metabolic bone disease Flashcards
how is bone classified?
-cortical bone (forms external part of long bones)
-trabecular / spongy bone
compare osteoblast vs osteoclast
-osteoblast produces bone matrix and initiates bone mineralisation
-osteoclast - bone resorption
what is an osteocyte?
-a mature bone cell that is derived from osteoblasts in bone
-transports CA2+ in bone
what are the 6 functions of bone?
-protects internal organs
-stores and releases fat
-produces blood cells
-stores and releases minerals
-facilitates movement
-supports the body
what is mechanotransduction?
-the process whereby the skeleton responds to imposed demands and adjusts its structure accordingly
when does bone loss happen?
-too little bone is formed to replace what has been removed - ie imbalance
-there are more places where bone is being removed - high turnover
what is the definition of osteoporosis?
-a disease characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk
what are non - modifiable risk factors for osteoporosis ?
-age
-gender
-early menopause
-FH
-low levels of oestrogen / testosterone
what are some examples of modifiable predisposing risk factors?
- smoking
-low BMI - excessive exercise
-diet
-sedentary lifestyle
-excessive caffeine
-excessive alcohol
what are some secondary causes of osteoporosis ?
-anorexia nervosa
-chronic liver disease
-renal disease
-RA
-hyperparathyroidism
what is corticosteroid induced osteoporosis ?
-OA caused by corticosteroids
-7.5mg a day or more, main loss occurs in the first 6 months
-osteoclastic activity increased (increased bone resorption)
what is type I primary osteoporosis?
-females
-hormone related
-post menopausal
what is type II primary osteoporosis?
-male and female
-age related - older than 70 yrs
-decrease in activity of osteoblasts
how is osteoporosis diagnosed?
gold standard is DEXA- to measure bone density
what are the clinical features of osteoporosis ?
-pain eg back pain, may only be present with fracture or severe deformity
-fractures eg mid-thoracic, low thoracic, femoral neck hip fracture
-deformity eg loss of height, kyphotic posture
-abnormal skin creams (changes in vertebral column)
what are the signs & symptoms of osteoporosis ?
-loss of height
-spinal deformity
-fracture due to minimal trauma
who are the groups at risk of developing osteoporosis ?
-elderly
-fallers
-women
what are ways to prevent osteoporosis ?
-education and awareness
-HRT
-diet - Ca & vit D
-medications
-weight bearing
when does peak bone mass occur?
in late teens / early 20s
what is bone mass influenced by?
-genetics
-sex
-diet
-physical activity
-hormones
how is osteoporosis managed?
-education and awareness NB
-drug therapy
-dietician
-fracture management eg orthopaedic surgeon
-falls services- identify people at risk of falls
what do anti-resorptive treatments do?
-reduce the amount of bone removed, reduce new damage and increase calcium
-eg denosumab
what are anabolic or bone forming treatment?
treatment to increase bone formation and improve structure
what medication improves formation and prevents resorption?
-romosozumab
what kind of things would you ask the pt in relation to osteoporosis in a subjective examination ?
-pain
-social history
-falls history
-fracture history
-DEXA results
-meds
-co-morbidities
what are you looking at in the physical exam of an osteoporosis pt?
-posture
-height
-spinal mobility
-UL & LL mobility
-strength endurance
-balance eg bergs
-function - TUG (timed up and go)
-aerobic fitness test eg 6 min / 2 min walk
how do physios manage osteoporosis ?
-education NB eg lifestyle risk factors, exercise and self management
-pain relief options
-postural correction
-hydrotherapy
-general mobility and balance for falls prevention
what kind of targeted WB or NWB exercise is suitable for osteoporosis pts?
-low impact WB activity - ie always having 1 foot on floor
-non WB exercise eg swimming, cycling
-resistance exercise - weights 3x week 30 mins
what are examples of exercise that should be avoided for osteoporotic pts?
-excessive spinal flexion
-high impact loading
-twisting mvts
what is a fragility fracture?
-type of pathologic fracture that occurs as a result of normal activities such as a fall from standing height or less
what is osteomalacia/ rickets
-osteomalacia is a disease characterized by the softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium.
-RARE
what are examples of causes of osteomalacia?
-vitamin D deficiency
-immobility in elderly
-malabsorption
-renal disease
what are the clinical features of osteomalacia?
-bone deformity
-fatigue
-proximal myopathy (weakness) eg to hip or spine region - waddling gait
-diffuse muscle and bone pain
how is osteomalacia diagnosed?
-bone biopsy , x ray etc
how is osteomalacia treated?
-oral vit D supplements
-sunlight
what is pagets disease?
-a progressive bone disease that occurs in people older than 40
-increased bone turnover and excessive bone destruction
-bone is placed by abnormal tissue and abnormal bone
what are common sites of Paget’s disease?
-pelvis
-lumbar spine
-femur
-humerus
-skull
-tibia
what are clinical features of pagets?
-may be asymptomatic
-dull bone pain
-night pain
-deformity of long bones and skull
-gait changes
-degenerative joint changes
what are examples of complications of pagets disease ?
-pathological fracture
-non-union
-stress fracture
-paraplegia
-visual loss/ hearing loss
