Bones and Joints Learning Objectives (L34-35) Flashcards
What hormonal conditions causes a decrease in bone mass?
Menopause, amenorrhoea, andropause
What nutritional and environmental factors can increase bone mass?
– Calcium
– Vitamin D
– Sun exposure
More activity is associated with __________ bone mass
Higher
What types of exercise have the greatest effect on peak bone mass?
Weight-bearing exercise
During resistance training, why do we observe increases in site-specificity bone mass?
Exercise acts by local mechanical stimulation of bone
* Mechanical stress stimulates osteoblasts
* Osteoblasts increase calcium uptake
* Bone rebuilds and becomes denser
If you wanted to increase site-specific bone accrual of the upper torso, how would you do it as safely and as quickly as possible?
- Increase the magnitude of mechanical force
- Increase the frequency of exposure
- Aim to increase strength and local muscle mass of upper torso specifically
What is age-related reduction in bone mass called?
Osteopenia
What are the %ages of bone loss for males and females over the age of 30?
Males lose ~ 0.4% pa after age 30
Females lose ~ 0.8% pa after age 30
Bone mass slowly declines with age. What will determine bone mass in older adults?
Bone mass in older age influenced by:
* Peak bone mass achieved
* Age of menopause (in females)
What characterises osteoporosis?
– Loss of bone mass (mineral density)
– Deterioration of bone architecture
– Increased bone fragility (fracture risk)
What is the best method of preventing osteoporosis?
– Maximise bone mass in childhood & early adulthood
– Maintain bone mass into older age
What are the non-modifiable risk factors of osteoporosis?
Genetic, age, sex
What are the modifiable risk factors of osteoporosis?
Hormonal status (amenorrhoea synonymous with decreases in oestrogen), smoking, medication use (Corticosteroids), diet/nutrition, PA
What are the PA risk factors for osteoporosis?
Sedentary lifestyle & low muscle mass
Prolonged bed-rest
What are the PA protective factors for osteoporosis?
An active lifestyle is protective against osteoporosis
What are some good preventative forms of PA against osteoporosis in childhood and adolescence
Vigorous weight-bearing exercise in childhood & adolescence
* Jumping on the spot; skipping; netball/basketball
What are some good preventative forms of PA against osteoporosis in adulthood?
Regular WB
Specific resistance exercise programs recommended
What are some good preventative forms of PA against osteoporosis women
Resistance training. Indicated when young and continued throughout lifespan.
Generally, if you have more muscle, you have ______ bone.
More
What are the incidences of fractures in females and males over 60?
2 in 3 women, and 1 in 3 men over the age of 60 will suffer an osteoporotic fracture in their remaining lifetime
What is the common concern in female patients with history of fracture(s) and osteoporosis?
Secondary thromboembolism
What is the nutritional management of osteoporosis?
Calcium and Vit D supplements
What is the pharmacological management of osteoporosis?
– Biphosphonates
– Selective Estrogen Replacement Therapy
– Hormone Replacement Therapy
What is the exercise management of osteoporosis?
– Maintain muscle leg strength to reduce risk of falls
– Balance exercises to reduce falls risk
– Deconditioning common at diagnosis
(Low intensity program initially)
What exercises should be avoided in the management of osteoporosis?
Activities that twist, bend or compress the spine
During the progression of osteoarthritis, which comes first: damage or inflammation?
Damage, then inflammation
How is OA classified?
Chronic disease involving deterioration of joint cartilage & formation of bone (spurs) at margins of joints
Athletes engaging in what types of sports would typically see OA develop sooner?
Often presents earlier in athletes from contact sports
At what age is OA present in most people?
Present in most people by 70 yrs
List the S&S of OA
- Pain during joint use is key symptom
- Deep aching joint pain
– Worse after weight-bearing or exercise
– Relieved by rest - Joint swelling
- Limited movement
- Morning stiffness
- Joint grating with motion
- Joint pain varies with weather
List the biomechanical factors that may initiate joint degradation in the progression of OA
- Joint trauma
- Occupational overuse
- Obesity
- Mal-alignment of joints
– E.g., bow-legs or knock-knees
– Congenital abnormalities - Rheumatoid arthritis
What is often linked to OA in the upper limbs?
Occupation
Which joints are very often associated with OA in most people?
Weight bearing joints
What are the joints that can develop OA?
Any synovial joint
What is the aim in exercise intervention for OA?
Increase strength around joints
– Pain relief
– Maintain or improve joint mobility
– Minimise ADL disability
- Improve body awareness
– Joint position sense (proprioception), especially after joint replacement surgery
– Posture, balance, coordination
What improves the prognosis of OA after joint replacement surgery?
Prehab and rehab
What are the current methods of pain relief from OA
NSAIDS
COX-2 inhibitors
Corticosteroids (local injections)
Glucosamine & chondroitin sulphate
Artificial joint fluid injections (e.g., Synvisc)
How would you determine the best type of exercise for someone with OA?
Whichever is associated with less pain (cycling normally better tolerated)
What characterises RA?
Autoimmune
Chronic systemic inflammatory disease
Disease onset gradual
Pain, swelling & stiffness
Periods of exacerbation and remission
List the S&S of RA
– Fatigue
– Stiffness in morning (> 1 hr) or after inactivity
– Diffuse muscle aches
– May have low-grade fever
– Loss of appetite (tissue catabolism)
– Weakness
What is the significant markers that are found in the blood that indicates RA?
Rheumatoid factor
Elevated ESR (Erythrocyte Sedimentation Rate)
CRP (C-Reactive Protein)
A patient is complaining of episodic periods of joint pain. You notice local joint deformities like ulnar deviation. What might they have?
RA
RA doesn’t just affect joints. List other structures that RA can affect
May cause inflammation of lungs, blood vessels, pericardium, eye
May lead to neuropathies
May lead to anemia & stomach bleeds
How does RA shorten life expectency?
CVD
