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Bone, bone disorders and arthritis Flashcards

1
Q

What is bone formed of?

A

Organic 1/3 - type 1 collagen + other proteins
Inorganic 2/3 - hydroxyapatite

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2
Q

Cellular structure of bone?

A

Osteoblasts
Osteocytes
Osteoclasts
Osteoprogentior cells

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3
Q

What do osteoblasts do?

A
  • Produce bone by secreting collagen matrix + calcium salts
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4
Q

Where do osteocytes come from?

A
  • Once osteoblasts lay down lamellar bone then get trapped in their lacunae and become osteocytes
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5
Q

What do osteocytes do?

A

Maintain bone production and secrete enzymes into matrix to maintain mature bone

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6
Q

What are osteoprogenitor cells? Where found?

A
  • In bone marrow
  • Responsible for producing new osteoblasts and osteocytes
  • Osteoblasts and osteocytes unable to undergo mitosis
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7
Q

What do osteoclasts do?

A
  • Resorb bone
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8
Q

How do osteoclasts resorb bone?

A

Release proteolytic enzymes and hydrochloric acid which breakdown the bone

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9
Q

List some chemical messengers associated with bone resorption

A

Vit D
Para + thyroid hormones
Growth hormones
Ca 2+

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10
Q

List some chemical messengers associated with bone formation

A

Oestrogen
Calcitonin
Androgens

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11
Q

What happens when metabolic homeostasis not maintained?

A

Bone formation > bone resorption
OR
Bone resorption > bone formation

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12
Q

What is 1st type of bone laid down?

A

Woven bone / immature bone

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13
Q

What is immature / woven bone remodelled into?

A

Secondary bone

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14
Q

What 2 types of bone is secondary bone divided into?

A

Cortical / lamellar bone - 80%
Cancellous / trabecular / spongy bone - 20%

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15
Q

Describe structure of cancellous bone

A
  • Low density
  • Spongy appearance
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16
Q

Describe structure of cortical bone

A
  • Dense
  • Compact
  • Contains bone marrow
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17
Q

What is role of vit D in bone metabolism?

A

Increases calcium and phosphate circulating in body

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18
Q

How is vit D obtained?

A

Sun exposure
Diet - oily fish, red meat, egg yolks

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19
Q

What does a deficiency in vit D lead to in adults / children?

A

Children - rickets = bowing of long bones
Adults - osteomalacia = softening of bones, bone aches / pains / fractures

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20
Q

Where does parathyroid hormone come from?

A

Thyroid, bow tie shape gland, 4 parathyroid glands which secrete PTH

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21
Q

What is the role of PTH in bone resorption?

A
  • Promotes kidneys to make vit D
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22
Q

What 2 types of disease are due to malfunctioning PTH gland?

A
  • Primary hyperparathyroidism
  • Secondary hyperparathyroidism
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23
Q

What causes primary hyperparathyroidism, what are the effects?

A
  • Due to adenoma (benign glandular tumour) of a PTH gland
  • Increases PTH level
  • Increases Ca2+ (hypercalcaemia)
  • Promotes bone resorption
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24
Q

What causes secondary hyperparathyroidism, what does it lead to?

A
  • Chronic renal disease gives urinary calcium
  • To compensate PTH gland secretes more PTH
  • Promotes bone resorption
  • Leads to kidney failure - renal osteodystrophy
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25
How might hyperparathyroidism present facially?
- In jaws - Central giant cell granuloma
26
How might hyperparathyroidism present facially?
- In jaws - Central giant cell granuloma
27
How does calcium homeostasis occur? (Briefly)
- PTH secreted - Ca 2+ and PO4 3- resorbed and Ca2+ reabsorbed from kidneys - Ca 2+ rises - Calcitonin secreted - Ca2+ excreted in urine and deposited in skeleton - Ca 2+ falls - Causing PTH to be secreted
28
What are the 3 stages of healing bone fractures?
1. Early inflammatory 2. Repair 3. Remodelling
29
What happens during early inflammatory stage?
- 1st 2 weeks - Bleeding at fracture = form haematoma - Inflammatory cells and fibroblasts at clot - BVs enter haematoma forming granulation tissue
30
What happens during repair stage?
- Takes 4-5 weeks - Granulation tissue become callus - Primary callus becomes secondary callus - Osteoid secreted into area forming new bone - Proteases degrade ECM - Collagen fibres enter area - New woven bone created at fracture
31
What happens during remodelling stage?
- Takes weeks - months to be complete - Osteoblasts and osteoclasts coordinate remodelling process - Compact and woven bone are redistributed and reproportioned
32
What factors can impact fracture healing? (9)
- Blood supply to site - Infection - Bone pathology - Whether fracture is closed / compound - Degree of tissue loss - Co-morbidities - Use of NSAIDs can impair healing - Nutritional status - Smoking and alcohol
33
Name some specific bone diseases need to be aware of (4), including types of arthritis (3)
- Osteogenesis imperfecta - Osteoporosis - Osteopenia - Paget's disease - Osteoarthritis - Rheumatoid arthritis - Ankylosing spondylitis
34
What type of mutation causes osteogenesis imperfecta?
Type 1 collagen mutation
35
What is a type 1 collagen mutation?
Partial / complete absence of collagen
36
What are the clinical effects of osteogenesis imperfecta?
- Brittle bones - Prone to fractures - Grey discolouration of sclera - Shortened / bowed long bone shapes
37
Oral features of osteogenesis imperfecta?
Skeletal class 3 Anterior open bites Impacted 6s and 7s Thin grey brown enamel Dentinogenesis imperfecta Delayed / premature eruption
38
What causes osteoporosis?
Osteoclasts fail to resorb bone
39
Effects of osteoporosis?
More bone formation than bone resorption so bone is denser, less elastic recoil
40
Oral features of osteoporosis and why?
Thicker bone with increased inorganic components leads to bone marrow being walled off so blood cellular composition deficiency - Delayed tooth eruption - Growth impairment - Nerve entrapment
41
What is osteopenia?
Bones thinned mildly
42
What would osteopenia suggest in a young person?
Vit D deficiency Warning sign Osteopenia expected in older pts
43
What is difference between osteopenia and osteoporosis?
Osteoporosis bones are more porous
44
Which lifestyle factors accelerate bone loss?
High caffeine High salt Low BMI Smoking Immobility Alcohol
45
Which lifestyle factors prevent bone loss?
Calcium rich diet Vitamins, minerals, green leafy vegetables Fish and nuts
46
Which genetic factors accelerate bone loss?
Female FH osteoporosis
47
Which genetic factors prevent against bone loss?
Obesity
48
Which diseases can accelerate bone loss?
Cushing's syndrome Hyperthyroidism Hyperparathyroidism
49
Which drugs accelerate bone loss?
Corticosteroids Heparin Diuretics Cytotoxic drugs
50
How can osteoporosis be managed? (7)
Lifestyle changes Pain relief methods - paracetamol, opioids, acupuncture Physiotherapy Physical aids - walking stick, frame Medx - Vit D, calcium supplements, Bisphosphonates, hormone replacement therapy Fall prevention Surgery for fractures / hip replacements etc.
51
What causes Paget's disease? (cells)
Overactive osteoclasts increase resorption leading to bone destruction
52
How do osteoblasts respond to overactive osteoclasts?
Become active and secrete bone which is larger and weaker than normal - leading to bone deformities and fractures
53
Most commonly affected sites in Paget's disease?
Pelvis Spine
54
Oral relevance of Paget's disease?
- Dull bone pain, avoid lengthy procedures - Enlarged mandible and maxillae -can make restorative / pros work challenging - Hypercementosis - PDL ossified makes XLA hard
55
Which pts is Paget's disease commonly seen in?
Over 50 years (Breast cancer, Paget's of the nipple, unrelated!!)
56
Tx options for Paget's?
Bisphosphonates Analgesia Physio Walking aides
57
3 main types of Arthritis need to know?
Osteoarthritis Ankylosing spondylitis Rheumatoid arthritis
58
What is osteoarthritis?
Wear and tear degeneration of joints Low level of chronic inflammation
59
Where is affected by osteoarthritis?
Large weight bearing joints e.g. hips, knees Wrists can be affected
60
Clinical effects of primary osteoarthritis?
Synovial softening Tearing of cartilage Bone cysts Bony spurs / osteophytes in the joint
61
When does secondary osteoarthritis develop?
Post trauma Alongside Paget's / osteoporosis / ankylosing spondylitis
62
What is the classical history of osteoarthritis?
Pain and stiffness after movement / using a joint Non inflammatory swelling of joints
63
Management of osteoarthritis
- Pt education - Weight loss - Physio and walking aides - Analgesia - topical NSAIDs - Corticosteroid injections (intra articular for single joints, intra muscular for widespread) - Glucosamine supplement - Surgery
64
Types of surgery available for osteoarthritis (4)
- Arthrocentesis (visualise joint space and washing out / remove osteophytes) - Osteotomy (remove bony deformity) - Arthrodesis (surgical fusion of unstable joint) - Total joint replacement
65
Define Rheumatoid Arthritis
Multi-system inflammatory condition
66
What and who does RA affect?
Multiple small joints in extremities e.g. hands and feet Younger pts under 40
67
What are the classical signs of inflammation?
Heat Pain Redness Swelling Loss of function
68
Key differences between OA and RA? (3)
- RA early morning stiffness / OA stiffness after long periods activity - RA under 40s / OA increasing age - RA inflammatory / OA non inflammatory
69
Systemic effects of RA?
- Ophthalmological - Neurological - Pulmonary - Haematological - Renal - Dermatological - Gastrointestinal - Musculoskeletal
70
Define ankylosing spondylitis
Chronic inflammatory arthritis
71
Who and what does ankylosing spondylitis effect?
Young males Neck and spine
72
What is AS initially characterised by?
Sacroiliitis - inflammation at sacra-iliac joints where pelvis joins spine
73
What are the later impacts of AS?
Vertebrae of spine become fused Fixed deformity at the neck
74
How should you support a pt with AS in practice?
- Neck support with pillows - Shorter appt. for comfort
75
What is the main difference between OA and RA versus AS?
In AS distal / peripheral joints of body are uncommonly affected
76
What commonly happens with pts who have an auto immune disease?
Accumulate further AI disease
77
Adverse effects of systemic corticosteroid use?
- Mood disturbances - Insomnia - Anxiety - Depression - Psychosis - Cataracts - Glaucoma - Hypertension - Accelerated atherosclerosis - Lymphocytosis - Neutrophilia - Osteoporosis - Increased fracture risk - Muscle wasting - Atrophy of the skin - Bruising of skin - Impaired wound healing - Acne - GI bleeding - Gastritis - Pancreatitis - Obesity - Diabetes - Infertility - Infection susceptibility - Delayed growth children - Increased appetite - Nightmares - Fluid retention

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