musculoskeletal (non-inflammatory) Flashcards
Information regarding diseases the affect the musculoskeletal system. Largely excluding inflammatory conditions (see Musculoskeletal inflammatory deck for more information).
definition of osteoporosis
a systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture
risk factors for osteoporosis
age parental history untreated menopause prolonged immobility BMI <19 rheumatoid arthritis >4 units alcohol/day reduced skeletal loading inflammatory disease endocrine disease smoking previous fracture medication
why does ageing increase risk of osteoporosis?
decrease in trabecular thickness
pathology of osteoporosis
loss of trabecular bone, crush fractures of vertebrae, loss of cortical bone (causing long bone fractures)
medications that cause osteoporosis
glucocorticoids
aromatase inhibitors
GnRH analogues
androgen deprivation
signs of osteoporosis
chronic pain
osteoporotic fractures
radicular pain (due to compression of spinal cord)
how many patients die within the first year of having a hip fracture?
20%
how do the results of a DEXA scan work for patients with osteoporosis?
they are given a T score, which is the standard deviation compared to average peak bone mass
primary causes of osteoporosis
menopause
old age
juvenile idiopathic
secondary causes of osteoporosis
drugs
smoking
alcohol
treatments of osteoporosis
weight bearing exercise balance exercise calcium and vitamin D rich diet bisphosphonates HRT calcitonin testosterone for men denosumab (anti-resorptive treatment)
how do bisphosphonates work in the treatment of osteoporosis?
stop osteoclasts working
how does denusomab work in the treatment of osteoporosis?
stops RANKL from activating osteoclasts so bone is not resorbed
it is a monoclonal antibody
what does a T score of less than -2.5 indicate?
osteoporosis
what does a T score of -1 indicate?
osteopenia
risk factors for mechanical lower back pain
poor posture
repetitive and fast work
heavy manual handling
what percentage of people recover from an acute attack of mechanical lower back pain within 6 weeks?
90%
risk factors for osteomalacia and rickets
vitamin D deficiency
anticonvulsant therapy
cancer
liver disease
what is rickets?
the result of osteomalacia during a period of bone growth
osteomalacia is if it is after fusion of growth plates
pathology of osteomalacia/rickets
mineral content of bone low
excess uncalcified osteoid and cartilage
signs of osteomalacia/rickets
femoral neck fractures
symptoms of osteomalacia/rickets
bone pain and tenderness
Proximal myopathy due to decrease in PO4 and vitamin D deficiency
diagnosis of osteomalacia/rickets from plasma
severe calcium depletion
increased phosphate ions
increased ALP (alkaline phosphatase)
decreased vitamin D
diagnosis of osteomalacia/rickets from biopsy
incomplete mineralisation
normal muscle
diagnosis of osteomalacia/rickets from XR
loss of cortical bone
partial fractures
treatment of osteomalacia/rickets
vitamin D
monitor plasma calcium
risk factors for vertebral disc degeneration
poor posture
repetitive and fast work
heavy manual handling
symptoms of vertebral disc degeneration
chronic back pain
radiating pain
tingling sensation in legs/arms
pain often worse when sitting
XR/MRI features of vertebral disc degeneration
black discs disc space narrowing vacuum disc end plate sclerosis osteophyte formation
features of vertebral disc degeneration on clinical examination
muscular weakness
limitations in motion
treatment for vertical disc degeneration
physical therapy NSAIDs traction epidural steroid injection surgery
risk factors for Paget’s disease
> 40
temperate climate
anglo-saxon
pathology of Paget’s disease
increased osteoblasts and osteoclasts –> extensive turnover –> extensive remodelling –> bony enlargement, deformity, and weakness
where does Paget’s disease typically affect?
axial skeleton
lumbar spine
symptoms of Paget’s disease
asymptomatic in 70%
deep boring pain
bony deformity
enlargement
complications of Paget’s diesase
spine pathological fractures
osteoarthritis
increased risk of osteosarcoma
XR signs of Paget’s disease
localised bone enlargement patchy cortical thickening sclerosis osteolysis deformity
blood test results for Paget’s disease
calcium and phosphate normal
ALP (alkaline phosphatase) raised
treatment of Paget’s disease
analgesia
alendronic acid
