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Pathophys Exam I > MSK Mod 1B > Flashcards

MSK Mod 1B Flashcards

1
Q

what are included in the cellular componene of connective tissue

A

fibroblasts, osteocytes, chondrocytes

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2
Q

the extracellular matrix is made up of 2 componenets

A
  1. non-fibours componenet

2. fibrous componenet

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3
Q

what is the nonfibrous component of the extracellular matrix os connective tissue

A

usually gel-like substance “ground substance”

-ex. proteoglycans, glycoprotein, minerals

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4
Q

what is the fibrous component of the extracellular matrix of connective tissue

A
  1. collagen - provides tensile strength

2. elastin - provides elastic properties

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5
Q

function of osteoblasts

A

formation of new bone

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6
Q

osteoblasts produces what

A

type 1 collagen and non mineralized bone matrix (osteoid) into immediate area surrounding osteoblast

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7
Q

osteoblasts facilitates

A

mineralization (calcification) of osteoid to complete the process

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8
Q

once the surround bone matrix (osteoid) is mineralized the osteoblast is now referred to as an

A

osteocyte

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9
Q

osteoblasts also produce substances that do what? (other than type 1 collagen)

A

regulate balance of bone formation/resorption

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10
Q

osteoblasts are located along

A
  1. trabecular surfaces (cancellous or spongy surface)
  2. inner surface of haversian’s canal
  3. inner surface of the periosteum (active bone formation)
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11
Q

osteocytes are formed from

A

osteoblast

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12
Q

the small cavity the osteocyte is located in is known as

A

lacunae

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13
Q

osteocytes make up how much of cells in mature human skeleton

A

90%

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14
Q

osteocytes blood supply

A

via small capillaries located and are a functionally active cell of bone

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15
Q

3 functions of osteocytes

A
  1. stimulate remodeling process of bone
    serve as sensory mechanism for mechanical stimulus to bone
  2. mantain homeostasis of the mineralized (calcificaation) bone
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16
Q

how do osteocytes stimulate remodeling process of bone

A
  1. directly signal steps in bone remodeling

2. assist by secreting enzymes to dissolve surrounding mineralized bone to prepare for bone remodeling

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17
Q

how do osteocytes maintain homeostasis of mineralized bone

A
  1. osteocytes synthesize molecules to assist with bone calcification
  2. osteocytes receive nutrients from the capillary blood supply which are needed to maintain mineral homeostasis
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18
Q

where are osteoclasts located

A

Howship’s lacunae

- depressions seen in microscopic view that represent areas of bone resorption

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19
Q

function of osteoclast function

A

resorption of bone

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20
Q

how do osteoclasts resorb bone

A
  • break down bone allowing release of calcium into blood stream
  • break down/resorption of inferior (poor quality) bone or surplus bone
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21
Q

osteoclast mechanism of bone resorption

A
  1. osteoclast secrete acid and lytic enzymes to breakdown and dissolve surrounding bone
  2. osteoclasts have microvilli (brush border) projecting out from cell
  3. elements of bone are resorbed into the osteoclast at he base of the microvilli
  4. the osteoclast eventually release the bony elements in the capillaries to allow the elements to be recycled into new bone at a different site
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22
Q

in different pathologies like metastatic bone dz and multiple myeloma - what is responsible fore the bone loss

A

osteoclast activity

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23
Q

what are collagen fibers

  • how many types
  • synthesized/secreted by
  • arrangement
A
  • part of the matrix component of bone
  • 14 different types ID’d in body
  • synthesized and secreted by osteoblasts
  • fibers are arranged in fibril network allowing resistance against tensile and compressive forces
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24
Q

what type of collagen accounts for 90% of collgen in bone

A

Type 1

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25
Q

role of type 1 collagen in bone

A

responsible for tensile strength of bones as well as weight bearing (comrpressive) sterngth)

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26
Q

what are proteoglycans

A
  • large polysaccharides attached to protein
  • located bw collagen fibers of bone
  • arrangement and location bw collagen fibers also assist in resisting compressive strength of bone
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27
Q

function of proteoglycans

A

play a role in calcification/fluid balance by attracting calcium (via ion exchange)

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28
Q

what are BMP’s

A

bone morphic proteins

-many types: BMP-2, BMP-6, BMP-9

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29
Q

function of BMP’s

A

promote formation of osteoblasts from stem cells, osteogenesis in osteoblasts

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30
Q

clinical application of BMPs

A

pharmaceutical intervention strategies for difficult/poor fracture

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31
Q

all connective tissue is composed of what two things?

A

cellular componenet and extracellular matrix

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32
Q

what are glycoproteins

  • found where
  • examples
  • function
A

many glycoproteins found in the found in bone

  • ex. sialoprotein, laminin, osteonectin, alpha-glycoprotein
  • function: assist in collagen fiber formation, may assist in calcification
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33
Q

what is osteocalcin

A

produced by osteoblasts (part of communication bw osteoblasts and osteoclasts
-function: promotes osteoclast activity therefore promotes bone resorption

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34
Q

what is the function of bone albumin

A

attracts fluid and maintains fluid balance in bone

transports hormones, ions and other metabolites to/from bone cells

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35
Q

examples of growth factors

A

aka cytokines
-transforming growth factor (TFG-beta), TFG - alpha, insulin growth like factor (IGF-1), tumor necrosing factor (TNF), interleukins, interferon-gamma

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36
Q

function of growth factors

A

play role in differentiation, acitivation, growth and turnover of bone (and other tiessue)

-ex. IGF-1 affects all cells of body & involved in stimulus f long growth (facilitates signaling of GH)

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37
Q

what is an example of bone minerals

A

calcium hydroxyapatite(HAP)

  • end stage of calcium crystallization for mineralization (calcification)
  • the HAP is an insoluble crystal that deposits within the collagen fibers
  • physical characteristics account for the compressive strength of bone
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38
Q

what is a BMU

A

bone multicellular unit

  • cluster of cells that breakdown an area of the bone surface and then fills it with new bone
  • multiple BMU clusters are activated/ inactivated at any given point in time and in different locations on a bone
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39
Q

bone remodeling steps

A
  1. originiation/activation of BMU
  2. initiation of osteoclastic acitivity
  3. resorption forms small cavity
  4. osteoblast maturation/recruitment
  5. osteoid formation
  6. mineralization/maturation of osteoid
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40
Q

bone remodeling steps - origination/activation of BMU

A

osteocytes will signal the start of BMU acitivity

  • stimulus - mechanical stress, trauma, cytokines/hormones or may occur at random
    ex. PTH, IGF, IL-1, IL-6, PGE, calcitriol, TNF, NO
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41
Q

bone remodeling steps - initiations of osteoclastic activity

A

pre-osteoblasts are formed and produce RANK-L

  • RANK-L signal pre-osteoclasts to mature into active osteoclasts
  • OPG (osteoprotogerin inhibits this step) - OPG is produced by mature osteoblasts
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42
Q

beon remodleling steps - resorption forms small cavity

A

the osteoclast continues to resorb bone for about two weeks

eventrually undergo pre-programmed death (apoptosis)

43
Q

clinical application of bone remodeling - resorption forms small cavity

A
  • estrogen and calcitonin inhibit this step and slow resorption
  • post menopausal estrogen deficiency prolongs resorption and allows osteoclast to keep breaking down bone
  • acidosis promotes osteoclast resorption
44
Q

bone remodeling steps - osteoblast maturation/recruitment

A

hormone, proteins and other substances promote osteoblast maturation/activity
ex. PTH, Wnt, BMPs, IGF, FGFs, PDGFs,calcitriol, Runx2, GST-RANK-Ligand, TGF-beta

45
Q

bone remodeling steps - osteoid formation

A

active osteoblasts secrete collagen and otehr compenents of bone matrix

46
Q

bone remodeling steps -mineralization/maturation of osteoid

A

calcium, phosphate and other ions are necessary for mineralization of osteoid

  • calcium is crystallized in stages
  • calcium hyroxyapatite (HAP) is final crystallized form that binds to the collagen fibers
47
Q

bone remodeling is dependent on what two acitivites

A

osteoblast activity coupled with osteoclasts activity

48
Q

the balance bw osteoblats and osteoclasts determines what

A

formatin/shape of new bone

49
Q

what are new strategies for pharmaceutical intervention to target slow bone loss

A

the communicator molecules (cytokine and proteins) bw osteoblasts and osteoclasts

50
Q

metaoblic disordres of bone

A
  1. osteoporosis
  2. osteomalacia
  3. Paget’s dz of bone
51
Q

examples of osteochondroses

A
  1. osteonecrosis (avascular necrosis)

2. apophysitis (epiphysitis)

52
Q

4 types of pathologies of bone

A
  1. metabolic disorders of bone
  2. osteochondroses
  3. infection of bone
  4. tumors of bone and related tissue
53
Q

what is osteopenia

A 
low BDM (bone mineral density) but not severe enough to be considered osteoporotic
-BMD of more than 1SD but thess than 2.5 SD
54
Q

what is osteoporosis

A

severe decrease in BMD

- BMD value of 2.5 SD or more below adult mean

55
Q

what is Osteomalacia

A

softening of bone

56
Q

what is osteopetrosis

A

increased BMD

57
Q

osteoclastic activity vs osteoblastic activity in osteoporosis

A

clastic>blastic

58
Q

bone density values defined by WHO

A

normal >833mg/cm3
osteopenia = 833-648 mg/cm3
osteoporosis =

59
Q

2 classificatinos of osteoporosis

A
  1. primary

2. secondary

60
Q

what is primary osteoporosis

A

generalized decreased bone density unrelated to any underlying dz or condition

61
Q

two types of primary osteoporosis

A

type 1 - post-menopausal - affects cancellous bone

type 2 - age related; typical in pts >75yo; will see both cancellous and cortical bone loss

62
Q

what is secondary osteoporosis

A

bone density loss secondary to med or dz

63
Q

3 phases of bone mass

A
  1. growth phase
  2. consolidation phase
  3. involution phase
64
Q

what is the growth phase of bone mass

A

continues until growth plates are closed

90% of bone density is reach in growth phase

65
Q

what is the consolidation phase of bone mass

A

bone density continues to increase until reaches peak bone mass
-remaining 10% of bone density occurs during this phase

66
Q

what is the involution phase of bone mass

A
  • gradual loss of bone density is multi-factorial

- normal and pathological causes

67
Q

what is peak bone mass

A

PBM

  • bone formation occurs at faster rate than bone resorption
  • peak bone mass is commonly reached by 30 yrs of age
  • short plateau of peak bone mass - approx 3-5 years
  • clinical poor dietary/exercise lifestyle in teens/20s result in lower peak bone mass
68
Q

what is the involution phase

A

bone loss

69
Q

what is age related bone loss

A

normal bone loss with age

70
Q

bone loss in men/women usually begins at what ages

A

35-40yo following a short plateau of bone density furing early 30s

71
Q

rate of age related bone loss

A

age related bone density loss if fairly equal bw male and female
men start out a higher PBM so don’t reach osteoporotic level as soon as women

72
Q

post menopausal bone loss

A

rate of bone loss in women is accelerated after menopause
-d/t decreased estrogen levels associated with post menopause causes increased rate of bone density loss
(estrogen has a protective effect on bone density)

73
Q

during 1st decade of menopause & rate of bone loss

A

bone loss accelerates during 1st decade

  • rate of loss may increase to 3-5% / year
  • 15% of total bone mass may be lost during 1st decade post menopause
  • this is approx 40-50% of the total expected lifetime bone density loss of a female
  • rate gradually slows down after 1st decade
74
Q

pathogenesis of osteoporosis - post-menopause

A
  • estrogen loss disrupts RANK-L with reduced levels of OPG

- clinical: drug - raloxifene stimulates OPG production

75
Q

regions of bone loos in post menopausal osteoporosis

A

most significant in cancellous (trabecular) bone

-vertebra, metaphysic of long bone (wrist and femur comon fx sites)

76
Q

pathogenesis of osteoporosis - age related bone loss

A

numerous age related factors suggest to contribute

  • decreased GH and IGF levels
  • decreased androgens
  • increased RANK-L and inhibited OPD
  • lifestyle - poor nutrition and inactivity = osteocytes are stimulated with mechanical stress
  • poor vitamin D calcium and other nutrients
77
Q

meds that can cause bone loss

A

corticosteoids and immunosuppressants can alter RNKS-L and OPG balance

78
Q

other metabolic/systemic disorders that can cause bone loss

A

RA, metastatic cancer also alter RANK-L and OPG balance

79
Q

which type of bone is more sensitive to conditions that alter osteoblast and osteoclast acitivity trabecular or cortical bone?

A

trabecular bone - large surface are and not large bone mass to begin with compared to cortical bone

80
Q

which type of bone has a larger percent of bone loss, trabecular or cortical?

A

trabecular

81
Q

which type of bone is more sensitive to post menopausal bone loss, trabecular or cortical

A

trabecular

82
Q

bone loss patterns - women - % of each type of bone that is lost

A

35-50% of trabecular bone mass

25-30% of cortical bone mass

83
Q

bone loss patterns - men - % of each type of bone that is lost

A

15-45% of trabecular bone mass

5-15% of cortical bone mass

84
Q

osteoporosis risk factors

A
  1. hormonal status
  2. physical inactivity
  3. genetics/ethnicity
  4. meds
  5. tobacco
  6. alcohol
  7. diet nutrition
85
Q

how is hormonal status a osteoporosis risk factors

A
  • post menopausal women have decrease estrogen levels
  • 5-8 years after menopause women have accelerated bone loss rate (greater than 1% per year)
  • HRT most effective during this time period
  • men have much more gradual loss of testosterone thus have slower steady rate bone loss
86
Q

how is physical inactivity a osteoporosis risk fact?

A
  • throughout all phases of lifespan

- low activity in aage groups

87
Q

-peak bone mass and loss has predetermined rates that will vary bw indviduals
-ethinic groups appear to have differences
how are meds osteoporosis risk facotrs

A
  • steriods
  • large loss occurs during first 6monnths of use then rate slows
  • they impaire osteoblast and incresae osteoclast acitvity
88
Q

how is tobacco an osteoporosis risk factor

A

imparis bone progenitor cells thus inhibiting osteobalstic activity

89
Q

how is alcohol an osteoporosis risk factor

A

impairs osteoblast activity

-also imparis calcium absorption and increas renal excretion of calcium

90
Q

how are diet and nutrition osteoporosis risk factors

A
  • low calcium intake in growing years

- anorexia/bulimia in females - amenorrhea & reduced estrogen

91
Q

what is the female triad

A

eating disorder, amenorrhea, osteoporosis

92
Q

osteoporosis evaluation

A

BMD tesets

93
Q

what are BMD tests

A

-statistical technique to measure the number of standard deviations from the population average

94
Q

calssifications of osteoporosis

A

normal: BMD: 1SD but 2.5 below the young adult mean

95
Q

types of BMD tests

A
  1. dual energy xray absorptiometry (DEXA)
    - gold standard
    - DEXA along does not help ID individuals who have greater risk of fx’s
  2. single photon absorptiometry
  3. dual photon absorptiometry
  4. quantitative US
  5. CT
  6. plain film xray = POOR SCREENING TOOL - only detects bone loss after significant loss has occurred
96
Q

what is the WHO online fx risk

A

FRAX

97
Q

what is osteomalacia

A

insufficient mineralization of bone

-no loss of bone, matrix just doesn’t mineralize

98
Q

etiology of osteomalaica

A

poor nutrition - poor vit D intake

  • intestinal dz that imparis absorption
  • renal dz
  • meds
  • tumors
99
Q

osteomalacia on x=-ray

A

Looser’s zones or milkman’s pseudo fractures = lesions composed of poorly mineralized osteoid matrix and are not true fx’s or stress fractures. oriented perpendicular to the long axis of the bone; bowing of long bones

100
Q

what is rickets

A

childhood osteomalacia

101
Q

what is Paget’s Dz of bone

A

results in bone deformation with associated complications
onset >50 yo
M>F (8:1)

102
Q

pathology of paget’s dz

A
  • distortion of bone resorption and formation of trabecular bone
  • communication bw osteoblasts and osteoclasts are altered
  • excessive resorption is followed by excessive bone formation
    result: enlarged deformed bone of poor quality; disorganized collagen fibers, poor mineralization
103
Q

potential complications of Paget’s dz

A
  1. fx
  2. deformity
  3. arthritis
  4. nerve dysfunction
  5. pain

Pathophys Exam I (9 decks)

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