Lecture 2: Osteoporosis Flashcards
Osteoarthritis
→ loss + damage of articular cartilage wear down over time
→ new bone formation of joint margins - pathophysiological
Osteoarthritis: Risk Factors
→ increased age
→ joint trauma, long term mechanical stress (i.e. high performer)
→ obesity (sig load on joints over a long term period)
Characteristics of Osteoarthritis
→ local areas of damage + loss of articular cartilage
→ subchondrial bone changes
→ variable degrees of mild synovitis + thickening of the joint capsule
→ INFLAMMATION = NO!
Manifestations of Osteoarthritis
→ pain (worsens w/ activity) → enlargement of joint → stiffness (diminishes w/ activity) → tenderness limited motion → muscle wasting, partial dislocation, deformity
Conservative treatment of osteoarthritis
→ exercise + weight loss (in cases of obese adults)
→ pharmacological therapies (Analgesics and anti-inflammatories)
→ nutritional supplements
Surgical Treatment of Osteoarthritis
→ is used to improve joint movement, correct deformity, or malalignment, or create a new joint w/ artificial implants
Rheumatoid Arthritis
→ 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
3 Processes of pathogenesis in rheumatoid arthritis
→ 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)
Insidious Onset of Rheumatoid Arthritis
→ systematic manifestations
→ painful, tender stiff joints),
→ joint deformities
→ inflammation, fever, fatigue, weakness, anorexia, weight loss, generalized aching + stiffness
→ rheumatoid nodules (chaplains syndrome)
Synovitis in Rheumatoid Arthritis
→ 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
MSK Injuries: Fractures
break in the continuity of bone (most serious MSK disease) - incompletely or completely fractured
MSK Injuries: stress fracture
common in athletes; normal or abnormal bone tissue > sudden increase in mechanical stress to the bone
MSK Injuries: Fatigue
normal bone is subjected to abnormal stress; acute injury
MSK Injuries: Insufficiency Fracture
normal weight bearing, very low level of activity (sitting upright or walking) - individual is frail/have abnormal bone structure
Healing Fractures: Direct
→ most often occur when surgical fixation is used to repair broken bone
→ intramembranous bone formation
Healing Fractures: Indirect
→ cast or other non-surgical method
→ intramembranous + endochondrial bone formation
→ callus formation
→ remodelling of solid bone
Disslocation
→ displacement of one or more bones in a joint
→ loss of contact b/w articular cartilage
→ causes implications for surrounding structures
Subluxation
→ 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
Stages of Bone Healing
- hematoma formation occurs (bleeding present at both bones - transverse fracture)
- hematoma becomes more organized (structured with a fibrous network that is arranging to help with bone healing)
- 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
- callus formation of tissue (new bone is made, old bone is destroyed)
- bone goes back to looking normal (callus is removed & replaced - normal bone is deposited)
Manifestations of Fractures
→ unnatural alignment swelling, muscle swelling, spasm, tenderness, pain, impaired sensation
→ often transient numbers due to nerve trauma
Treatment of Fractures
→ immobilization
→ closed manipulation, traction + open reduction
→ internal + external fixation (casts)
Strain
tearing or stretching to a tendon or muscle
sprain
tear or injury to a ligament
avulsion
complete separation of a tendon or ligament from its bony attachment site (tendon - muscle to bone, ligaments - bone to bone)
tendon + ligament injuries
→ 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
Muscle Strain
→ suddenly, forced motion causing the muscle to become stretched beyond its normal phases:
healing in 3 phases (destruction of damaged muscle, repair, remodelling)
Muscle Strain: Myositis Ossification
→ 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
Tendinopathy
inflammation of a tendon
Epicondylopathy
inflammation of a tendon where it attaches to a bone
- tennis elbow (lateral epicondylitis)
- golfers elbow (medical epicondylitis)
Burtis
→ 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
Definition of Osteoporosis
“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
Epidemiology of osteoporosis: Canada
→ 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+
Epidemiology of Osteoporosis: worldwide
→ over 200 million people worldwide suffer
→ aging population - increase of indecencies of osteoporosis + fractures over time
Vertebral Fracture (stats)
→ 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
Hip fracture(stats)
→ 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
Osteoporosis
→ 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)
Potential Causes of Osteoporosis
→ 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
Postmenopausal Osteoporosis
→ 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
Secondary Osteoporosis
caused by other conditions
→ hormonal imbalances
→ medications
→ disease
Regional Osteoporosis
→ confined to a segment of the appendicular skeleton
→ associated with disuse
→ may be transient
glucocorticoid-induced osteoporosis
→ type of secondary osteoporosis
→ glucocorticoids improve osteoclast survival, which inhibits osteoblast formation + function
age-related bone mass
→ 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
Bone Balance
→ 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
Negative bone balance
→ 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
Factors related to negative bone Balance
→ hormonal factors
→ nutritional factors
→ genetic disorders
→ environmental factors
Kyphosis
→ spinal disorder
→ excessive outward curve of the spine
→ abnormal rounding of upper back
→ can occur at any age but common during adolescence
Site of Osteoporosis Fractures
→ 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
Duel x-ray Absorptiometry (DXA)
→ 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
Trabecular Bone Score (TBS)
→ evaluates pixel variations in the grey-level areas of lumbar spine images from DXA scans
→ enhanced predictions of fracture risk
bone mineral density (BMD)
bone mineral content (g)/region area (cm2)
T-score
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
Osteoporosis (Low BMD) + Fracture Risk
→ low Bmp is associated with higher fracture risk
→ relationship b/w BMD + fracture risk is a continuous gradient
Treatment of Osteoporosis
→ 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)
