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Advanced MSK - physio > metabolic bone disease > Flashcards

metabolic bone disease Flashcards

1
Q

how is bone classified?

A

-cortical bone (forms external part of long bones)
-trabecular / spongy bone

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2
Q

compare osteoblast vs osteoclast

A

-osteoblast produces bone matrix and initiates bone mineralisation
-osteoclast - bone resorption

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3
Q

what is an osteocyte?

A

-a mature bone cell that is derived from osteoblasts in bone
-transports CA2+ in bone

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4
Q

what are the 6 functions of bone?

A

-protects internal organs
-stores and releases fat
-produces blood cells
-stores and releases minerals
-facilitates movement
-supports the body

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5
Q

what is mechanotransduction?

A

-the process whereby the skeleton responds to imposed demands and adjusts its structure accordingly

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6
Q

when does bone loss happen?

A

-too little bone is formed to replace what has been removed - ie imbalance
-there are more places where bone is being removed - high turnover

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7
Q

what is the definition of osteoporosis?

A

-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

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8
Q

what are non - modifiable risk factors for osteoporosis ?

A

-age
-gender
-early menopause
-FH
-low levels of oestrogen / testosterone

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9
Q

what are some examples of modifiable predisposing risk factors?

A
  • smoking
    -low BMI
  • excessive exercise
    -diet
    -sedentary lifestyle
    -excessive caffeine
    -excessive alcohol
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10
Q

what are some secondary causes of osteoporosis ?

A

-anorexia nervosa
-chronic liver disease
-renal disease
-RA
-hyperparathyroidism

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11
Q

what is corticosteroid induced osteoporosis ?

A

-OA caused by corticosteroids
-7.5mg a day or more, main loss occurs in the first 6 months
-osteoclastic activity increased (increased bone resorption)

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12
Q

what is type I primary osteoporosis?

A

-females
-hormone related
-post menopausal

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13
Q

what is type II primary osteoporosis?

A

-male and female
-age related - older than 70 yrs
-decrease in activity of osteoblasts

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14
Q

how is osteoporosis diagnosed?

A

gold standard is DEXA- to measure bone density

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15
Q

what are the clinical features of osteoporosis ?

A

-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)

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16
Q

what are the signs & symptoms of osteoporosis ?

A

-loss of height
-spinal deformity
-fracture due to minimal trauma

17
Q

who are the groups at risk of developing osteoporosis ?

A

-elderly
-fallers
-women

18
Q

what are ways to prevent osteoporosis ?

A

-education and awareness
-HRT
-diet - Ca & vit D
-medications
-weight bearing

19
Q

when does peak bone mass occur?

A

in late teens / early 20s

20
Q

what is bone mass influenced by?

A

-genetics
-sex
-diet
-physical activity
-hormones

21
Q

how is osteoporosis managed?

A

-education and awareness NB
-drug therapy
-dietician
-fracture management eg orthopaedic surgeon
-falls services- identify people at risk of falls

22
Q

what do anti-resorptive treatments do?

A

-reduce the amount of bone removed, reduce new damage and increase calcium
-eg denosumab

23
Q

what are anabolic or bone forming treatment?

A

treatment to increase bone formation and improve structure

24
Q

what medication improves formation and prevents resorption?

A

-romosozumab

25
Q

what kind of things would you ask the pt in relation to osteoporosis in a subjective examination ?

A

-pain
-social history
-falls history
-fracture history
-DEXA results
-meds
-co-morbidities

26
Q

what are you looking at in the physical exam of an osteoporosis pt?

A

-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

27
Q

how do physios manage osteoporosis ?

A

-education NB eg lifestyle risk factors, exercise and self management
-pain relief options
-postural correction
-hydrotherapy
-general mobility and balance for falls prevention

28
Q

what kind of targeted WB or NWB exercise is suitable for osteoporosis pts?

A

-low impact WB activity - ie always having 1 foot on floor
-non WB exercise eg swimming, cycling
-resistance exercise - weights 3x week 30 mins

29
Q

what are examples of exercise that should be avoided for osteoporotic pts?

A

-excessive spinal flexion
-high impact loading
-twisting mvts

30
Q

what is a fragility fracture?

A

-type of pathologic fracture that occurs as a result of normal activities such as a fall from standing height or less

31
Q

what is osteomalacia/ rickets

A

-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

32
Q

what are examples of causes of osteomalacia?

A

-vitamin D deficiency
-immobility in elderly
-malabsorption
-renal disease

33
Q

what are the clinical features of osteomalacia?

A

-bone deformity
-fatigue
-proximal myopathy (weakness) eg to hip or spine region - waddling gait
-diffuse muscle and bone pain

34
Q

how is osteomalacia diagnosed?

A

-bone biopsy , x ray etc

35
Q

how is osteomalacia treated?

A

-oral vit D supplements
-sunlight

36
Q

what is pagets disease?

A

-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

37
Q

what are common sites of Paget’s disease?

A

-pelvis
-lumbar spine
-femur
-humerus
-skull
-tibia

38
Q

what are clinical features of pagets?

A

-may be asymptomatic
-dull bone pain
-night pain
-deformity of long bones and skull
-gait changes
-degenerative joint changes

39
Q

what are examples of complications of pagets disease ?

A

-pathological fracture
-non-union
-stress fracture
-paraplegia
-visual loss/ hearing loss

Advanced MSK - physio (23 decks)

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