Musculoskeletal 4

Question 1

Osteochondroses

Answer 1

Group of disordrs that impact the growing (pediatric) skeleton

Question 2

General info on Osteochondroses

Answer 2

Growth plate injury by:
- Abnormal growth
- Injury
- Overuse

Diminished blood supply
- Avascular necrosis

Patients may present with pain and related diminished function

Question 3

Osteoporosis

Answer 3

Reduced bone mass leading to fragile and fracture prone bones

Question 4

Types of Osteoporosis

Answer 4

Primary and Secondary

Question 5

Primary Osteoporosis

Answer 5

Associated with Aging
- reach peak bone mass in 3rd-4th decade, steady 0.5% decline after that
- post menopausal state accelerates process
- more common in females

Question 6

Secondary Osteoporosis

Answer 6

• Metabolic Diseases
• Vitamin Deficiencies
• Drug Exposure

Question 7

Osteoporosis

Answer 7

Reduced Bone density but normal Osteoclastic activity

Question 8

Morphology of Osteoporosis

Answer 8

Thinned Cortices
- Dilated Haversian Canals

Question 9

2 types of osteoporosis

Answer 9

a) Postmenopausal
b) Senile

Question 10

Postmenopausal Osteoporosis

Answer 10

Trabecular Bone loss is severe
- compression fractures
- Collapse of vertebral bodies

Question 11

Senile Osteoporosis (both M & F)

Answer 11

• Cortical bone loss is prominenet
• Fracture of weight bearing bones (femoral neck)

Question 12

Primary causes of Osteoporosis

Answer 12

1) Aging
2) Postmenopausal State
3) Physical Activity
4) Genetic Influences
5) Calcium Nutritional State

Question 13

Secondary causes of osteoporosis

Answer 13

• Cortical Steroid Therapy
• Smoking
• Alcohol

Question 14

Osteoporosis cause: Aging

Answer 14

Lower osteoblastic activity, normal osteoclast function

Question 15

Osteoporosis cause: Postmenopausal State

Answer 15

• Estrogen drops –> increased IL-1, IL-6, TNF production
• stimulates RANK-RANKL activity (inc’d osteoclast activity)
• Suppress OPG (osteoprotegrin) - OPG protects from bone resorption by binding to RANKL

Question 16

Osteoporosis causes: Genetic Influences

Answer 16

Vitamin D receptor polymorphisms influence peak bone density

Question 17

Osteoporosis most common vertebral fractures

Answer 17

Thoracic and lumbar

Question 18

Osteoporosis: Fractures of femoral neck spine and pelvis lead to

Answer 18

Fat Embolism

Question 19

Osteoporosis Diagnosis

Answer 19

• Fracture (radiograph doesnt show until 30-40% loss of bone mass
• Specialized radiographic techniques

Question 20

Prevention of Osteoporosis

Answer 20

• Calcium intake
• Vit D supplementation
• Regular Exercise (before 30) to max peak bone mass

Question 21

Treatment

Answer 21

Anti-resorptive agents (none are good options)
- bisphosphonates
- Denosumab
- Estrogen
- Calcitonin

Question 22

Why is it bad to supplement with estrogen for postmenopausal state osteoporosis where estrogen is lowered?

Answer 22

leads to cardiac events