Bones and Joints Flashcards by Mike Hamilton

Describe the difference between cortical and cancellous bone

Cortical = compact bone, layers of concentric rings (osteons)
Cancellous = Spongy bone, interconnecting layers of rods and plates

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what is the main protein that forms in lamellae

Type 1 collagen

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Osteoblasts ____, osteoclasts ____

Osteoblasts synthesize bone, osteoclasts resorb bone

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How does the parathyroid hormone influence bone?

Stimulates osteoclasts to resorb bone to increased serum calcium levels

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How does Vitamin D influence bone?

synthesized in the skin and taken in from diet, Vit D promotes calcium absorption

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What is calcitonin and what does it do?

Enzyme that acts as opposite to PTH, lowers blood calcium levels by promoting calcium deposition into bones

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What are the stages of bone healing?

Cellular stage, vascular stage, primary callus, bony callus, mature callus
(Haematoma, granulation tissue, bony resorption, proliferation, reorganisation)

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What is the cause of osteogenesis imperfecta?

Rare, autosomal dominant genetic condition

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What does osteogenesis cause?

collagen defect that causes brittle bones
4 types that vary in severity (1 least severe, 2 kills you)

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Symptoms of osteogenesis imperfecta?

Blue sclera
deafness
bruising easily
can have cardiac complications

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What are some dental considerations of osteogenesis imperfecta?

XLA caution > massive fracture risk
GA risk > normally have cardiac issues

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What is cleidocranial dysplasia

Rare, autosomal dominant genetic condition

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What are the symptoms of cleidocranial dysplasia

absent or defective clavicle
broad, short skull
hypoplastic midface

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What are dental considerations of cleidocranial dysplasia?

can cause mandibular protrusion CIII occlusion
can cause clefts, hypodontia, supernumeraries
abnormal root morphology

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What is another name for Albers-Schonberg Disease?

Osteopetrosis

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What does osteopetrosis cause?

Autosomal dominant condition
Causes defective osteoclasts, excessive bone density (opposite to osteoporosis)

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What causes Rickets? (osteomalacia)

Lack of Vitamin D/calcium as a child

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What is the treatment for osteomalacia (rickets)

Vitamin D supplements and dietary advice

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What is osteoporosis?

A condition that causes diminished bone mass, low bone density

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What are the symptoms for osteoporosis?

Back pain, reduced height, stooped posture, unexpected fractures

How do you diagnose and manage osteoporosis?

DEXA scan > measures bone density
Managed with exercise, Ca and Vit D supplements, bisphosphonates

What happens in fibrous dysplasia

Fibrous dysplasia = abnormal growth of fibrous tissues
chronic disorder, scar-like tissue grows in place of normal bone, weakening it over time

What is the presentation of fibrous dysplasia?

ground-glass appearance on radiographs
ALP is raised, but Ca and K ions normal

What is ALP?

Alkaline phosphatase
Enzyme found in osteoclasts

What is Paget's Disease?

Unknown aetiology, causes unbalanced bone remodelling shows areas of mixed lysis and sclerosis

Dental considerations of Paget's Disease

- Bisphosphonates are a common Tx - can get AV fistulas > cardiac failure - hypercementosis of teeth - bulging of maxilla - risk of excessive bleeding and osteomyelitis

Calcitonin is released by the ____ when the ___ is ____

Thyroid gland, blood calcium levels are too high

What is primary hyperparathyroidism

parathyroid adenoma, causing excessive release of PTH: hypercalcemia, bone pain, peptic ulcers, pancreatitis

What is secondary hyperparathyroidism?

a condition outside of the parathyroid gland causes parathyroid hyperplasia (chronically low vit D, kidney failure)

How can a clinician differentiate primary and secondary hyperparathyroidism?

Primary = high Ca serum levels

What is the aetiology of marfan's syndrome?

Autosomal dominant, connective tissue disorder

What happens in Marfan's syndrome?

connective tissue disorder causing hyper-flexible joints, lax ligaments, hernias mitral valve prolapse, cardiac issues

What is Ehlers-Danlos Syndrome?

group of rare autosomal dominant disorders that impacts collagen formation

Signs and symptoms of Ehler-Danlos Syndrome?

Hyperflexible skin, bruising, loose joints, recurrent spontaneous dislocations, poor healing

Define osteoarthritis

Degeneration of the articular cartilage and proliferation of new bone remodelling of joint contour

Where are you likely to find a patient presenting with osteoarthritis?

Load-bearing joints (knees, hips)

Tx for osteoarthritis

Analgesia, joint replacement, weight loss

What is rheumatoid arthritis

Systemic Auto-immune disease causing symmetrical, destructive inflammation joints

How does Rheumatoid arthritis affect the joints?

Causes inflammation of the Synovium (soft tissue inside/lining the joint space)

How do you diagnose Rheumatoid arthritis?

Stiffness of the hands/feet, worse in morning ulnar deviation makes hands point outward 5 cardinal inflammatory signs in joints +ve testing for rheumatoid factor

Management for Rheumatoid arthritis

NSAIDS corticosteroids DMARDS (Disease modifying anti-Rheumatic drugs)

Dental consideration of rheumatoid arthritis

in hands -> OHI often associated with Sjorgen's syndrome Medications: risk of bleeding/MRONJ

What is ankylosing spondylitis

Form of chronic inflammatory arthritis, mostly in males, causes fusion of spinal vertebrae over time

Treatment for ankylosing spondylitis

Physiotherapy, exercise, NSAIDS

What is gout?

Form of chronic inflammatory arthritis

What is the mechanism of gout?

Chronically high urate levels (from breakdown of purines, meat and seafood) forms crystals of monosodium urate which are deposited into the joints

Clinical features of gout

-inflammatory arthritis - inflammation of synovium membrane - renal disease - most common joints: joint on big toe, wrist, base of thumb

Causes of gout

High uric acid (from breaking down purines found in red meat, seafood) high BP diabetes, obesity

Tx for Gout

NSAIDs, Allopurinol