Care of Patients with Musculoskeletal Patients

Question 1

Osteoporosis:

Answer 1

chronic metabolic disease in which bone loss causes decreased density and possible fracture

Question 2

Bone is a dynamic tissue that is constantly undergoing changes in a process called

Answer 2

bone remodeling

Question 3

Osteoporosis and osteopenia (low bone mass) occur when

Answer 3

Osteoclastic (bone reabsorption) activity is greater than osteoblastic (bone building) activity
The result is a decreased bone mineral density (BMD): determines bone strength and peals between 25-30 years of age

Question 4

A T-score represents the

Answer 4

number of standard deviations above or below the average BMD for young, healthy adults

Question 5

Osteopenia is present when the T score is at

Answer 5

-1 and above -2.5

Question 6

Osteoporosis is diagnosed when the T score is

Answer 6

at or lower than -2.5

Question 7

Medicare reimburses for BMD testing every 2 yr in people ages of 65 and older who are:

Answer 7

Estrogen deficient 
Have vertebral abnormalities 
Receive long term steroid therapy
Have primary hyperparathyroidism
Being monitored while on osteoporosis therapy

Question 8

Generalized osteoporosis involves many structures in the skeleton and is further divided into 2 categories:

Answer 8

Primary: occurs in postmenopausal women and in men in their seventh or eighth decade of life

Secondary: result from other medical conditions, such as hyperparathyroidism; long term drug therapy, such as with corticosteroids; or prolonged immobility, such as seen w/ spinal cord injury

Question 9

Excessive ______ in the diet can cause calcium loss in the urine

Answer 9

caffeine

Question 10

What can also reduce bone density?

Answer 10

Protein deficiency

Yet, excessive protein intake may increase calcium loss in the urine

Question 11

Other risk factors of Osteoporosis:

Answer 11

Excessive alcohol and tobacco use

Question 12

Kyphosis:

Answer 12

curvature of the thoracic spine, “dowager’s hump”

-2-3 in shorter w/in previous 20 years

Question 13

The most common type of osteoporotic fracture:

Answer 13

back pain accompanied by tenderness and voluntary restriction of spinal movement suggests one or more compression vertebral fractures

Question 14

Quality of life might also be impacted by

Answer 14

pain, insomnia, depression, and fallophobia (fear of falling)

Question 15

Lab assessments:

Answer 15

biochemical markers
Bone specific alkaline phosphate (BSAP)
Osteocalcin
N-telopeptide (NTX)
C-telopeptide (CTX)

Question 16

Imaging assessments:

Answer 16

Most common: Dual x-ray absorptiometry (DXA or DEXA)

• painless scan that emits less radiation than a chest x-ray
• best tool

Peripheral quantitative ultrasound (pQUS) is an effective and low cost tool that can detect osteoporosis and predict risk for hip fracture

Question 17

Nutrition therapy and lifestyle changes:

Answer 17

Avoid alcohol and caffeine
Lactose intolerance - choose a variety of soy and rice products
Calcium and Vit D are added to many fruit juices, bread, and cereal products
The promotion of a single nutrient will not prevent or treat osteoporosis
Exercise is important in prevention & management
Encourage active ROM

Question 18

Drug therapy:

Answer 18

Provider may prescribe calcium and vit D supplements, bisphosphonates, or estrogen agonist/antagonists

Question 19

Hypercalcemia can cause serious

Answer 19

damage to the urinary system and other body systems

Question 20

Bisphosphonates (BPs) do what?

Answer 20

slow bone reabsorption by binding w/ crystal elements in bone, especially spongy, trabecular bone tissue

Question 21

Oral BPs are commonly associated w/ a serious problem called

Answer 21

esophagitis (inflammation of esophagus)

Question 22

Osteomalacia:

Answer 22

loss of bone related to a Vit D deficiency

Ex. rickets = children’s version

Question 23

Osteomalacia and osteoporosis can occur

Answer 23

at the same time

Question 24

Manifestations of osteomalacia:

Answer 24

Nonspecific

Muscle weakness and bone pain may be mistaken as arthritis or another connective tissue disorder

Question 25

Paget’s disease or osteitis deformans:

Answer 25

chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) and re-formed (osteoblastic activity)

Question 26

Manifestations of Paget’s disease

Answer 26

Common:
Fragility fractures
Different size and shape of skull: soft, thick, enlarged
Deafness
Vertigo
Changes in vision, swallowing, hearing, and speech

Less common:
Hyperparathyroidism and gout
Hyperuricemia and gout occur because increased metabolic activity of bone creates an increase in nucleic acid catabolism
Increased cardiac output

Question 27

Diagnostic assessment of Paget’s disease

Answer 27

Serum alkaline phosphatase (ALP) and urinary hydroxyproline levels are primary lab findings

Question 28

Drug therapy for Paget’s disease

Answer 28

Bisphosphonates = 1st line defense

NSAIDs

Question 29

Other interventions for Paget’s

Answer 29

gentle massage
application of heat
exercise program

Question 30

Bacteria, viruses, or fungi can cause infection in bone known as

Answer 30

osteomyelitis

Question 31

Ischemia of bone tissue follows and results in necrotic bone. This area of necrotic bone separates from surrounding bone tissue, and what is formed?

Answer 31

sequestrum = prevents bone healing and causes superimposed infection, often in the form of bone abscess

Question 32

Osteomyelitis is categorized as

Answer 32

exogenous, infectious organisms enter from outside the body

and Endogenous

Question 33

Osteomyelitis has 2 major types:

Answer 33

Acute osteomyelitis: results from bacteremia, underlying disease, or nonpenetrating trauma
Ex. Salmonella infections of GI tract may spread to bone - Endogenous

Chronic osteomyelitis: develops especially in older adults who have foot ulcers when treatment is to short, delayed, or inappropriate - gram negative bacteria - Exogenous

Question 34

Poor dental hygiene and periodontal (gum) infection can be causative factors in

Answer 34

contiguous osteomyelitis in facial bones

Question 35

Older adults may have __________ because of lower core body temperature and compromised immune system that occur w/ normal aging

Answer 35

extreme temperature elevation

Question 36

What is less common in those with chronic osteomyelitis?

Answer 36

fever, swelling, and erythema

Question 37

What is more common in those with chronic osteomyelitis?

Answer 37

ulceration resulting in sinus tract formation, localized pain, and drainage

Question 38

Interventions for Osteomyelitis: nonsurgical management

Answer 38

Antimicrobial (antibiotics) therapy
In precense of copious wound drainage, Contact precautions are used
Oxygen therapy

Question 39

Interventions for Osteomyelitis: surgical management

Answer 39

Surgery is reserved for chronic osteomyelitis
Sequestrctomy may by performed to debride necrotic bone and allow revascularization of tissue
Bone grafts
Microvascular bone transfers - most common donor sites are the patient’s fibula and iliac crest

Question 40

Assess and document the patient’s Neurovascular (NV) status:

Answer 40

Pain
Movement
Sensation
Warmth
Temperature
Distal pulses
Capillary refill