Lecture 2: Osteoporosis

Question 1

Osteoarthritis

Answer 1

→ loss + damage of articular cartilage wear down over time

→ new bone formation of joint margins - pathophysiological

Question 2

Osteoarthritis: Risk Factors

Answer 2

→ increased age
→ joint trauma, long term mechanical stress (i.e. high performer)
→ obesity (sig load on joints over a long term period)

Question 3

Characteristics of Osteoarthritis

Answer 3

→ local areas of damage + loss of articular cartilage
→ subchondrial bone changes
→ variable degrees of mild synovitis + thickening of the joint capsule
→ INFLAMMATION = NO!

Question 4

Manifestations of Osteoarthritis

Answer 4

→ pain (worsens w/ activity)
→ enlargement of joint
→ stiffness (diminishes w/ activity)  
→ tenderness limited motion
→ muscle wasting, partial dislocation, deformity

Question 5

Conservative treatment of osteoarthritis

Answer 5

→ exercise + weight loss (in cases of obese adults)
→ pharmacological therapies (Analgesics and anti-inflammatories)
→ nutritional supplements

Question 6

Surgical Treatment of Osteoarthritis

Answer 6

→ is used to improve joint movement, correct deformity, or malalignment, or create a new joint w/ artificial implants

Question 7

Rheumatoid Arthritis

Answer 7

→ inflammatory autoimmune disease
→ systematic autoimmune damage to connective tissue, primarily in the joints (synovial membrane)
→ similar symptoms to osteoarthritis
→ multifactorial with strong genetic deposition
→ prevalence: any age

Question 8

3 Processes of pathogenesis in rheumatoid arthritis

Answer 8

→ neutrophils and other cells in the synovial fluid becomes activated
→ inflammatory cytokines
→ t-cells also interact with synovial fibroblasts through, TNF alpha, converting synovium into a thick abnormal layer of granulation tissue (panes)

Question 9

Insidious Onset of Rheumatoid Arthritis

Answer 9

→ systematic manifestations
→ painful, tender stiff joints),
→ joint deformities
→ inflammation, fever, fatigue, weakness, anorexia, weight loss, generalized aching + stiffness
→ rheumatoid nodules (chaplains syndrome)

Question 10

Synovitis in Rheumatoid Arthritis

Answer 10

→ pannus - harder in terms of structural integrity (fibrous)
→ deeper layer - softer in nature - synovium
→ outer layer - where additional tissue can bind on + lead to additional tissue and deformity

Question 11

MSK Injuries: Fractures

Answer 11

break in the continuity of bone (most serious MSK disease) - incompletely or completely fractured

Question 12

MSK Injuries: stress fracture

Answer 12

common in athletes; normal or abnormal bone tissue > sudden increase in mechanical stress to the bone

Question 13

MSK Injuries: Fatigue

Answer 13

normal bone is subjected to abnormal stress; acute injury

Question 14

MSK Injuries: Insufficiency Fracture

Answer 14

normal weight bearing, very low level of activity (sitting upright or walking) - individual is frail/have abnormal bone structure

Question 15

Healing Fractures: Direct

Answer 15

→ most often occur when surgical fixation is used to repair broken bone
→ intramembranous bone formation

Question 16

Healing Fractures: Indirect

Answer 16

→ cast or other non-surgical method
→ intramembranous + endochondrial bone formation
→ callus formation
→ remodelling of solid bone

Question 17

Disslocation

Answer 17

→ displacement of one or more bones in a joint
→ loss of contact b/w articular cartilage
→ causes implications for surrounding structures

Question 18

Subluxation

Answer 18

→ contact b/w articular surfaces is only partially lost
→ partial lost of articulating surfaces
→ associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability

Question 19

Stages of Bone Healing

Answer 19

1. hematoma formation occurs (bleeding present at both bones - transverse fracture)
2. hematoma becomes more organized (structured with a fibrous network that is arranging to help with bone healing)
3. first step where the osteoblasts start to invade + both collagen (strands start to lengthen) & calcium (deposits are made at the site) start to play a role
4. callus formation of tissue (new bone is made, old bone is destroyed)
5. bone goes back to looking normal (callus is removed & replaced - normal bone is deposited)

Question 20

Manifestations of Fractures

Answer 20

→ unnatural alignment swelling, muscle swelling, spasm, tenderness, pain, impaired sensation
→ often transient numbers due to nerve trauma

Question 21

Treatment of Fractures

Answer 21

→ immobilization
→ closed manipulation, traction + open reduction
→ internal + external fixation (casts)

Question 22

Strain

Answer 22

tearing or stretching to a tendon or muscle

Question 23

sprain

Answer 23

tear or injury to a ligament

Question 24

avulsion

Answer 24

complete separation of a tendon or ligament from its bony attachment site (tendon - muscle to bone, ligaments - bone to bone)

Question 25

tendon + ligament injuries

Answer 25

→ usually lack sufficient strength with withstand stress for 4-5 weeks after injury
→ painful + generally accomplished by soft tissue swelling, changes in tendon or ligament contour, and dislocation or subluxation. of bones
→ rehabilitation is crucial to regaining good functional outcome

Question 26

Muscle Strain

Answer 26

→ suddenly, forced motion causing the muscle to become stretched beyond its normal phases:
healing in 3 phases (destruction of damaged muscle, repair, remodelling)

Question 27

Muscle Strain: Myositis Ossification

Answer 27

→ is also called neterotopic ossification
→ late complication of local muscle injury
→ associated with burns, joint injury, and trauma to the MSK system or CNS
→ soft tissue calcification causes stiffness or deformity of an extremity

Question 28

Tendinopathy

Answer 28

inflammation of a tendon

Question 29

Epicondylopathy

Answer 29

inflammation of a tendon where it attaches to a bone

• tennis elbow (lateral epicondylitis)
• golfers elbow (medical epicondylitis)

Question 30

Burtis

Answer 30

→ contributes to fluid movement at a joint
→ inflammation of a bursa (skin over bone, skin over muscle, muscle + tendon over bone)
→ inflammation caused by overuse or excessive pressure

Question 31

Definition of Osteoporosis

Answer 31

“thinning of bones” is characterized by a reduction in bone + a disruption of skeletal microarchitecture leading to reduced bone strength and an increase susceptibility to fracture with minimal trauma

Question 32

Epidemiology of osteoporosis: Canada

Answer 32

→ almost 2 million Canadians with osteoporosis
→ 1/4 women and at least 1/8 men
→ increased cost for treatment
→ cost to the CHS of treating osteoporosis
→ at least 80% of fractures in people 60+

Question 33

Epidemiology of Osteoporosis: worldwide

Answer 33

→ over 200 million people worldwide suffer

→ aging population - increase of indecencies of osteoporosis + fractures over time

Question 34

Vertebral Fracture (stats)

Answer 34

→ patients are at highest risk for subsequent fracture in the first few months following a vertical fracture
→ 1/4 women with vertebral fracture will fracture within 1 year
→ fracture again + again

Question 35

Hip fracture(stats)

Answer 35

→ hip fracture related to osteoporosis will result in death in up to 30% of cases
→ 23% of patients who fracture a hip die in less than a year
→ hip fractures consume more hospital bed days than stroke, diabetes or heart attack

Question 36

Osteoporosis

Answer 36

→ poorly mineralized bone + increased risk of fractures due to alteration in bone microarchitecture
→ old bone is reabsorbed faster than new bone thats been made

• spontaneous fractures (osteoblasts + their ability to form bone is outweighed by osteoclasts)

Question 37

Potential Causes of Osteoporosis

Answer 37

→ endocrine dysfunction (parathyroid hormone, cortisol, thyroid hormone + growth hormone)
→ medications
→ vitamin D deficiency 
→ underlaying diseases
→ low physical activity 
→ abnormal BMI
→ fractures are the major complication

Question 38

Postmenopausal Osteoporosis

Answer 38

→ middle aged women + older women
→ estrogen deficiency + 2nd causes
→ remodelling imbalance b/w a cavity of osteoclasts + osteoblasts
→ males + females have same level of growth
→ women fo not accumulate as much bone mass as compared to men
→ estrogen - helps women maintain bone mass before reaching menopause - when removed –> accelerated bone mass + density

Question 39

Secondary Osteoporosis

Answer 39

caused by other conditions
→ hormonal imbalances
→ medications
→ disease

Question 40

Regional Osteoporosis

Answer 40

→ confined to a segment of the appendicular skeleton
→ associated with disuse
→ may be transient

Question 41

glucocorticoid-induced osteoporosis

Answer 41

→ type of secondary osteoporosis

→ glucocorticoids improve osteoclast survival, which inhibits osteoblast formation + function

Question 42

age-related bone mass

Answer 42

→ cause unclear
reduced physical activity is likely a factor
→ to prevent osteoporosis - promotion of physical activity early on and later in life
→ bone mass is related to mechanical stress

Question 43

Bone Balance

Answer 43

→ after growth + up until the third decade of life, bone remodelling occurs such that the amount of bone formed is equal to the amount of bone

Question 44

Negative bone balance

Answer 44

→ with aging, bone resorption starts to exceed bone formation such that there is an overall net loss of bone or ned bone balance
occurs at the end-cortical and intracortical surface

Question 45

Factors related to negative bone Balance

Answer 45

→ hormonal factors
→ nutritional factors
→ genetic disorders
→ environmental factors

Question 46

Kyphosis

Answer 46

→ spinal disorder
→ excessive outward curve of the spine
→ abnormal rounding of upper back
→ can occur at any age but common during adolescence

Question 47

Site of Osteoporosis Fractures

Answer 47

→ osteoporotic fractures occur at the hip, wrist, spine
→ the most deliberating fractures are hip and vertebral fractures b/c they cause pain, disability, physical disfigurement + can increase death

Question 48

Duel x-ray Absorptiometry (DXA)

Answer 48

→ gold standard for detecting and monitoring osteoporosis

→ scanner that can scan the entire human body as you lay flat in a bed + quantified the bone mineral density

Question 49

Trabecular Bone Score (TBS)

Answer 49

→ evaluates pixel variations in the grey-level areas of lumbar spine images from DXA scans
→ enhanced predictions of fracture risk

Question 50

bone mineral density (BMD)

Answer 50

bone mineral content (g)/region area (cm2)

Question 51

T-score

Answer 51

the number of standard deviation above or below the mean for a healthy 20/30 year old adult of the same sex + ethnicity as the patient

Question 52

Osteoporosis (Low BMD) + Fracture Risk

Answer 52

→ low Bmp is associated with higher fracture risk

→ relationship b/w BMD + fracture risk is a continuous gradient

Question 53

Treatment of Osteoporosis

Answer 53

→ drug treatments (biophosphates, 4 currently approved for use in Canada)
→ nitroglycerin
cutting edge use - usually used in the control of aging
nitroglycerine stimulates bone resorption (ONLY DRUG TO DO BOTH)