Degenerative Bone and Joint Diseases Flashcards
How many men were there in the UK in mid 2009? What is this projected to be by mid 2033?
- 37 million
33. 51 million
What is sarcopenia?
Decreased total muscle mass
Normal individuals exhibit how much of a decrease in total muscle mass between the ages of 30 to 80 years?
Approx 30%
What are the causes of sarcopenia? (5)
Low sex hormones Low IGF-1 Decrease in activity OA Neuronal degeneration
What % of muscle mass is lost per decade after age 30?
3% to 5%
Leads to
What does sarcopenia lead to? (3)
Camptocormia, frailty and falls
Why is height lost with age? (3)
Disc degeneration
Sarcopenia and camptocormia
Osteoporosis and vertebral collapse
What is camptocormia?
Progressive forward bend/curvature of spine, generally due to weak paraspinal muscles
How can sarcopenia be prevented and treated? (3)
Exercise
Vitamin D repletion
HRT
What is osteoarthritis?
A disease of synovial joints characterised by focal cartilage loss and an accompanying reparative bone response.
What is spondylosis?
Degenerative condition of discal articulation of the spine - degeneration of the disc surfaces, extra growths/bony spurs on the edge of the bone or the joints and loss of disc height.
What is seen on the x-ray for OA? (3)
- cartilage loss (joint space narrowing)
- presence of osteophytes
- bone sclerosis
How many % of 65 year olds have OA on x-rays?
50%
What is there a pronounced female preponderance for in OA? (3)
Severe radiographic grades of OA
OA of the hand and knee
Symptoms
OA of the hips is uncommon in…?
Africans and Asians
Polyarticular OA of the hand is rare in…?
Africans and Malaysians
What are the risk factors for OA? (7)
Obesity (esp knee OA)
Abnormal mechanical loading (e.g. meniscectomy, instability and dysplasia)
Intra-articular fracture (trauma accelerates degenerative changes)
Inherited type II collagen (premature polyarticular OA)
Inheritance (nodal OA)
Occupation (e.g farmers for OA hip)
Non-gonococcal septic arthritis
What is affected in nodal generalised OA? (6)
PIPs (Heberden’s nodes) DIPs (Bouchard’s nodes) First CMC of thumb Feet (bunions - hallux valgus/rigidus) Knee and hip (OA) Apophyseal joints
What is calcium pyrophosphate dihydrate (CPPD) disease?
Who (and what joint) does it mainly affect?
A type of crystal-associated OA – crystals are deposited, usually in large joints. The patient has sudden acute attacks of pain, associated with swelling.
Mainly elderly women, principally the knee.
What is apatite-associated destructive arthritis? What joint(s) does it mainly affect?
A type of crystal-associated OA, with a poor outcome. The patient experiences extreme pain, swelling and destruction of joints due to deposition of hydroxyapatite crystals.
Hips, shoulder (Milwaukee shoulder), and knees.
What may premature onset OA (occurs under the age of 45) be caused by? (3)
Trauma
Surgery (e.g. menisectomy)
Haemochromatosis
What are the physical signs in OA? (7)
Crepitus Bony enlargement Deformity Instability Restricted movement Effusion Muscle weakness or wasting
What is an important determinant of symptomatic and functional outcome in OA?
What does this mean?
Patient’s psychological status (anxiety, depression, and social support)
Providing social support, reassurance and patient education can ameliorate symptoms.
Who does joint replacement have to be considered in?
Patients with radiographic evidence of OA who have refractory pain and disability
Osteoporosis affects an estimated … people in Europe, the US, and Japan. This figure is projected to … over the next 50 years.
75 million
Double
One new osteoporotic fracture occurs every … worldwide.
3 seconds
___ women and ___ men over the age of 50 worldwide will experience an osteoporotic fracture.
1 in 2
1 in 5
The prevalence of vertebral fracture is ___% in Caucasian men and women over the age of 50; this rises to ___% in women over the age of 80.
20–25%
50%
Around ___% of all patients experiencing one osteoporotic fracture will experience another.
50%
What is osteoporosis?
It is a skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture. It is not just a problem of low BMD, but the bone architecture is also lost.
What can be said of the curvature of the spine in osteoporosis?
Excessive kyphosis
What is meant by the fracture cascade?
A first osteoporotic fracture significantly increases the risk of further fractures. The first fracture is usually a peripheral fracture, then a vertebral one and then a hip fracture.
In patients who have already had a fracture, there is an increased risk of sustaining another fracture of how many %?
86%
Relative risk of new fractures increases ? fold after the first fracture, ? fold after the second and ? fold after the third fracture.
- 2
- 8
- 3
_ in _ women with vertebral fractures experience another spinal fracture within 1 year. Patients with two or more prevalent vertebral fractures elevates the risk of having another fracture within a year by __ fold.
1 in 5
7-fold
In women, what is the major determinant of bone loss after the menopause? Why?
Oestrogen deficiency
Due to the removal of the ‘brakes’ from osteoclastic activity.
What is peak bone density?
The point at which a person has the greatest amount of bone that they will ever have.
What is T-score measured in? What does it measure?
Standard deviations - how much your bone density is above or below normal compared to a young, healthy 30-year-old adult with peak bone density.
How has WHO defined osteopenia in terms of T-scores?
-1 to -2.5
How has WHO defined osteoporosis in terms of T-scores?
How is osteoporosis classified?
Primary
Idiopathic (at ages <50)
Secondary
What can cause secondary osteoporosis? (6)
Thyrotoxicosis Cushing’s syndrome Malabsorption Malignancy Hypogonadism Drugs e.g. steroids
What types of primary osteoporosis are there?
Type I (postmenopausal) Type II (“senile”, age >70)
How many % of women are affected by vertebral fractures?
20% - most are asymptomatic
How many % of women living to the age of 85 are affected by hip fractures?
25%
What is the lifetime risk of hip fracture?
15%
Colles’ fracture affects __% of women.
15%
What are the clinical consequences of osteoporosis? (4)
Increased mortality (20% in the first year after a hip fracture)
Pain (after fracture, or prolonged pain due to secondary OA, costal margin impingement)
Deformities (kyphosis, loss of height, abdominal protrusion)
Loss of independence
What is the FRAX tool used for?
To evaluate fracture risk of patients – it gives the 10-year probability of fracture
What factors does FRAX take into account to calculate the risk? (12)
Age, sex, weight, height, previous fracture, parent history of hip fracture, current smoking, glucocorticoids, RA, secondary osteoporosis, 3 or more units of alcohol a day, femoral neck BMD.
If the FRAX probability is high, the patient is treated. If it is low, they are given lifestyle advice and reassurance. If it is intermediate, what is done?
Measure BMD and reassess
What can children and adolescents do to prevent osteoporosis later in life? (6)
Adequate calcium intake
Avoid under-nutrition and protein malnutrition
Adequate supply of vitamin D
Regular physical activity
Avoid smoking
Education about risk of high alcohol consumption
How can we optimise peak bone mass? (2)
Exercise - regular and weight-bearing
Dietary Calcium - especially during growth
How can we reduce the rate of bone loss? (5)
Regular exercise Maintain calcium intake Moderate alcohol intake Stop smoking HRT
What other measures can be taken for osteoporosis? (3)
Prevention of falls
Hip protectors
Patient education
What drug treatments are there for osteoporosis? (7)
Bisphosphonates Selective oestrogen receptor modulators HRT Vitamin D & Calcium Calcitonin Teriparatide Denosumab
Give an example of a bisphosphonate.
Alendronate (etidronate, risedronate, ibandronate, pamidronate and zoledronate…)
Give an example of a selective oestrogen receptor modulator.
Raloxifene
When is teriparatide given?
In severe unresponsive cases
