MSK 2 Flashcards
What are 4 causes of arthritis?
(1) DJD (degenerative)
(2) Rheumatoid
(3) Post-traumatic
(4) Post-infection
What are 5 modifiable local risk factors of DJD/OA?
(1) Muscle strength
(2) Physical activity/occupation
(3) Joint injury
(4) Joint alignment
(5) Leg length inequality
What are 3 modifiable systemic risk factors of DJD/OA?
(1) Obesity
(2) Diet
(3) Bone metabolism
What are 4 non-modifiable systemic risk factors of DJD/OA?
(1) Age
(2) Sex
(3) Genetics
(4) Ethnicity
What is one of the strongest predictors of OA?
Age
Are men or women at a higher prevalence and severity of OA?
Women
What are 3 facts of the quadriceps femoris?
(1) primary antigravity muscle of the lower limb (2) absorbs limb loading (3) provides dynamic joint stability
___ rupture is one of the most important knee injuries seen in the context of OA.
ACL rupture is one of the most important knee injuries seen in the context of OA.
What is one of the strongest predictors of knee OA progression?
Knee malalignment
Medial progression of knee OA 4x more likely in individuals with ____ alignment, and lateral progression is 5x more likely in individuals with ____ alignment.
Medial progression of knee OA 4x more likely in individuals with varus alignment, and lateral progression is 5x more likely in individuals with valgus alignment.
In varus alignment, stress is on the ___ side.
In varus alignment, stress is on the medial side.
In valgus alignment, stress is on the ___ side.
In valgus alignment, stress is on the lateral side.
What are 6 tx options for arthritis?
(1) Pain control
(2) Physical therapy
(3) Assistive devices
(4) Viscosupplementation
(5) Surgery (arthroplasty, osteotomy, bracing)
(6) Risk factor modification (weight management, muscle strengthening)
What is the first line tx for mild or moderate pain?
Acetaminophen (+ topical analgesics PRN)
If conservative therapy and acetaminophen fail to control pain, or if there is inflammation, what are your next 2 tx options?
(1) NSAIDs
(2) viscosupplementation
What are the 2 topical analgesic used in arthritis tx?
(1) Diclofenac Gel
(2) Capsaicin
What is the role of narcotics in arthritis tx?
Short term use in exacerbations (minimal role)
Define osteoporosis.
skeletal disorder characterized by a loss of bone matrix that reduces bone integrity, resulting in an increased risk of fractures
Differentiate osteoporosis from osteomalacia.
Osteoporosis: bone matrix and mineral both decreased
Osteomalacia: bone matrix intact, mineral decreased
What are the 3 key cells of bone tissue and what do they each do?
(1) Osteoblasts: synthesize the bone matrix and are responsible for its mineralization *blasts build
(2) Osteocytes: inactive osteoblasts that have become trapped w/in the bone they have formed *structural support
(3) Osteoclasts: break down bone matrix through phagocytosis *clasts breakdown
What are 8 etiologies of osteoporosis?
(1) Hormone deficiency (estrogen-W, androgen-M)
(2) Hormone excess (Cushing syndrome or corticosteroid admin, thyrotoxicosis, hyperparathyroidism)
(3) Genetic disorders (Aromatase deficiency, collagen disorders, Ehlers-Danlos syndrome, homocystinuria
(4) Alcoholism
(5) Immobilization and microgravity
(6) Inflammatory bowel disease
(7) Malignancy, especially multiple myeloma
(8) Tobacco
What are 8 medications etiologies of osteoporosis and what is the effect of each?
(1) Heparin anticoags: reduces bone formation
(2) Anticonvulsants: increases bone turnover, decreasing bone density
(3) Glucocorticoids
(4) Chemotherapeutics: changes d/t chemo and radiation induced hypogonadism
(5) Psychotropics: inc fx risk
(6) Narcotics: inc fx risk
(7) Barbiturates: inc fx risk
(8) PPIs: dec Ca absorption
Osteoporosis is often asymptomatic until _____.
Osteoporosis is often asymptomatic until fracture occurs w/relatively light activity.
What type of fractures lead to thoracic kyphosis?
Successive vertebral compression fractures
What is DXA used to determine?
Used to determine the bone density of the lumbar spine, hip, and distal radius
What 3 groups of pts are at risk for osteoporosis?
(1) postmenopausal women (2) men over age 70
(3) younger pts w/pathologic fxs or radiographic evidence of diminished bone density
What is a T score?
Pt’s bone mineral density as compared to gender and ethnicity matched young adult
What T score is indicative of osteoporosis? Severe osteoporosis?
Osteoporosis =T score < -2.5
Severe= T score < -2.5 with fracture
What is a Z score?
Pt’s bone mineral density as compared to age, gender, and ethnicity matched peer
Differ from T score by including age-match!
What can DXA not distinguish b/w?
Cannot distinguish osteoporosis from osteomalacia
DXA overestimates BMD in ____ pts, and underestimates BMD in ____ pts.
DXA overestimates BMD in taller pts, and underestimates BMD in smaller pts.
What vitamin deficiency is common in osteoporosis?
Vitamin D
What are 7 tx options of osteoporosis?
(1) Adequate dietary calcium and Vit D
(2) Weight-bearing exercise
(3) Calcium and Vit D supplements
(4) Bisphosphonates
(5) Calcitonin
(6) Estrogens
(7) Selective estrogen receptor modulators
What level of calcium should be taken daily in osteoporosis tx?
> /=1,200 mg/day
What level of Vit D should be taken daily in osteoporosis tx of pts 50+?
800-1,000 IU/day
What is the first line pharm tx for osteoporosis?
Bisphosphonates
What is the MOA of bisphosphonates, and what are you concerned about b/c of this?
They inhibit osteoclast activity, allowing osteoblasts to work more effectively; d/t inhibiting osteoclast activity, they are getting set up for stress fractures (bisphosphonate insufficiency fracture)
What are the 2 tx options for bisphosphonate insufficiency fractures?
(1) protected WB
(2) prophylactic IM rodding
