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my revision > Bones and joints > Flashcards

Bones and joints Flashcards

1
Q

What is the composition of bone

A

Non-cellular matrix:
ECM: type 1Collagen associated with calcium hydroxyapatite , regulatory proteins & growth factors

Cellular matrix:
- Osteoblasts, osteocytes, osteoclasts

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2
Q

What is the function of bone?

A

-Protection
-Haematopoesis
- support
-Lipid and mineral storage

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3
Q

What is the function of osteoblasts

A

Secrete uncalcified/ unmineralised extracellular matrix (known as osteoids) which is later mineralised

  • regulate bone resoprtion: rich in APL
    -Synthesis matrix
  • express receptors for PTH, Glucortocioids, vit D, Oestrogen (influence remodelling)
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4
Q

What is an osteoid

A

Unmineralised extracellular matrix

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5
Q

What is an osteocytes function

A

Osteoblast that is entomed in lamella in lacunae- mineralises osteoids

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6
Q

What is the function of osteoclasts

A

Monocyte derivatives, resorb bone via secretion of H+ and lysozyme enzymes

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7
Q

What are the phases of bone formation

A

Woven:
- embryo/ fracture
- full of osteoids (unmineralised ecm)
- collagen randomly arranged

Lamella:
- Compact/ spongy

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8
Q

What is meant by ‘Compact bone’

A

Type of lamella bone
- dense rigid
- found in outerbone

Contains:
Haversian canal- nerve & lymphatic vessels

Volkmans canal- Horizontally connected- transmit blood

Cannalculi = osteocytes between laemalla and connect by interconnecting tunnels

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9
Q

What is meant by spongy bone

A
  • interior of bone
  • Honeycomb texture
  • Light and porous
  • non structural fill
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10
Q

How are osteoblasts activated

A

hormone/ damage

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11
Q

What affects bone formation

A
  • PTH
  • Vitamin D
  • Calcitonin
  • (BMP) Bone morphogenic proteins
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12
Q

What is the effect of PTH

A

Regulated by blood calcuium, vitamin D and phosphate levels

  1. Increases intestinal transport of CA & phosphate
  2. Removal of calcium from bone
  3. Increases absorption of vitamin D in upper small intestine
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13
Q

What is the role of calcitonin

A

Opposes action of PTH
-Lowers blood calcium levels
- deposits calcium in bones

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14
Q

What are the stages of fracture healing

A
  1. Fracture: inital haematoma: formed with granulation tissue- results in inflammation causing immune response
  2. Proliferation stage: macrophages move in and devour debris & dead cells
  • proliferation of fibroblasts
    -differenation of osteoclasts and osteoblasts

3.Bone callus: primary callus, osteoids replace with mature bone & becomes mature callus (6 weeks- 3months+) new bone is liad down along lines of stress,

  1. Remodelling:
    reduces size of bone callus, bone ends rejoin so now a whole bone
    - bone marrow cavity is restored, new bone is laid down along lines of stress
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15
Q

What is osteogenesis imperfecta & signs and symptoms

A

Autosomal dominant
collagen defect (affect 1-5)

signs & symptoms:
- blue sclera, bruising easily, deafness, loose joints/ tendons
- +/- cardiac complications
- short stature
- multiple fractures

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16
Q

How does osteogenesis imperfecta affect dentistry

A
  • Caution with XLA
    -GA risk: chest defomity/ cardiac issues
  • Brown/ blue/ pruple/ soft dentine teeth
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17
Q

What is cleidocranial dysplasia & its presentations

A

Autosomal domiant- defect of skull & clavicle

Presentations:
- clavicles absent/ defective
- brachycephalic: broad short skull
- hypoplastic midface: mandibular protrusion
- +/- clefts

18
Q

How does cleidocranial dysplasia affect dentistry

A
  • Hypodontia
  • supernumeraries
    -Retained decidious dentition
  • abnormaltieis with dentition: root formation, cysts
19
Q

What is osteopetrosis & how does it present

A

Excessive bone density due to defect in osteoclastic activity & remodelling
- risk of fracture for bones but normal healing

clinical presentations:
- incidental radiographically
-bone pain, fractures, osteomyelitis
- +/- anaemia
- susceptible to infections : RISK OF SEPSIS

20
Q

How does ostepetrosis affect dentistry

A
  • fractures of jaw
  • osteomyelitis (surgical complications)
  • if infection confirmed it is difficult to eradicate
    -consider abx
21
Q

What is rickets

A

acquired childhood disease due to lack of vitamin D/ calcium:

  • fish & eggs
22
Q

How does rickets affect dentistry?

A

fractures

23
Q

What is osteoporosis
- How is it diagnosed

A

Demineralised bone mass
Low bone density
Results in fragile bones

affects: 1 in 3 women

diagnosed: FRAX tool, DEXA scan

24
Q

What are the signs and symptoms of osteoporosis

A

asymptomatic until fracture- back pain, reduced height overtime with stooped posture

25
Q

How does osteoporosis affect dentistry

A

Patients are on bisphosphonates- risk of MRONJ

  • Pt weaker bones fractures
26
Q

How is osteporosis managed

A

Exercise
Ca, Vit D supplements
HRT +/-
Bisphosphonates

Medications: hormone replacement, bisphosphonates, PTH, fluoride, vitamin D, calcitonin

27
Q

What is the mechanism of bisphosphonates

A
  1. Attach to hydroxyapatite binding sites
    Particularly on surfaces that are actively resorbing
  2. Impairs osteoclastic ability to bind to the bony surface & inhibit resorption
  • Reduce osteoclast activity by promoting osteoclast apoptosis & inhibit new osteoclast developing
28
Q

What is fiborous dysplasia

A

benign, chronic fibro-osseous lesions in craniofacial region

  • monostoic/ polystoic
  • chronic disorder: scar tissue grows in place of normal bone
  • fiborous tissue weakens bone overtime

Linked with Albrights syndrome: bone, skin, endocrine tissues

29
Q

How does a pt with fibrous dysplasia present & how is it diagnosed

A

Firm swelling in maxilla

Diagnosis:
Imaging: appear dense ground glass, poorly defined margins

raised APL & urinary hdroxyproline

biospy

30
Q

What is pagets disease

A

Common in 40 years old, unknown aetiology, change in balance of remodelling of bone

31
Q

What are the signs and symptoms of pagets disease & how is it diagnosed

A

Bone pain, no symptoms in early stages, systemic effects
- Enlargement of maxilla
-bulging zygomatic area
- hypercementosis of teeth

Diagnosis: radiographs shows lysis and sclerosis

  • raised ALP
  • normal Ca, PO
32
Q

What is the tx for pagets disease

A

bone bisphosphonates
- calcitonin: pain relief

33
Q

What are the systemic effects associated with pagets disease

A

Musculoskeletal:
- bone pain, bone deforbity, fractures, osteoarthritis, spinal stenosis

Neurological:
Tinnitus, cranial nerve, basilar impressions, hearing loss,

cardiovascular:
- congestive heart disease, increase CO, aortic stenosis, generalised atheroscleoriss

metabolic: hypercalcaemia, immboilsation

neoplasia:
- sarcoma, giant cell tumour

34
Q

How does PTH work

A
  • acts on kidneys : increases renal reabsorption
    -reabsorption of phosphate
  • increases absoprtion of calcium in gut
  • promote osteoclastic bone resoprtion: rise in calcium plasma levels & ALP
35
Q

What is primary hyperparathyroidism

A

too much PTH
- associated with adenoma

36
Q

What are the signs and symptoms of primary hyperparathyroidism

A
  • Associated with renal tones
  • Hypercalcemia
  • Bone pain
  • Fractures
    -Pathological fractures
    -Giant cell tumours
    -peptic ulcers
  • pancreatitis
  • hypertension
37
Q

How does hyperparathyroidism affect the hesd and neck

A
  • Local swelling in mandible
  • corneal calcification
  • thinning bone trabeculae
  • Develop bony lesions
  • jaw/ skull lesions
  • pepperpot skull
  • fibrous replacement of reabsorbed bone- osteitis fibrosa cystica
38
Q

What is the tx for hyperparatyrodisim

A

Surgical removal of adneoma
post-op issue with hypocalcemia

39
Q

What is secondary hyperparathyroidism caused by

A

Response to persistently low calcium:

  • chronic renal failure
  • malabsoprtion
40
Q

How does secondary hyperparathyroidism affect dentistry

A
  • Giant cell lesions
  • Brown tumourd
    -GC lesions
  • Other systemic issues

my revision (13 decks)

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