METABOLIC DISORDERS/GENETIC INF DISEASES Flashcards
last lecture
Metabolic disorders occur from abnormal physiological processes of the ____ and ____ system
nervous and endocrine system
True or false: the skeleton is a metabolically active organ that finishes remodeling at 25-35 years
false: undergoes continuous remodeling throughout life
*resorption and formation
Bone mass reaches peak levels between ages __and ____
25-35 years
after this time, rate of resorption begins to exceed rate of formation
metabolic bone diseases are characterized by loss of bone ____and ___
density and strength
What is the most serious, potentially life threatening, costly complication of metabolic bone disease
fracture
kyphosis due to metabolic bone disease could affect what
cardiopulmonary function
what is osteomalacia
softening of bones
what is osteopenia
low bone mass
osteopetrosis
increased bone density
osteoporosis
systemic disease decreases bone density
Secondary osteoporosis is due to
(Metabolic) Diseases, meds (increase bone reabsorption), other conditions
Osteoporosis is defined as what?
Chronic, progressive disease with low bone mass, impaired bone quality, decreased bone strength, enhanced risk of fractures
Primary osteoporosis is due to what?
Age related physiological changes!
-long term calcium deficiency
-declining gonadal/adrenal function
-progressive estrogen deficiency
-sedentary lifestyle
Is primary or secondary osteoporosis more common?
Primary osteoporosis
Risk factors for osteoporosis
Hormonal status
Genetics
Sedentary
Tobacco, alcohol
Meds
Depression (sedentary?)
Diet/nutrition
Bone strength is based on what two factors?
Bone density
Bone quality
Without weight bearing/mechanical stimuli, you pee out more ____ and bone density _____
Calcium (calcium excretion increases)
Bone density decreases
What are the most common presenting features of osteoporosis?
Loss of height
Postural changes
Back pain
Fractures
Where is muscular pain/trigger points in people with osteoporosis?
Lower back para spinals
Rhomboid muscles
What is an unrecognized early sign of osteoporosis?
Stress fractures
VERTEBRAL COMPRESSION FRACTURES ARE MOST COMMON OSTEOPOROSIS RELATED SPINAL FRACTURES
What are the most common spinal fractures in osteoporosis?
Vertebral compression fractures
MEDICAL MANAGEMENT SLIDE: STUDY
Osteomalacia is what?
Soft bone (lack of mineralization without loss of bone matrix)
Due to lack of calcium, vitamin D, phosphate
*known as adult rickets
What is paget disease?
Increased bone resorption (by osteoclasts)
Excessive, unorganized new bone formation (by osteoblasts)
Normal bone marrow replaced by vascular and fibrous tissue
What is the second most common metabolic bone disease?
Osteitis deformans/pagets disease
(Big bones that are weak)
What is developmental dysplasia of the hip?
A genetic/developmental disorder
Affects infants/kids
*developmental hip disorder happening DYNAMICALLY in utero and 1st year of life
Developmental dysplasia of the hip can be
Unilateral
Bilateral
Occur in 3 forms of varying severity
- Unstable hip dysplasia is what?
Hip positioned normally, can be dislocated with manipulation
Subluxation or incomplete dislocation DDH is what?
Femoral head is in contact with acetabulum, but head of femur is partially displaced/uncovered
complete dislocation in DDH is what?
Femoral head is totally outside acetabulum
What does DDH look like in newborns-1 year old
Ortolani/Barlow signs
Positive Galeazzie sign in asymmetric cases
Physical asymmetry in ROM (as limitation of hip abduction)
Asymmetry in butt fold (higher on affected side)
Extra skin folds
Leg length discrepancy
In ambulating kids, what does DDH look like?
Bilateral dysplasia-compensated trendelenburg
(Lean to weight bearing side, compensate for weak glute med)
Osteogenesis imperfecta is what?
Brittle bone disease
Generalized connective tissue disorder: skeletal fragility
Growth deficiency
(Growth retardation, long bone and spinal deformities)
Osteogenesis imperfecta may be evident at birth in severe forms because
fractures/deformities in utero (long bone and spinal deformities)
when do less severe forms of OI become evident?
when child begins to walk and fractures happen
what is common in children with osteogenesis imperfecta?
short stature (abnorm epiphysial growth plates, deformity after fx, osteoporosis, vertebral collapse)
what are other clinical features of OI?
LE more than UE
bruise easily
lax ligmanets
thin skin
hypermobility
hearing impairments
scoliosis
deformed teeth and pectus
cardiovascular complications
What is osteomyelitis caused by?
inflammation of bone by infectious organism (bacteria, also fungi, parasites, viruses)
what areas are most affected with osteomyelitis?
arms, legs, spine, pelvis
acute osteomyelitis is usually seen in
children, older adults, IV drug abusers
(new infection, rapid destructive pyogenic infection through open wound or GI…leads to speticemia/septic infectious joint)
subacute/chronic osteomyelitis is usually seen in
adults secondary to open injury to bone/soft tissue around it
chronic osteomyelitis is result from
persistent bone infection or acute disease undiagnosed
what is the primary cause of prosthetic failure?
Implant infection (acutely in 1st month post op or months/years after)
nearly 80% of prosthetic infections are due to what bacteria?
staphylococcus
______ infections occur around the time of surgery and are probably caused by contaminated instruments at the surgical site
perioperative infections
hematogenous infections are due to
primary infection elsewhere in body
continguous infections occur secondary to
nearby infections
Other types of prostheses or implants susceptible to infection include
internal fixation of the spine, breast implants, penile implants, dental implants, cardiac implants, other orthopedic devices and hardware, shunts, and even contact lenses.
what may be the only symptom of prosthetic/implant infection?
persistent joint pain
acute symptoms: could be fever, joint pain, warmth, redness
what is spondylodiscitis?
infection affecting vertebral spine
what is the most common site for spinal infection?
intervertebral disk
classic signs in children of spondylodiscitis
fever and spinal pain
*young children: back pain, refusal to walk, pain with hip extension
*abdominal pain and weight loss, maybe can’t flex lower back
in adults, what would spondylodiscitis look like?
spinal pain, radiating into lower extremities involving multiple nerve levels
*worse with activity, rest does not relieve pain
*unusual postures and movement patterns in adults
