metabolic bone disease

Question 1

how is bone classified?

Answer 1

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

Question 2

compare osteoblast vs osteoclast

Answer 2

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

Question 3

what is an osteocyte?

Answer 3

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

Question 4

what are the 6 functions of bone?

Answer 4

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

Question 5

what is mechanotransduction?

Answer 5

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

Question 6

when does bone loss happen?

Answer 6

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

Question 7

what is the definition of osteoporosis?

Answer 7

-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

Question 8

what are non - modifiable risk factors for OA?

Answer 8

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

Question 9

what are some examples of modifiable predisposing risk factors?

Answer 9

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

Question 10

what are some secondary causes of OA?

Answer 10

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

Question 11

what is corticosteroid induced OA?

Answer 11

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

Question 12

what is type I primary osteoporosis?

Answer 12

-females
-hormone related
-post menopausal

Question 13

what is type II primary osteoporosis?

Answer 13

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

Question 14

how is OA diagnosed?

Answer 14

gold standard is DEXA- to measure bone density

Question 15

what are the clinical features of OA?

Answer 15

-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)

Question 16

what are the signs & symptoms of OA?

Answer 16

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

Question 17

who are the groups at risk of developing OA?

Answer 17

-elderly
-fallers
-women

Question 18

what are ways to prevent OA?

Answer 18

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

Question 19

when does peak bone mass occur?

Answer 19

in late teens / early 20s

Question 20

what is bone mass influenced by?

Answer 20

-genetics
-sex
-diet
-physical activity
-hormones

Question 21

how is OA managed?

Answer 21

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

Question 22

what do anti-resorptive treatments do?

Answer 22

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

Question 23

what are anabolic or bone forming treatment?

Answer 23

treatment to increase bone formation and improve structure

Question 24

what medication improves formation and prevents resorption?

Answer 24

-romosozumab

Question 25

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

Answer 25

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

Question 26

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

Answer 26

-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

Question 27

how do physios manage OA?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

-excessive spinal flexion
-high impact loading
-twisting mvts

Question 30

what is a fragility fracture?

Answer 30

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

Question 31

what is osteomalacia/ rickets

Answer 31

-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

Question 32

what are examples of causes of osteomalacia?

Answer 32

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

Question 33

what are the clinical features of osteomalacia?

Answer 33

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

Question 34

how is osteomalacia diagnosed?

Answer 34

-bone biopsy , x ray etc

Question 35

how is osteomalacia treated?

Answer 35

-oral vit D supplements
-sunlight

Question 36

what is pagets disease?

Answer 36

-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

Question 37

what are common sites of Paget’s disease?

Answer 37

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

Question 38

what are clinical features of pagets?

Answer 38

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

Question 39

what are examples of complications of pagets disease ?

Answer 39

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