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Case 1 > Bone Health > Flashcards

Bone Health Flashcards

1
Q

What are the causes of fracture?

A
  1. Single traumatic event
  2. Repetitive stress
  3. Pathological - abnormal weakness in bone
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2
Q

What are open/closed fractures?

A

open breaks skin, closed doesn’t

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3
Q

What are comminuted/simple fractures?

A 
comminuted = break or splinter of bone into 2+ fragments
simple = fracture of bone only, no damage surrounding tissues
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4
Q

What is bone made up of?

A

Cells + ECM

Matrix:

  • organic components (collagen = tensile strength)
  • inorganic components (minerals = compressive strength)
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5
Q

What are Haversian canals?

A

Tubes which form network in cortical bone - allow BV’s + nerves to travel through.
Surrounded by lamellae.

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6
Q

What are the main 2 stages of bone formation?

A
  1. Osteoblasts deposit osteoid
  2. Osteoid is mineralised (apatite incorporated into bone)
    10 days between deposit + mineralisation
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7
Q

What are the main 2 stages of bone remodelling?

A
  1. Osteoclast resorption

2. Osteoblast deposit new bone

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8
Q

Summarise what happens in fracture repair

A

Cell proliferation + tissue differentiation

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9
Q

What are the stages of bone healing?

A
  1. Haematoma
  2. Inflammation
  3. Granulation
  4. Callus
  5. Consolidation
  6. Remodelling
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10
Q

Describe the haematoma stage of bone healing

A
  • BV tearing
  • Local bleeding
  • Defect between fracture ends filled with blood clot
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11
Q

Describe the inflammation stage of bone healing

A
  • acute
  • macrophages invade clot + destruct
  • followed by vascular growth
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12
Q

Describe the granulation stage of bone healing

A
  • vascular ingrowth
  • day 5: granulation tissue replaced clot
  • groups of cartilage cells form in granulation tissue
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13
Q

Describe the callus stage of bone healing

A
  • cartilage islands
  • fracture ends united by vascularised granulation tissue + cartilage = provisional callus

By end of week 1:

  • Ca deposited in cartilage
  • osteoblasts produce osteoid across fracture
  • endochondal ossification established + adds to new bone
  • callus calcifies + ends unite with bony callus
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14
Q

Describe the remodelling stage of bone healing

A
  • woven bone (immature) replaced by lamellar (osteoblasts + osteoclasts)
  • excess bone resorbed
  • takes years, often incomplete
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15
Q

Define osteoporosis

A

Metabolic bone disorder characterised by low bone mass + microstructure deterioration in bone tissue = increased bone fragility = increasing fracture risk

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16
Q

What are the 2 types of osteoporosis?

A
  • Primary = post menopausal or age related

- Secondary = drug related/comorbidities

17
Q

How is osteoporosis diagnosed?

A
  • DEXA bone density scan - measured in spine + hip
  • Underestimates
  • Osteoporosis: If T score less than or equal to -2.5 SD
    Fragility fracture whatever the T-score
  • Osteopenia: T score -1 - -2.5 SD
18
Q

What are the risk factors associated with osteoporosis?

A

Female, >50y, no children, post-menopausal, early menopause, caucasian/asian, sedentary lifestyle, slim, alcohol, smoking, thyroid, hypogonadism, PPI’s

19
Q

What are the effects of oestrogen in osteoporosis?

A
  • Low levels = increase in osteoclast : osteoblast

- Low levels = apoptosis of osteoblast

20
Q

What are the signs of osteoporosis?

A
  • Shorter than they were
  • Skeletal tenderness
  • Kyphosis
  • Hump
  • Unsteady
  • Plaster
21
Q

What tests are done in osteoporosis?

A
  • XR if fracture
  • DEXA
  • FBC
  • Bone profile
  • Renal test
  • LFT
  • Thyroid function test

Blood tests = NORMAL in IDIOPATHIC osteoporosis

22
Q

Define an osteoporotic fracture

A

Fragility fracture caused by force which would not normally break bone

23
Q

What is the strongest predictor of osteoporosis?

A

Previous fracture

24
Q

What is the primary prevention of osteoporosis?

A

For post-menopausal without fracture

  • Weightbearing + strengthening exercise
  • Stop smoking
  • Reduce alcohol
  • Healthy diet
  • Ca + Vit. D
25
Q

What is the secondary prevention of osteoporosis?

A

For post-menopausal with history of fracture

  • Bisphosphonates
  • Strontium
  • SERM
  • PTH
  • Ca + Vit D
  • HRT
26
Q

How do bisphosphonates work in the treatment of osteoporosis?

A
  • 1st line
  • e.g. alendronate
  • bind to Ca, collecting it in high concentration in bone + inhibits enzymes which use it
  • inhibits bone resorption by encouraging osteoclast apoptosis so slows bone loss
27
Q

How does strontium work in the treatment of osteoporosis?

A
  • increases bone deposit by osteoblast
  • reduces resorption by osteoclasts
  • high risk of MI
28
Q

How does SERM work in the treatment of osteoporosis?

A

Oestrogen receptor modulator

29
Q

How does PTH work in the treatment s osteoporosis?

A

Triggers new bone formation

30
Q

What are the 2 types of arthritis?

A
  1. Degenerative - osteoarthritis + post-traumatic

2. Inflammatory e.g. rheumatoid

31
Q

What are the risk factors for degenerative arthritis?

A
  • young : middle age : elderly = 1 : 6 : 9
  • obesity
  • injury
32
Q

What is the prognosis for inflammatory arthritis?

A

Reduces life expectancy by 6-10 yrs

33
Q

In which groups inflammatory arthritis less common?

A

Pakistan + Afro-caribbean

34
Q

Compare the age on onset of rheumatoid and osteoarthritis

A 
Rheumatoid = any age 
Osteoarthritis = usually older
35
Q

Compare the rapidity of onset in rheumatoid and osteoarthritis

A 
Rheumatoid = rapidly over weeks/months 
Osteoarthritis = slowly, over years
36
Q

Compare the joint symptoms in rheumatoid and osteoarthritis

A

Rheumatoid = pain, swelling + stiffness = SYMMETRICAL

Osteoarthritis = ache + tenderness, rarely swollen = one side then other

37
Q

Compare the length of morning stiffness in rheumatoid and osteoarthritis

A 
Rheumatoid = longer than 1 hour 
Osteoarthritis = less than an choir + returns later in day
38
Q

Compare symptoms in the rest of the body in rheumatoid and osteoarthritis

A

Rheumatoid = fatigue + feeling unwell

Osterarthritis = none

Case 1 (9 decks)

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