Musculoskeletal Osteoporosis and Fractures (Exam 4) Flashcards
Gender and Bone Mass
Women experience greater bone loss in early postmenopausal years
Women have a lower peak density so they reach the fracture threshold earlier
By age the 30 the amount of bone reabsorbed by osteoclasts is __________ than bone formed by osteoblasts
greater
Osteoporosis Definition
Bone mineral density 2.5 standard deviations below peak bone mass
Low bone density
Osteoporosis is measured with
Dexas scan
Results reported in a T-score
Normal T-score
-1 or greater
Osteopenia T score
-1 and -2.5
Osteoporosis and Severe Osteoporosis
< -2.5
It is severe when patient has history of fragility fracture (Patient fell and broke a bone)
Osteopenia
Thinning of the trabecular matrix of the bone before osteoporosis
T score( -1) - (-2.5)
Osteoporosis
Porous bone
Common yet serious disease
Osteoporosis is characterized by
Low bone density and structural deterioration of the bone
ACTUAL BREAKS in trabecular matriz have occurred
Osteoporosis most commonly appears in what bones?
Hips
Vertebrae
Wrists
Osteoporosis Characterisitics
Low bone mass
Micro - architectural deterioration (microscopic fractures)
Increase bone fragility leading to weak bones and fractures
Osteoporosis: Major RF’s
Aging (bone break down after 30)
Female (post menopausal women)
Caucasians
History fracture as adult
Family history and genetics (1 degree)
Body weight < 127
Smoking (bones cannot heal)
Alcohol use
Long term steroid use (inhibits osteoblast function)
Osteoporosis: Minor RF’s
Thin small frame
Lack of weight bearing exercises
Lack of calcium and or vitamin D
Eating disorders and gastric bypass surgery
Lack of estrogen/testosterone
Excessive Caffeine consumption
Osteoporosis Pathogenesis
Increased bone resorption (Breakdown) (Osteoclast activity increased)
Decrease bone formations (Osteoblast (builderd) activity decreased)
Problem can be: Failure to make new bone (Osteoblasts) Too much bone resorption (Osteoclasts)
Osteoclasts activity is increased
Osteoblast activity is decreased
Osteoporosis: Clinical Manifestations
Early and Late
Early: None
Late:
Fractures
Pain
Loss of height
Stooped posture (Kyphosis)
Complications of Osteoporosis: Hip Fractures
Hip fractures linked to increased risk of mortality.
2.8-4x greater risk of death
More common in women greater than 65
Dependent living is lost
Most common location of hip fracture related to osteoporosis
Proximal third of the femur
Hip fracture: Clinical Presentation
Sudden onset of hip pain before or after a fall
Inability to walk
Severe groin pain
Tenderness
Affected leg is externally rotated and shortened
Goal of Pharmacotherapy: Osteoporosis
Reduce fractures
Primary Prevention of Osteoporosis
Calcium supps
Vitamin D supps
Primary Treatment of Osteoporosis
Promote bone formation
Decrease bone resorption (most common)
Fractures
Any break in the continuity of bone that occurs when more stress is placed on the bone that is able to absorb
Fractures Causes
Traumatic (Fall) (Massive muscle contraction)
Fatigue (Repeated prolonged stress)
Pathologic (weakened bone in elderly) (Bone tumor) (Infection)
Closed vs Open Fractures
Open (compound)
-Fracture bone penetrates skin
Closed (Simple)
-Does not break through the skin
Know Fracture Orientations
Transevere: Most common seen in falls.
Spiral: Twist
Comminuted: More than one fracture line and more than 2 bone fragments (Compression)
Impacted: (Compression)
Greenstick: Incomplete break where the bone bends (most common in children)
Clinical Manifestations of fractures
Pain: At site
Edema: Inflammation to help stabilize
Deformity: Loss of function and abnormal mobility
PED
Phases of bone healing
- Hematoma
- Cartilage
- Callous
- Ossification
- Remodeling
Complication of Fractures
Delayed Healing
Bone growth impairment
Compartment syndrome
Fat embolism syndrome
Complication of Fracture: Delayed Healing
- Delayed Union
- Malunion
- Nounion
Fracture Complication Delayed Healing: Delayed Union
Bone pain and tenderness increase
-Tobacco use
-Old age
-Anemia
-Low Vitamin D
Fracture Complication Delayed Healing: Malunion
Improper alignment
Fracture Complication Delayed Healing: Nounion
No healing 4-6 months post fracture
Poor blood supply like DM and infection in the area. Repetitive stress
Complication of Fractures: Impaired Bone Growth
-Pediatric consideration
-Fracture through epiphyseal plate
-Can delay future bone growth
Complication of fracture: Compartment Syndrome
Seen with crush injuries or cast that are to tight
Results from:
Increase pressure within limited anatomic space. Compression of blood vessels and nerves
Compartment Syndrome: Tourniquet Effect
-Edema at fracture site puts intense pressure on soft tissue
-Can lead to tissue hypoxia of muscles and nerves
Compartment Syndrome: Manifestations
Edema (non pitting)
Loss or weak pulse
Extreme Pain
Compartment Syndrome Treatment
Fasciotomy to let edema ooze out
Complication of Fractures: Fat Embolism
Fat molecules in the lung following a LONG BONE fracture associated with a major trauma
Patient fine one min and the next min they can be in respiratory arrest
Fat molecules from bone marrow or trauma tissue is release into blood stream and travel to lung
Fat molecules will resolve on their own
Complication of Fracture: Osteomyelitis
An acute or chronic pyogenic (pus producing) infection of bone
Caused by Staph Aureus on the skin
Osteomyelitis: RF’s
-Recent trauma
-Diabetes
-Hemodialysis
-IV drug use
-Splenectomy
Osteomyelitis Direct Route of Contamination
(Un-Common)
Open wound
Open fracture
Gunshot
Puncture (Stabbing)
Surgery (Sternotomy)
Osteomyelitis Indirect Route of Contamination
(More Common)
-From blood stream (most common)
-Bacteremia
Osteomyelitis: Why is it problematic
Pressure increases within the bone causing local arteries to collapse
This decreases or eliminates supply of: O2 - Nutrition - Immune cells - Antibiotics can not get there
Leads to impaired healing
Osteomyelitis: Clinical Manifestations
Local and Systemic
Local:
-Tenderness - warmth - redness
-Wound drainage
-Restricted movement
-Spontaneous fracture
Systemic:
Fever
Postive blood culture
Increase WBC
Osteomyelitis Pharmacotherapy
Obtain blood culture
Nafcillin
Cefazolin
Vancomycin
Switch to bacteria specific therapy once blood culture comes back (IV for long time)
