bone loss and menopausal women?
accelerated loss in post metapausal women.
5% per year for 3-5 years
what is the red flag for PTs dealing with osteoporosis?
PT should avoid movements that can result in spinal fractures, including:
- forward bending
- twisting motions
- lifting heavy objects
- sudden forceful movements involving spinal stability
what are the clinical manifestations for osteoporosis?
- structural weakening
- decreased ability to support loads
- high risk of fractures
- acute LBP
- Kyphosis
- Hip and vertebra fractures (compression fractures can be asymptomatic)
what is the percentage of individuals that will experience orthopedic problems related to osteoporosis?
1/3 will experience orthopedic problems related to osteoporosis
what is type 1 osteoporosis?
postmenopausal osteoporosis, caused by a deficiency in estrogen
what is type 2 osteoporosis
senile osteoporosis, vitamin D deficiency and decreased ability to absorb calcium
what issues are associated with type 2 osteoporosis?
Endocrine issues: hyperplasia of the parathyroid, diabetes mellitus
Gastrointestinal issues: malnutrition
Drug issues: steroids, heparin
what are the non-modifiable risk factors for Osteoporosis?
Age➔ decreased ability to make new bone
Gender
Body Size
Ethnicity
Genetics
what are the modifiable risk factors for Osteoporosis?
Smoking
Alcohol
Decreased Estrogen or Androgens ➔ menopause or hypogonadism
Low BMI
Low Dietary Calcium and Vitamin D
Lack of Weight Bearing Exercise➔ decreased PA
Medication
what are the morphological risk factors for Osteoporosis?
Thin cortex
Thin Trabeculae
how do you diagnose osteoporosis? (what machine do you use)
DEXA scans for bone density measurements
what are the risk factors for osteonecrosis?
- Corticosteroids
- Trauma
- Radiation
- Smoking
- Alcohol
- Idiopathic
what are the clinical presentation of osteonercrosis
Epiphysis of the femur most common
Progressive joint pain
osteonecrosis can lead to what
fractures and trauma to the bone
osteomalacia is characterized as a deficiency of what vitamin?
due to a deficiency in vitimin D
osteomalacia is known as?
soft bone disease
what are the symptoms of osteomalacia?
severe pain
fractures
weakness
deformities
what are the diagnostic tests for osteomalacia
x-ray
urinalysis/CBC
bone scans
bone biopsy
what are the two types of osteomyelitis
pyogenic and tuberculous
how does infection occur with osteomyelitis
infection of the bone via blood stream or bone directly
what patient population is osteomyelitis most seen?
more common in children and immunosuppressed children
how can diabetes be connected to osteomyelitis?
foot ulcers and neuropathy
what are the symptoms of osteomyelitis
- fever
- swelling
- warmth
- redness
- pain
- fatigue
what bones show pyogenic osteomyelitis the most?
long bones and vertebral bones
what is the morphology of pyogenic osteomyelitis?
infection can lift the periosteum
impair blood flow - ischemia
necrotic bone fragments called sequestrum
what are the normal laboratory findings associated with osteomyelitis?
leukocytosis
what do the radiographic findings show for osteomyelitis?
bone destruction
tuberculous osteomyelitis mostly effects what?
spine most commonly affected
knees and hips
what patient population is at a high risk for fractures
OLDER ADULTS
why is there a higher risk of fractures in older adults?
osteoporosis
co morbidities
dementia
poly pharmacy
age
how many are hospitalized by hip fractures a year?
300,000 older adults 65+ hospitalized per year
when talking about falls will the patient return to the full function that they had before the fall?
NO the patient will not return to the function they had before the fall
what are some risk factors for patients with hip fractures?
95% due to falls
75% women
mortality 20% associated with medical complications
50
5 will not regain functional baselines
majority will be treated by surgery
what is the red flag when treating a patient with fractures?
PAIN MEDICATION CAN CAUSE DISORIENTATION OR SEDATION AND INCREASE FALL RISK
Vetebral compression fractures are caused by?
osteoporosis
risk factors:
postmenopausal women
advanced age for males and females
what are the clinical manifestations seen in patients with Vetebral compression fractures?
typically causes severe pain
decreased ability to perform ADL’s
often due to bending, lifting, and standing from a chair.
red: what does a complete fracture mean
extends through the bone
red: what does a incomplete fracture mean
does not extend through the bone
red: what does a closed fracture mean
intact overlaying skin
red: what does a compound fracture mean
lacerated skin, exposed bone
red: what does a comminuted fracture mean
bone is broken into many smaller fragments
red: what does a displaced fracture mean
edges of the fractured bone are no longer aligned
red: what does a pathologic fracture mean
fracture at the site of pathology ie. tumor
red: what does a spiral fracture mean
along the shaft of the bone
what is the timeline for the inflammation phase of a fractures healing?
0-2 weeks
site protection and clearance
what is the timeline for the callus formation phase of a fractures healing?
2-3 weeks
scaffold for new bone
soft to hard
fluffy opacity on x-rays
what is the timeline for the union phase of a fractures healing?
4- 6 weeks
bridging by cartilage
immature bone
feature is stable but weak
what is the timeline for the consolidation phase of a fractures healing?
6-8 weeks
all callus replaced by bone
immature bone- la cellar bone
bone is secure
what is the timeline for the remodeling phase of a fractures healing?
1-2 years
continued osteoblast and osteoclast activity
reshaping to best density and shape
what type of diseases is osteoarthritis?
degenerative joint disease
what is the patient population for OA
gradual onset of symptoms after 40 years of age
65+ 50% diagnosed with OA
how many people in the us have OA
30 million
who gets OA more women or men
women
how does OA occur
occurs as a result of degeneration of the articular cartilage
what is the pathogensis of OA
Normal articular cartilage undergoes turnover of bone➔ in osteoarthritis this turnover does not occur
Due to wear and tear and genetic factors
Can also be secondary➔ due to trauma or poor biomechanics
what joints are involved with OA
Weigh bearing joints➔ hips and knees
Lower lumbar vertebrae
Cervical vertebrae
Interphalangeal joints
what might you see in a patients hand that has OA
bouchards nodes (in the pip)
Heberdens nodes (dip )
what is primary osteoarthritis
no identifiable reason for arthritis development
what is secondary
osteoarthritis
a likely cause for osteoarthritis exists
joint injury in professional athletes
what are the risk factors for OA
Age
Joint Injury
Obesity
Genetics
Anatomic Factors
Gender
what are the clinical manifestations of OA
Aching pain ➔ progressively worse
Decreased mobility
Morning stiffness
Joint crepitus
Advanced stages ➔ bone on bone
what do most OA patients report?
43% report functional limitations
Associated with depression
what is rheumatoid arthritis?
An autoimmune disorder with an unknown antigen–antibody combination
what is rheumatoid arthritis associated with?
hypersensitivity of immune systems and synovial inflammation
what joints are affected by RA?
Metacarpophalangeal
Interphalangeal
Feet
Wrist
Ankle
Elbows
Knees
what is the morphology of RA?
Edematous and thick synovium with rough surface projections
what are the radiological findings for RA?
Osteopenia
Narrow joint space with bony erosions
what are the clinical presentations of RA
Morning stiffness
3+ joints affected. (systemic)
Symmetric involvement of joint on the hand
Weight loss
Fatigue
Fever
Warm tender joints
Radial deviation of wrist
Ulnar deviation of phalanges
Stiffness after activity
what is the key clinical presentation of RA
wrist collapse
end-stage RA complete destruction of the carpal bones and radioulnar joint
morning stiffness for RA will last for
30 minutes
morning stiffness for OA will last for
> 1 hr
give an overview for the differences between OA and RA
OA vs RA
Osteoarthritis is degeneration of articular cartilage, and is often associated with wear and tear; therefore, symptoms will improve with rest.
Rheumatoid arthritis, the disease is caused by the formation of a pannus, which causes fusion of the joint. Rest allows the fusion to progress and causes the joint to become stiffer; thus, conversely, use will keep the joint more mobile and decrease stiffness.
morphological of OA
Articular cartilage ➔ collagen network damage = water absorption = chondrocyte activation = inflammatory response
what is Eburnation seen in OA
thickened and polished subchondral bone
what is Subchondral cysts seen in OA
synovial fluid leaks through defective cartilage into subchondral bone
what is Osteophytes seen in OA
bony outgrowths at the interphalangeal joints
what is Joint mice seen in OA
loose fragments of cartilage and bone in the joint
