joint disease Flashcards
what is osteoporosis?
Osteoporosis is becoming more prevalent as we are getting an ageing population, it is a disease of age but it does start early in life.
There are things we can do in school years to prevent the affects of osteoporosis.
osteoporosis is a generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture.
what is the epidemiology of OP?
> 30,000 fractures a year
£3 billion to NHS a year
- 1 in 2 women over 50 years will have OP
- 1 in 5 men over 50 will
what is the pathogenesis/
• Thick outer shell of bone = cortex
• Meshwork of bone inside cortex = trabecular bone this is what becomes weaker as you develop it which means it is more likely to fracture
• Bone constantly turned over/ remodeled
o Takes around 3 months to remodel
• Osteoblasts build new bone
• Osteoclasts break down old bone (resorption)
what cayses OP?
o increased osteoclast activity this means bone is being broken down quicker than it can be remodeled, so we want to try and rebalance this to make sure you have bone less likely to fracture
o low peak bone mass – 25-40 years old and after this you lose about 1% of bone mass a year
what are the signs and symptoms of OP/
- Fracture- usually first presentation
- Reduced bone density on DXA scan - high intensity scan calculates to determine if the bone is weaker. Very expensive and don’t have them everywhere. Only scan the high risk patients
- Pain
- Reduced mobility
- Kyphosis- in vertebral fractures. Spine starts to curve and this is the first indication they have it. Can cause loss of height and indigestion – this is because there is an increase of pressure
- Reduction in height
what are vertebral fractures?
- Can result in height reduction of 10-20cm
- Often underdiagnosed
- Can cause problems with indigestion, neck weakness, back pain, loss of mobility
what is bone density?
changes throughout life with a peak around 25-40 years.
post maturity you lose 0.5-1% a year
what are DXA scans?
onlu used for high risk patients or those with OP
usually measure bone density at hip or lower spine
what is a T score/
measure the risk of chance of developing OP
T score<2.5
what are the risk factors of OP?
history smoking low body weight female oestogren defiency coricosteroid use low calcium intake excess alcohol lack of excerise dementia recurrent falls impaired eyesight white race
what is primary prevention of OP?
– Adequate Ca and Vit D – Weight bearing exercise – Reduced alcohol intake – Stop smoking – Reduce risk of falls esp in elderly
what is secondary prevention of OP?
– Calcium – Vit D – Calcitriol – HRT – SERMS – Bisphosphonates – Calcitonin – Strontium – PTH – Denosumab
what is osteoarthritis?
disease of wear and tear and is usually limited to 1-2 joints and associated with increased use and abuse of the joint
what is the epidemoilogy of OA?
- Overall affects 2%
- > 65yrs – affects 12%
- Onset most common at 40-60yrs
- More common in women
- Obesity increases risk
- Unknown aetiology
what are the clinical features of OA?
- Joint pain, worsened on movement and at end of day
- May be accompanied by swelling
- Most common in knee, hands, lumbar & cervical spine
- EMS up to 30 mins
