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MSK 1 > Unit 2 Bone Injury (fractures) and Osteoporosis > Flashcards

Unit 2 Bone Injury (fractures) and Osteoporosis Flashcards

1
Q

what are the functions of bone?

A

support structures and provide shape to the body
protect vital structures
allow movement and anchors for muscle
provide mineral storage
contribute to blood cell formation in the red marrow

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2
Q

Bone is a highly specialized ___ tissue and is ___ vascular.

A

connective; highly

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3
Q

Bone is able to ___ and ___ without breaking and can ___ impact.

A

deform; adapt; absorb

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4
Q

Bone is a dynamic tissue that undergoes constant ___ in response to ___ and ___ stimulation.

A

remodeling; mechanical and physiological

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5
Q

what is wolf’s law?

A

bones are organized to resist the load placed on them. the more resistance, the more they are going to remodel.

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6
Q

what are the risk factors for fracture?

A

history of fall or trauma, advancing age, female, BMI<25, decreased BMD, nutrition, hormonal factors, neoplasm, low PA level, smoking

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7
Q

what diseases cause insufficiency or fragility fractures?

A

osteoporosis; osteomalacia; rickets; hyperparathyroidism; hypogonadism, osteogenesis imperfecta; scurvy; Marfans syndrome/Ehlers-Danos syndrome; Paget disease; medications (corticosteroids, antirheumatics, anti-seizures)

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8
Q

what is an insufficiency/ fragility fracture?

A

makes bones especially fragile due to some physiological mechanism or insufficient to take stress of normal activity

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9
Q

what are the 3 phases of repair in bone healing? what are the timeframes for each phase?

A

inflammatory (several days), reparative (3-6 weeks), and remodeling (months to years)

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10
Q

Bone has ___ potential to return to optimal function?

A

good

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11
Q

By end of the first week following a bone injury what has occurs?

A

most of the debris has been removed and fibrosis and revascularization have started

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12
Q

Bone remodels in response to ___.

A

mechanical stresses

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13
Q

The end of the reparative phase is indicated by what?

A

stability on an x-ray: the fracture lines begin to disappear

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14
Q

what is occurring during the inflammatory phase of bone healing? what are the signs and symptoms of this phase?

A

hematoma formation and angiogenesis; fibrous union
pain, swelling, heat

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15
Q

what is occurring during the reparative phase of bone healing?

A

soft cartilage formation including calcification then cartilage removal and bone formation

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16
Q

what does the clinical presentation of a fracture include?

A

unusual pain after trauma
deformity of alignment
pain with WB or leading and/or tenderness at bone region
dull, deep ache; sharp and severe
edema and ecchymosis
if displaces, complete or large will see major loss of function
crepitus that is atypical, unusual, or unexpected

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17
Q

fractures may not show on a radiograph due to ___.

A

swelling

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18
Q

what signs and symptoms should a PT be suspicious of in relation to a fracture?

A

negative initial radiograph then no progression with therapy and history includes considerable trauma
pain response to US and/or tuning fork

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19
Q

what is included in primary fracture management?

A

ORIF
closed reduction internal fixation
external fixator (complicated fractures)
traction for realignment (halo)
bone lengthening procedures

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20
Q

what is included in secondary fracture management?

A

no intervention: activity restriction, brace, crutch, boot, sling
closed reduction and casting

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21
Q

what are some PT interventions done during an immobilization phase of the fracture?

A

transfer training, ADL’s, gait per MD order (WB status)

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22
Q

After immobilization mobility is important. What should a PT start with once cast/immobilizer is removed?

A

stretch/mobilize with short level ROM and joint mobilizations

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23
Q

what are the signs of infection following a bone injury?

A

redness, swelling, fever, hotness, loss of appetite, nausea

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24
Q

what are some negative predictors for normal bone healing? other complications?

A

smoking, diabetes, corticosteroids, EtOH, renal and vascular insufficiency
poor stabilization, damage to blood supply, infection

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25
Q

what is the healing prognosis for bone injuries in children?

A

4-5 weeks

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26
Q

what is the healing prognosis for bone injuries in adolescents?

A

6-8 weeks

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27
Q

what is the healing prognosis for bone injuries in adults?

A

10-18 weeks

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28
Q

what are stress fractures caused by?

A

crepe in the bone that results from cyclic or sustained loading

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29
Q

what are some risk factors that may lead to stress fractures?

A

repetitive high intensity exercise, history of amenorrhea, family history of osteoporosis

30
Q

what are the most common bones to see stress fractures in?

A

tibia, 2nd metacarpal, femoral neck, par interarticularis

31
Q

what is the clinical presentation of a stress fracture?

A

history-insidious onset with microtrauma
pain - cortical-local, trabecular-diffuse
does not improve with activity
tenderness to palpation

32
Q

what are some interventions for stress fractures?

A

rest/immobilization (NWB)
correct muscle imbalances and gait deviations
graduated return to training
promote shock absorption (shoes, modify surface)
orthotics PRN
train muscle endurance

33
Q

what is osteoporosis?

A

a chronic, progressive disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to decreased bone strength enhanced bone fragility and a consequent increase in fracture incidence

34
Q

what are the two types of osteoporosis?

A

primary: most common; most often in postmenopausal women
secondary: associated with other medical conditions or medications

35
Q

what does the World Health Organization classify osteoporosis as?

A

BMD T-score of -2.5 SD or less

36
Q

Bone strength is related to:

A

bone mass and other factors =, such as remodeling frequency, bone size and area, bone microarchitecture and degree of bone mineralization

37
Q

Cortical bone makes up __% of the resistance to compression.

A

75%

38
Q

why does osteoporosis occur?

A

imbalance of remodeling.
high bone turnover rate leads to weakening due to weaker trabecular/cancellous bone
new bone formation falls behind resorption due to declining osteoblast function

39
Q

at what age does bone mass peak?

A

mid-30s

40
Q

risk of fracture increases with __.

A

BMD loss

41
Q

what are the non-modifiable risk factors for osteoporosis?

A

> 50 y.o.
caucasian/asian
menopausal
family history of osteoporosis
depression
lactose intolerance

42
Q

what are the modifiable risk factors for osteoporosis?

A

inactivity, immobilization, sedentary lifestyle
excess EtOH, tabacco, caffeine
medications (steroids, immunosuppressants, anticoagulants)
low BMI, small body frame
diet (deficiency of Ca, Mg, Vitamin D, vitamin C)
eating disorders

43
Q

what are the secondary causes of osteoporosis?

A

renal insufficiency, cushing’s, hyperthyroid/hyperparathyroidism, type II DM, multiple myeloma, osteomalacia, Paget’s dz/osetogenesis imperfecta, GI malabsorption/celiac, mets to bone, SCI, stroke

44
Q

what are the major risk factors for osteoporotic falls?

A

body weight <70kg or BMI<21
corticosteroids
personal history of fractures as adult
first-degree relative with fragility fracture
current smoking

45
Q

what are the major risk factors for osteoporotic falls?

A

early menopause
nutrition
decreased activity
ETOH
impaired vision
dementia
poor health
recent falls

46
Q

what is osteomalacia?

A

softening of bones
disorder of mineralization of newly formed bone; causes weakness in bone and more prone to fracture.
caused by vitamin D deficiency and low blood phosphate

47
Q

what is osteopenia?

A

low bone mass
bone loss is not as severe

48
Q

what is osteoporosis?

A

decreased bone density (strength)
includes osteopenia but also includes a deterioration of bone tissue and decreased bone strength

49
Q

who should be getting BMD testing?

A

all women 65+
men >/= 70
younger postmenopausal women and men 50-70 with clinical RF’s
adults with fracture after age 50
adults with a condition or a medication a/w low bone mass
perimenopausal women with high-risk risk factors

50
Q

how often does medicare permit BMD testing?

A

every 2 years

51
Q

what is included in a general nutrition treatment for osteoporosis?

A

calcium, vitamin D (800-1000 IU), vitamin K, vitamin A (RDA of 700 micrograms), magnesium

52
Q

how can caffeine effect osteoporosis?

A

may reduce calcium absorption
some association with increased bone loss and fracture rates

53
Q

how does ETOH affect osteoporosis?

A

can suppress osteoblasts
moderate intake in women 65+ is associated with lower BMD and increased risk of hip fracture
heavy intake increases risks of falls and hip fractures

54
Q

what is included in pharmacological management for osteoporosis?

A

-antiresorptive: decreases the amount of bone that is lost (estrogrens/HRT, selective-estrogen receptor modulators, calcitonin, biphosphonates)
-anabolic PTH: builds up bone mass

55
Q

what are the effects of estrogens/HRT on osteoporosis?

A

-recommended for prevention only
-increases BMD
-decrease in hip, vertebral, and other osteoporotic fracture rates
-increased risk of CV events, venous thromboembolism, and breast CA
-decrease in colon CA

56
Q

what are SERMS (selective estrogen receptor modulators)?

A

-prevention and treatment of postmenopausal OP vertebral fracture risk
-daily oral dosing
-modest increase in BD of spine and hip; decreases bone turnover

57
Q

what are the side effects of SERMs?

A

hot flashes, leg cramps, increased VTE

58
Q

what is calcitonin used for? what are the side effects?

A

-treatment of postmenopausal only
-minimally inhibits bone resorption: possible analgesic effect for acute vertebral fx (acts directly on the osteoclasts which break down bone)
-nasal irritation, nausea, local inflammation and flushing

59
Q

how do bisphosphonates effect osteoporosis?

A

decreases risk of vertebral fractures or hip fractures with side effects that are not a major as other pharmacological treatments

60
Q

what is alendronate (fosamax) used for? what does it do?

A

prevention and treatment of male and postmenopausal OP
treatment of glucocorticoid-induced OP
inhibits osteoclasts, increased BMD

61
Q

what is risedronate (actonel) used for? what does it do?

A

prevention and treatment of glucocorticoid-induced, male, and postmenopausal OP
reduced risk of spine fracture by 41-49% and hip fractures by 36% over 3 years

62
Q

what is ibandronate (boniva) used for? what does it do?

A

prevention and treatment of postmenopausal OP
decreases risk of vertebral facture by 50% over 3 years

63
Q

what is zoledronate (reclast) used for? what does it do?

A

treatment of postmenopausal OP
reduced incidence of spine fracture by 70%, hip fracture by 41%, and non-vertebral fx by 25% over 3 years

64
Q

what is PTH: teriparatide (forteo) used for? what does it do?

A

treatment of high risk postmenopausal and male OP
anabolic: stimulated osteoblast activity -> increased trabecular bone density

65
Q

what are the non-pharmacologic intervention for osteoporsis?

A

exercise (strengthening muscles of back and legs), orthotics, gait training, pain management

66
Q

what exercises should be done with a patient that has osteoporosis?

A

weight-bearing, flexibility, strengthening (spine extension, chin tucks, scapular retraction, thoracic extension, hip extension), postural (prevent structural changes), balance

67
Q

what exercises would be contraindicated for osteoporosis?

A

spinal flexion exercises could lead to vertebral fractures

68
Q

what patient education should be given to patients with osteoporosis?

A

body mechanics
-avoid forward bending
-carry loads close to the body
-never twist with load
-sit up straight with knees level to hips
-change position every 30 min
-sleep with back straight
-log roll when getting out of bed

69
Q

what home environment adjustments are needed for safety with patient’s with osteoporosis?

A

non slip floors
lighting
nightlights
telephone access
electrical cords secured
grab bars
avoid rugs
clear walkways
handrails on stairs

70
Q

what is conservative treatment for management of vertebral fractures?

A

oral pain management
physical therapy

71
Q

what surgical treatment is done for management of vertebral fractures?

A

kyphoplasty and vertebroplasty (injecting cement which restores vertebral body height, can partially correct kyphosis, relieves pain)

MSK 1 (10 decks)

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