Osteoporosis and painful limp Flashcards
Define osteoporosis
Reduced bone density
More fragile
Reduction of bone mass
Define osteomalacia
Reduced mineralisation (no calcium deposition) Causes bone softness
What causes osteoporosis?
Post-Menopause (low oestrogen)
Hypogonadism
Long periods of inactivity e.g. bed rest
Disorder’s of the adrenal glands
What causes osteomalacia?
Vitamin D deficiency
Premature babies
How would you diagnose osteoporosis (OP) and distinguish it from osteomalacia?
Bone density scan (DEXA)
T-score
How can people with osteoposis reduce the risk of falls?
Remodel their homes
- bath mats
- hand rails in bathroom
- stairlifts
What is the difference between clerking adults and children?
Patient might not be able to verbalise how/what they feel
Need to involve parents/ carers
Talk to a children in a way they understand
Greater emphasis on non-verbal signs
Be aware of parent/child interaction too
Why is the parent/child interaction important?
Child will act differently with parents
Parents can ‘translate’ for child
Watch for signs of abuse
- child is frightened
- different timelines for injuries
- child is withdrawn
What are important things to ask in a paediatric history?
How were they born? C-section, any birth complications?
When did they start walking?
Were their milestones on time?
History of development
Do their siblings have any issues?
What clinical signs are you looking for?
welling of the joint
Redness/ Heat
Pain
Examine movement of the joints and leg
Symmetry of the joints/legs
What are your initial differentials from the parent’s history?
Infection? Bacteria in the limb can cause osteoporosis
Fracture/ break
Synovitis- inflammatory factors in the joint
What investigations can you perform?
Blood test for inflammatory proteins e.g. CRP/ white blood cells
ESR marker of long term inflammation
X-ray to check for fracture
Joint fluid analysis: alteration to colour, consistency, volume and makeup of the fluid
Joint aspiration
Are there any diagnostic criteria to diagnose septic arthritis for the hip?
High fever> 38.5
ESR greater than 40mm per hour
Are they bearing weight on the joint
WBC count> 12,000 cells/mm^3
How will bacteria change the joint fluid and blood?
Alteration to colour, consistency, volume and makeup of the fluid
Raised ESR, CSP, WBC’s particulary neutrophilic
What are the different routes of spread of bacteria?
Infect the bone
Travel through blood
Directly via skin
