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LOCO 2 > Degenerative Bone and Joint Diseases > Flashcards

Degenerative Bone and Joint Diseases Flashcards

1
Q

How many men were there in the UK in mid 2009? What is this projected to be by mid 2033?

A
  1. 37 million

33. 51 million

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2
Q

What is sarcopenia?

A

Decreased total muscle mass

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3
Q

Normal individuals exhibit how much of a decrease in total muscle mass between the ages of 30 to 80 years?

A

Approx 30%

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4
Q

What are the causes of sarcopenia? (5)

A 
Low sex hormones
Low IGF-1
Decrease in activity
OA
Neuronal degeneration
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5
Q

What % of muscle mass is lost per decade after age 30?

A

3% to 5%

Leads to

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6
Q

What does sarcopenia lead to? (3)

A

Camptocormia, frailty and falls

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7
Q

Why is height lost with age? (3)

A

Disc degeneration
Sarcopenia and camptocormia
Osteoporosis and vertebral collapse

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8
Q

What is camptocormia?

A

Progressive forward bend/curvature of spine, generally due to weak paraspinal muscles

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9
Q

How can sarcopenia be prevented and treated? (3)

A

Exercise
Vitamin D repletion
HRT

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10
Q

What is osteoarthritis?

A

A disease of synovial joints characterised by focal cartilage loss and an accompanying reparative bone response.

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11
Q

What is spondylosis?

A

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.

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12
Q

What is seen on the x-ray for OA? (3)

A
  • cartilage loss (joint space narrowing)
  • presence of osteophytes
  • bone sclerosis
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13
Q

How many % of 65 year olds have OA on x-rays?

A

50%

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14
Q

What is there a pronounced female preponderance for in OA? (3)

A

Severe radiographic grades of OA
OA of the hand and knee
Symptoms

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15
Q

OA of the hips is uncommon in…?

A

Africans and Asians

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16
Q

Polyarticular OA of the hand is rare in…?

A

Africans and Malaysians

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17
Q

What are the risk factors for OA? (7)

A

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

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18
Q

What is affected in nodal generalised OA? (6)

A 
PIPs (Heberden’s nodes)
DIPs (Bouchard’s nodes)
First CMC of thumb
Feet (bunions - hallux valgus/rigidus)
Knee and hip (OA)
Apophyseal joints
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19
Q

What is calcium pyrophosphate dihydrate (CPPD) disease?

Who (and what joint) does it mainly affect?

A

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.

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20
Q 
What is apatite-associated destructive arthritis?
What joint(s) does it mainly affect?
A

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.

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21
Q

What may premature onset OA (occurs under the age of 45) be caused by? (3)

A

Trauma
Surgery (e.g. menisectomy)
Haemochromatosis

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22
Q

What are the physical signs in OA? (7)

A 
Crepitus
Bony enlargement
Deformity
Instability
Restricted movement
Effusion
Muscle weakness or wasting
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23
Q

What is an important determinant of symptomatic and functional outcome in OA?
What does this mean?

A

Patient’s psychological status (anxiety, depression, and social support)
Providing social support, reassurance and patient education can ameliorate symptoms.

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24
Q

Who does joint replacement have to be considered in?

A

Patients with radiographic evidence of OA who have refractory pain and disability

25
Q

Osteoporosis affects an estimated … people in Europe, the US, and Japan. This figure is projected to … over the next 50 years.

A

75 million

Double

26
Q

One new osteoporotic fracture occurs every … worldwide.

A

3 seconds

27
Q

___ women and ___ men over the age of 50 worldwide will experience an osteoporotic fracture.

A

1 in 2

1 in 5

28
Q

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.

A

20–25%

50%

29
Q

Around ___% of all patients experiencing one osteoporotic fracture will experience another.

A

50%

30
Q

What is osteoporosis?

A

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.

31
Q

What can be said of the curvature of the spine in osteoporosis?

A

Excessive kyphosis

32
Q

What is meant by the fracture cascade?

A

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.

33
Q

In patients who have already had a fracture, there is an increased risk of sustaining another fracture of how many %?

A

86%

34
Q

Relative risk of new fractures increases ? fold after the first fracture, ? fold after the second and ? fold after the third fracture.

A
  1. 2
  2. 8
  3. 3
35
Q

_ 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.

A

1 in 5

7-fold

36
Q

In women, what is the major determinant of bone loss after the menopause? Why?

A

Oestrogen deficiency

Due to the removal of the ‘brakes’ from osteoclastic activity.

37
Q

What is peak bone density?

A

The point at which a person has the greatest amount of bone that they will ever have.

38
Q

What is T-score measured in? What does it measure?

A

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.

39
Q

How has WHO defined osteopenia in terms of T-scores?

A

-1 to -2.5

40
Q

How has WHO defined osteoporosis in terms of T-scores?

A
41
Q

How is osteoporosis classified?

A

Primary
Idiopathic (at ages <50)
Secondary

42
Q

What can cause secondary osteoporosis? (6)

A 
Thyrotoxicosis
Cushing’s syndrome
Malabsorption
Malignancy
Hypogonadism
Drugs e.g. steroids
43
Q

What types of primary osteoporosis are there?

A 
Type I (postmenopausal)
Type II (“senile”, age >70)
44
Q

How many % of women are affected by vertebral fractures?

A

20% - most are asymptomatic

45
Q

How many % of women living to the age of 85 are affected by hip fractures?

A

25%

46
Q

What is the lifetime risk of hip fracture?

A

15%

47
Q

Colles’ fracture affects __% of women.

A

15%

48
Q

What are the clinical consequences of osteoporosis? (4)

A

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

49
Q

What is the FRAX tool used for?

A

To evaluate fracture risk of patients – it gives the 10-year probability of fracture

50
Q

What factors does FRAX take into account to calculate the risk? (12)

A

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.

51
Q

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?

A

Measure BMD and reassess

52
Q

What can children and adolescents do to prevent osteoporosis later in life? (6)

A

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

53
Q

How can we optimise peak bone mass? (2)

A

Exercise - regular and weight-bearing

Dietary Calcium - especially during growth

54
Q

How can we reduce the rate of bone loss? (5)

A 
Regular exercise
Maintain calcium intake
Moderate alcohol intake
Stop smoking
HRT
55
Q

What other measures can be taken for osteoporosis? (3)

A

Prevention of falls
Hip protectors
Patient education

56
Q

What drug treatments are there for osteoporosis? (7)

A 
Bisphosphonates
Selective oestrogen receptor modulators
HRT
Vitamin D &amp; Calcium
Calcitonin
Teriparatide
Denosumab
57
Q

Give an example of a bisphosphonate.

A

Alendronate (etidronate, risedronate, ibandronate, pamidronate and zoledronate…)

58
Q

Give an example of a selective oestrogen receptor modulator.

A

Raloxifene

59
Q

When is teriparatide given?

A

In severe unresponsive cases

LOCO 2 (28 decks)

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