HLTH 2501: bone, muscle, ligament and tendon disorders Flashcards
osteoporosis
is a common metabolic bone disorder when there is a decrease in bone mass and density, combined with the loss of bone matrix and mineralization
who is osteoporosis more common in?
older women
what do most osteoporosis fractures involve?
the hip and the vertebrae
two forms of osteoporosis
primary or secondary
primary osteoporosis
is postmenopausal, senile, or idiopathic
secondary osteoporosis
follows a specific primary disorder such as cushing syndrome
how does osteoporosis develop?
during the bone remodeling process, bone resorption exceeds bone formation, leading to thin, fragile bones
what bones does osteoporosis affect more?
those with high proportions of cancellous bones, such as the vertebrae and femoral neck
osteopenia
occurs as the bone density slowly becomes lower and is considered a midpoint on the progression to osteoporosis
what factors contribute to osteoporosis?
genetic factors (ex. vitamin D receptors), nutrition, hormonal levels, aging, decreased mobility or sedentary lifestyle, cigarette smoking, excessive caffeine, and small, light bone structure
disuse osteoporosis
occurs when an area of the body is immobilized due to something like a fracture, developing osteoporosis as a result
what lack of nutrients is a risk for developing osteoporosis?
calcium, vitamin D and protein
why does aging lead to osteoporosis?
osteoblast activity declines with age, as well estrogen levels decline after menopause
what hormonal conditions are associated with osteoporosis?
hyperparathyroidism, cushing syndrome, or continued intake of catabolic glucocorticoids such as prednisone
who has light and small bone structure?
Asian and Caucasian people
signs of compression vertebrae fractures
back pain, loss of height, and abnormal curvature of the spine (leads to kyphosis, lordosis, and scoliosis)
kyphosis
excessive forward rounding of the upper back
lordosis
excessive natural curve of the lower spine
scoliosis
irregular curve of the spine
treatment for osteoporosis
dietary supplement of calcium, vitamin D, and flouride, calcitonin, bisphosphonates, injected human parathyroid hormone, regular weighlighting and walking, selective estrogen drugs, strontium ranelate, and surgery
how much calcium should premenopausal and postmenopausal women take?
1000 mg for pre and 1500 mg for most
why do fluoride supplements help?
they promote bone deposition
what is an example of bisphosphonates?
alendronate which inhibits osteoclast activity
selective estrogen drugs
ex. raloxifene or tamoxifen; these are better than estrogen therapy as there is less effect on uterine and breast tissue
strontium ranelate
new medication that appears to decrease bone resorption and increase bone formation, as well as antibody preparations that bind to osteoclasts, preventing bone resorption
what do rickets and osteomalacia result from?
vitamin D and phosphate deficines which are associated with dietary defects, malabsorption, prolonged intake of phenobarbital (for seizures), or lack of sun exposure
rickets
soft bone in children resulting from lack of calcification of the cartilage forming at the epiphyseal plate
why is vitamin D important for bones?
it is required for the absorption of calcium
osteomalacia
occurs in adults who have poor vitamin D absorption, causing soft bones and resulting compression fractures
renal rickets
is osteomalacia associated with severe renal disease
paget disease
is a progressive bone disease that occurs in 40+ adults; bone destruction occurs and is replacements by fibrous tissue and abnormal bone
causes of paget disease
has not been established however childhood infection with a virus or genetic factors may be the cause
another name for paget disease
osteitis deformans
signs of paget disease
structural abnormalities like thickening in the long bones, vertebrae, pelvis, and skill
risk of paget disease
pathologic fractures, if in the spine, can cause compression fractures and kyphosis; if in the skull, can cause increased pressure; and can increase risk for cardiovascular disease
osteomyelitis
is a bone infection caused by bacteria or fungi; microorganisms enter the blood and spread to the bones
signs of osteomyelitis
local inflammation and bone pain, fever, excessive sweating, chills, and general malaise
treatment for osteomyelitis
antibiotics to eliminate the infection and sometimes surgery to repair the damaged tissue
three types of curvature disorders
lordosis, kyphosis, and scoliosis
function of the spine curves
help the spine to absorb stress of body movement and gravity
another name for lordosis
swayback
causes of lordosis
achondroplasia (genetic condition affecting protein), obesity, discitis, and slipping forward of the vertebrae
kyphosis another name
hunchback or humpback
causes of kyphosis
poor posture, spina bifida, congenital defects, spinal tumors or infections, and scheuermann disease
causes of scoliosis
not really known but can be genetic, or the result of disease or trauma
general treatment for spine disordesr
medication for pain and inflammation, weight loss, wearing a brace, physical therapy, and surgery
what are most bone tumors?
malignant and secondary tumors
where do bone tumors commonly develop?
the spine and pelvis
what are bone tumors often secondary to?
breast, lung, or prostate tumors
osteosarcoma
is a primary malignant neoplasm that usually develops in the metaphysis of the femur, tibia, or fibula of children or young adults, mostly males
ewing sacroma
is another malignant neoplasm common in adolescents that occurs in the diaphysis of long bones
where do ewing sarcoma and osteosarcoma tend to spread to?
the lungs
signs of bone cancer
usually bone pain that increases in severity, especially at night
treatment for bone cancer
surgical amputation or excision of the tumor, followed by chemo
chondrosarcomas
arise from cartilage cells and are more common in 30+ adults
where does chondrosarcoma tend to develop?
the pelvic bone or shoulder girdle at the points of muscle attachment; they often spread to the lungs
prognosis for bone cancer
about 70% survive, and about 30% if the tumor has spread
muscular dystrophy
is a group of inherited disorders characterized by degeneration of skeletal muscle; the groups differ in their inheritance, area affected, age at onset, and rate of progression
most common type of muscle dystrophy
duchenne
duchenne MD
inherited by X-linked recessive (in males), age of onset if 2-3 years, distribution is hips, legs, ascending shoulder girdle, and progresses rapidly
facioscapulohumeral MD
inherited by autosomal dominant, age is before 20, distribution is shoulder, neck, and face, and it progressed slow to moderate
myotonic MD
inherited by autosomal dominant, specifically chromosomes 19, age is birth to 50 years, occurs in the face and hands, and progresses slow
limb girdle MD
inherited by autosomal recessive gene, age of onset is all ages, distributed in the shoulder and pelvis, and progression varies
what in blood is elevated in duchenne MD?
creatine kinase
how does muscle dystrophy occur?
a metabolic defect leads to degeneration and necrosis of the cell, causing skeletal muscle fibres to be replaced by fat and fibrous CT, leading to hypertrophy appearance of the muscle, but function is gradually lost
common risk for MD
cardiomyopathy and mental retardation
duchenne MD signs
around age 3, motor weakness and regression become apparent (difficulty walking stairs, waddling gait, gower maneuver)
gower maneuver
when the child pushes up in an erect position by using the hands to climb up the legs
risks for those with duchenne MD
vertebral deformities such as kyphoscoliosis, respiratory insufficiency, and infections
tests for MD
genetic abnormalities, elevated CK levels, EMG, and muscle biopsy
treatment for MD
to support motor function with moderate exercise and the use of supportive appliances, OTs, and somes ventilators
primary fibromyalgia syndrome
is a group of disorders characterized by pain and stiffness affecting muscles, tendons, and surrounding soft tissues (not joints)
causes of primary fibromyalgia syndrome
not known but is related to altered central neurotransmission, resulting in increased sensitivity to substance P
substance P
a neurotransmitter involved in pain sensation
risk population for primary fibromyalgia syndrome
women 20-50, a prior history of trauma or OA, and sleep deprivation, stres, or fatigue
diagnosis for primary fibromyalgia syndrome
18 specific tender or trigger points are used to diagnosed this; they are tendons and ligaments in the neck, shoulder area, trunk, and limbs
signs of primary fibromyalgia syndrome
muscle aching pain, marked fatigue, sleep disruptions, depression, and IBS or urinary symptoms caused by interstitial cystitis
treatment for primary fibromyalgia syndrome
stress reduction, regular early morning exercise, massage therapy, resting, heat or massage, antidepressants, and NSAIDs
antidepressant drugs for primary fibromyalgia syndrome
low doses of tricyclic antidepressants or selective serotonin-norepinephrine reuptake inhibitors
drug for fibromyalgia
lyrica which mediates the pain pathway
myositis
is a general term referring to severe inflammation and subsequent damage of the muscles
diseases in the myositis group
autoimmune diseases like polymyositis, dermatomyositis, and juvenile myositis, as well as medication ones like boy myositis and toxic myositis
signs of myositis
difficulty climbing stairs or lifting arms, tired after standing and walking, trouble swallowing and breathing, muscle pain and soreness, and elevations in muscle enzymes in the blood (creatine phosphokinase or aldolase)
tests for myositis
blood tests, MRI, EMG, and muscle biopsy
treatment for myositis
drugs that suppress the immune system like prednisone, azathioprine, and methotrexate
recommended vitamin D intake
400-800 IU daily
bone disorders associated with vitamin D and phosphate deficiencies
rickets (children) and osteomalacia (adults)
risk factors for rickets and osteomalacia
lack of sun exposure or prolonged intake of phenobarbital (for seizures)
another name for paget’s disease
osteo deformans
where does osteosarcoma develop and where does ewing sarcoma develop?
osteosarcoma in the metaphysis (femur, tibia, or fibula) and ewing sarcoma in the diaphysis (long bones)
