MS: Disorders of Bone Flashcards
What are metabolic bone diseases?
osteoporosis and osteomalacia
bone is not strong as it should be
What is an infectious bone disease?
osteomyelitis
What is a viability of bone disease?
osteonecrosis
What is the definition of osteoporosis?
a multifactoral skeletal disorder that leads to decreased bone density and organization, which leads to reduced bone strength
What are osteoporosis and osteopenia based off of?
bone mineral density or BMD
What are cut off levels for BMD?
normal- within 1 SD
osteopenia- within 1-2.5 SD
osteoporosis- more than 2.5 SD
How many people are affected by osteoporosis?
10 million diagnosed, 18 mill undiagnosed
What are the non modifiable risk factors for osteoporosis?
age- over 50
female, genetics, caucasian/Northern European
long periods of immobilization
arthropometric- small stature, thin build
What are additional risk factors for osteopo?
hormonal- early menopause, absence of menses
dietary- low calcium, excess sodium, high caffine?
lifestyle- sedentary, smoking, alcohol
Concurrent illness- RA, CVA, parkinsons, spinal cord injury
What endocrine disorders can be risk factors?
hyperparathyroidism, hyperthyroidism, male hypogonadism
What medications can be risk factors for osteopo?
if taken longer than 6 months
corticosteroids- pt feels better but bone weak as it strips bone of Ca+
immunosuppressants, anticoagulants
antacids with aluminum- AL replaces Ca in bone
What organic compound is scaffold for bone?
collagen contributes to bones flexibility and tensile strength
resist twisting and stretching
What inorganic compound?
calcium phosphate gives bone hardness which resists compression
What two things equal bone strength?
bone quality and bone density (BMD)
What are prime years for bone deposition?
birth to 30
What two hormones are important in bone health
parathyroid hormone and Calcatonin
Why is PTH?
in early osteoporosis HYPER-PTH will remove Ca from bone in put into bloodstream
activates osteoclasts to break down bone
Why calcitonin?
coming from thyroid gland it will counteract PTH
leads to building of bone
What vitamin is important for bone growth?
Vitamin D
allows for reabsorption of Ca through small intestines
Why is Wolff’s law so important to osteoporosis prevention or healing?
bone grows and remodels in response
it is important as PT to walk a fine line between good stress and bad stress
What two ways can stress be provided?
Gravity- weight bearing
muscle pull- activity or exercise
So why does osteoporosis occur?
- low calcium and possibly magnesium intake
- decreased estrogen- decreases sensitivity of osteoclasts to PTH
- inactivity- wolff’s law
- smoking- tobacco has anti estrogen effect leading to bone resorption
- Diet high in phosphorus- same affect as AL
What are clinical manifestations of osteoporosis?
often silent- major problem
usually discovered with fx ( femur, humerus, vertebrae, distal radius)
can cause radicular symptoms due to bone collaspe
How to diagnose osteopo?
Bone density measures
- dual energy xray
- ultrasound
- CT scan- sees bone better than MRI and Xray
- lab tests- calcium levels, phosphate
What is an osteoporotic posture?
kyphosis in Thoracic region
weight moves to anterior portion of IV discs bc thinner
head moves forward to compensate with can shut off blood flow to brain (OTN)
How to manage osteoporosis?
reduce risk factors, nutrition is huge (calcium and magnesium)
PT management of osteopo?
education
exercise- wolffs law balance
focus on back extensors for posture
What type of medications can be used for osteopo?
- bisphosphonates
- hormone replacement therapy
- calcitonin
What is osteomalacia and rickets?
disorder where there is insufficient mineralization of bone matrix, resulting from calcium or phosphate deficiency
rickets- bowed femurs
Risk factors for osteomalacia and rickets?
lack of vitamin D
this leads to hypocalcemia which will then activate increased PTH secretion taking Ca out of bone
Clinical Manifestations of osteomalacia and rickets?
bone pain and tenderness, softening of cranium in children, proximal myopathy (waddling gait due to weak glute med and max
Management of osteomalacia and rickets?
address cause, increased vitamin D and calcium
PT- joint protection, progressive loads, positioning
What is osteomyelitis? (OM)
mostly a bacterial infection of bone- Staph aureus most common
can be viral, parasitic or fungal but less common
What are two types of OM?
exogenous and endogenous (hematogenous)
What is exogenous OM?
occurs from outside of body (cut in skin, surgery, open fracture)
soft tissue to bone
What is endogenous OM?
occurs from inside body and is harder to diagnose
from ear infection etc.
What is acute OM?
looks very inflammed
either exo or endo with infection lasting less than one month
What is chronic OM?
low level infection, usually an extension from acute case, last more than 4 weeks
Pathophysiology of OM?
if invading pathogen is in bone then there is an inflammation response in bone
this can cause part of bone to be cut off from blood supply
can lead to necrosis of bone if infection not caught and treated in time
Clinical manifestations of OM?
warmth, swelling, tenderness, delayed pain
fever present in more endogenous OM
infection will go from local to systemic effects as time goes on
Diagnosis of OM?
Lab values of WBC count, imagining
Treatment of OM?
acute- antibiotics
chronic- cut bad part of bone out, hyberbaric chamber to help fight infection
PT implications?
universal precautions, clarify WB precautions, use vitals and lab results to guide exercise progression
What is osteonecrosis? (ON)
death of bony tissue as result of lack of blood supply
common in 20-50 year olds
Common sites for ON?
femoral head ( Bo jackson) scaphoid, talar dome, lunate, proximal humerus
Pathogenesis of ON?
compromise of precarious blood supply
causes flattening collapse of femoral head, common to be bilateral and with repeated traumas
Causes of ON?
idiopathic- genetic
trauma- sports?
associated with steroid use and high alcohol intake
sickle cell anemia- cuts off blood flow to distal areas
Clinical manifestations of ON?
pain, loss of motion, painful or antalgic gait, degenerative changes
Intervention of ON?
activity modification
surgical- create microtraumas or total joint replacement to increase blood flow to joint
