Osteoarthritis and Osteoporosis

Question 1

What is the definition of osteoarthritis?

Answer 1

Non-inflammatory degenerative disorder of moveable joints –> Deterioration of articular cartilage and formation of new bone

Question 2

What trend is seen in OA with age?

Answer 2

Prevalence increases from cumulative effect of trauma and decrease in N-M function

Question 3

What are the main RF for developing OA?

Answer 3

1) Genetic predisposition
2) Trauma
3) Abnormal biomechanics (Hypermobile joints)
4) Occupation (Manual labour)
5) Obesity (Pro-inflammatory state)

Question 4

What are the most important cells responsible for OA?

Answer 4

Chondrocytes (Deterioration of cartilage)

Question 5

What are the main symptoms of OA?

Answer 5

1) Morning stiffness (<30 mins)
2) Pain increased by activity
3) Tenderness
4) Deformities
5) Joint swelling and bony enlargement
6) Walking and ADLs affected
7) Crepitus

Question 6

What radiological S/S are seen with OA?

Answer 6

1) Joint space narrowing
2) Osteophyte formation
3) Sub-chondral sclerosis
4) Sub-chondral cysts
5) Bone contour abnormalities

Question 7

Which parts of hands and knees are most commonly affected in osteoarthritis?

Answer 7

Hands: Distal I-P, proximal I-P and C M-C joints
Knees: Medial surface of the knee

Question 8

What is main method of investigating OA and what would surgical management involve?

Answer 8

INV: X-Ray looks for asymmetric loss of joint space --> Sclerosis, cysts and osteophytes
SM: Arthroscopy for loose bodies,
- Osteotomy (Changing bone length)
- Arthroplasty (Joint replacement)
- Fusion (Ankle and foot)

Question 9

What is the P and N-P management of OA?

Answer 9

P: NSAIDs, Paracetamol, Intra-Articular steroid injections and DMARDs
N-P: Education, Exercise, weight loss, physiotherapy, occupational therapy and walking aids

Question 10

What would “locking” for a patient mean in the case of OA?

Answer 10

Loose body causation (e.g. bone/cartilage fragment)

Question 11

How are loose bodies treated?

Answer 11

Arthroscopy

Question 12

What is osteoporosis?

Answer 12

Systemic skeletal disease shown by low bone mass and micro-architectural deterioration (^ fractural risk)

Question 13

What is the epidemiology and main factors for working out osteoporotic fracture risk?

Answer 13

^ w/ age with 50% women over 50 and 20% of men

1) Propensity to fall (Trauma)
2) Bone strength

Question 14

What are the main qualities of bone contributing to bone strength?

Answer 14

1) Bone mineral density
2) Bone size
3) Bone turnover rate
4) Bone micro-architecture
5) Mineralisation
6) Geometry

Question 15

What hormone affects bone turnover and how does this affect rate in women developing OP?

Answer 15

• Oestrogen: Controls osteoclast action
  Post-menopausal so less oestrogen and osteoclast action not inhibited (High bone turnover rate so more loss and higher chance of fracture)

Question 16

How does RA link to OP?

Answer 16

Inflammatory disease causes increase in IL-6 and TNF –> Increased bone resorption

Question 17

How does ageing contribute to micro-architecture seeing reduction in bone strength?

Answer 17

Trabecular thickness decreases, so fewer connections between trabecular and overall decrease in trabecular strength causing increased risk of fracture

Question 18

What 3 endocrine diseases can be responsible for osteoporosis?

Answer 18

1) Cushings: Cortisol sees increased bone resorption and osteoblast apoptosis
2) Early menopause: Male hypogonadism, less oestrogen/testosterone to control bone turnover
3) Hyperthyroidism and primary hyperparathyroidism (TH and PTH see increased bone turnover)

Question 19

What are the main risk factors for OP?

Answer 19

1) Previous fracture
2) FHx
3) Excessive alcohol and smoking
4) Immobility
5) Medications

Question 20

What investigation for suspected Op and what area is focused on as a result?

Answer 20

DEXA scan –> Lumbar spine and Hip

FRAX used for suspected osteoporotic fracture

Question 21

What is a T score and what do each of the different categories mean?

Answer 21

• Standard deviation compared to a gender-matched young adult mean
  OP

Question 22

What do anti-resorptive treatments do and what are 2 main examples?

Answer 22

Decrease osteoclast activity

1) Bisphosphonates
2) HRT

Question 23

What do anabolic treatments and anti-resorptive treatments do?

Answer 23

Ana: Increase osteoblast activity
AR: Decrease osteoclast activity

Question 24

What are advantages and disadvantages of HRT?

Answer 24

Adv: Reduce fracture risk, stop bone loss and prevent menopausal symptoms
DisAdv: Increases risks of breast cancer, stroke, CVD and thrombo-embolism