Week 4 - Osteoporosis and Arthritis

Question 1

What is peak bone density determined by?

Answer 1

• Genetics
• hormones
• physical activity
• nutrition

Question 2

What is osteoporosis?

Answer 2

• critically low bone mass and density with loss of bony matric and mineralization
• cortical bone becomes porous and thin
• trabecular bone loss

Question 3

Bone mass

Answer 3

the amount of bone tissue in the skeleton

Question 4

Bone density

Answer 4

mineral mass per unit volume of bone

Question 5

Primary osteoporosis

Answer 5

age related

Question 6

Secondary osteoporosis

Answer 6

due to another disorder or issue
- diseases associated with bone loss
- prolonged use of certain drugs
- immobility

Question 7

Osteoporosis pathophysiology

Answer 7

bone resorption > bone formation

Question 8

Estrogen and control of bone remodeling

Answer 8

• inhibits expression of RANK-L
• increases production of OPG
  result: inhibition of osteoclast formation

Question 9

OPG and control of bone remodeling

Answer 9

• decoy receptor
• blocks action of RANK-L by binding to it
• RANK-L cant bind to its receptor on osteoclast precursor cell
• Osteoclast differentiation is inhibited

Question 10

Osteoporosis signs and symptoms

Answer 10

• spontaneous fractures
• back pain from compression fractures
• abnormal spine curvature with loss of height

Question 11

Osteoporosis treatmetn

Answer 11

• dietary supplements
• pharmaceuticals
• estrogen replacement therapy

Question 12

Ways to diagnose osteoporosis

Answer 12

• bone mineral density testing
• fracture risk assessment

Question 13

Osteoporosis therapeutic goal

Answer 13

• prevent falls
• decrease fractures

Question 14

Osteoporosis exercise recommendations

Answer 14

• mod/vig aerobic exercise
• weight bearing activities
• resistance training
• exercises challenging balance and flexibility
• spine sparing strategies

Question 15

Osteoarthritis

Answer 15

• considered a disease of mechanical degeneration + inflammation of a synovial joint
• localized to affected joint
  -favors breakdown of cartilage

Question 16

Osteoarthritis pathophysiology

Answer 16

• something triggers chondrocytes to release degradative enzymes
• favors breakdown of cartilage
• small pieces of cartilage break off into the joint space
• cells of the synovium try to remove debris; immune cells recruited; cytokine secretion; inflammation of the synovium
• cracks form in the cartilage; synovial fluid enters and widens cracks
• no longer have smooth articular surface with even load distribution; bone is eventually exposed and rubs against articulating bone
• bone eburnation; osteophytes and cysts develop

Question 17

Osteoarthritis signs and symptoms

Answer 17

• weight-bearing joints
• asymmetrical, <4 joints
• stiffness at beginning and end of day; increases with activity
• Limited ROM
• enlarged joint that can harden as osteophytes develop

Question 18

Osteoarthritis treatment

Answer 18

• minimize stress placed on joint
• exercise, physiotherapy
• medications
• surgery to repair or replace

Question 19

Rheumatoid Arthritis

Answer 19

• chronic inflammatory disease - autoimmune
• exacerbations and remissions
• slow onset, usually symmetrical (begins with small joints in the fingers)
• severity based on # of joints affected, degree of inflammation, rapidity of progression

Question 20

Rheumatoid arthritis pathophysiology

Answer 20

• autoimmune response
• inflammation of synovial membrane; vasodilation, increased capillary permeability, immune cells recruited, cytokine release, exudate
• cytokines trigger synovial cells to proliferate
• forms a pannus
• pannus releases proteolytic enzymes and cytokines
• destruction of the cartilage
• pannus becomes more fibrotic over time
• nutrient supply in joint is cut off
• articulating bone exposed
• antibodies continue to activate inflammatory mediators

Question 21

What is a Pannus?

Answer 21

thickened and inflamed synovial membrane with granulation scar tissue

Question 22

What is visible on an x ray of rheumatoid arthritis

Answer 22

• narrowing of the joint space
• decreased bone density around the affected joints
• soft tissue swelling around the joint
• bone erosion

Question 23

Rheumatoid arthritis signs and symptoms

Answer 23

• 3+ joints affected, symmetrically
• begins in fingers
• morning stiffness; better throughout the day
• decreased ROM
• joint deformities with progression
• blood markers

Question 24

Rheumatoid arthritis blood markers

Answer 24

• elevated blood CRP
• elevated erythrocyte sedimentation rate (ESR)
• elevated rheumatoid factor

Question 25

Rheumatoid arthritis treatment

Answer 25

• “treat-to-target”
• symptom management
• multidisciplinary treatment to manage chronic pain and other symptoms
• OT, physiotherapy
• all exercise is safe

Question 26

Ankylosing Spondylitis

Answer 26

• chronic inflammatory disease
• affects vertebral joints; makes them stiff
• thought to be autoimmune + genetic predisposition

Question 27

Ankylosing spondylitis physiology

Answer 27

• inflammatory/immune response
• destroys the intervertebral, facet, and sacroiliac joints
• fibroblasts replace destroyed joints with fibrin
• eventually fibrous tissue ossifies through activation of osteoblasts

Question 28

Ankylosing spondylitis symptoms

Answer 28

pain and mobility depends on location

Question 29

Ankylosing spondylitis treatment

Answer 29

Meds, physiotherapy, OT, exercise to maintain/improve spinal mobility, postural and functional ability

Question 30

Bursitis

Answer 30

• inflammation of bursae
• due to repetitive strain or physical irritation

Question 31

Bursitis treatment

Answer 31

rest, cold, meds for pain and inflammation, physiotherapy, surgical drainage

Question 32

Synovitis

Answer 32

• inflammation of the synovial membrane within joints
• due to infection or gout, or sing of OA or RA

Question 33

Synovitis treatment

Answer 33

treat underlying cause

Question 34

Tendinitis

Answer 34

• inflammation of the tendons
• usually a repetitive strain injury

Question 35

Tendinitis treatment

Answer 35

rest, cold, meds for pain and inflammation, physiotherapy, surgery