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bone and joint pathology Flashcards

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1
Q

how does osteoporosis occur?

A

it is due to a decrease in bone mass

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2
Q

the decrease of bone mass seen in osteoporosis leads to what?

A
  1. bone reabsorption and destruction (occurs due to the osteoclast activity)
  2. bone formation (osteoblast activity)
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3
Q

the decrease in bone mass often leads to an increase in what?

A

the risk for fractures

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4
Q

what is a primary disorder

A

the diagnosis

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5
Q

what is a secondary disorder

A

due to another diagnosis

think metapause can cause osteoporosis

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6
Q

what is the epidemiology of osteoporosis

A

incidence of osteoporosis increases with age

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7
Q

what vitamins/ molecules are associated with osteoporosis?

A

calcium phosphate and collagen

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8
Q

The WHO criteria for osteoporosis is?

A

bone mineral density (BMD) at hip or spine > 2.5 SD bellow young normal mean reference population

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9
Q

The WHO criteria for osteopenia is ?

A

BMD 1.0 - 2.5 SD below young normal mean reference population

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10
Q

what are the stats associated with osteoporosis

A

-10 million in the USA with osteoporosis
33.6 million in the USA with osteopenia

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11
Q

At what ages is bone loss from osteoporosis seen in men and women?

A

women 1% per year after 30-35
50-55 for men

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12
Q

what is the correlation seen in bone loss and menopausal women?

A

accelerated loss in post metapausal women.
5% per year for 3-5 years

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13
Q

what is the red flag for PTs dealing with osteoporosis?

A

PT should avoid movements that can result in spinal fractures, including:
- forward bending
- twisting motions
- lifting heavy objects
- sudden forceful movements involving spinal stability

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14
Q

what are the clinical manifestations for osteoporosis?

A
  • structural weakening
  • decreased ability to support loads
  • high risk of fractures
  • acute LBP
  • Kyphosis
  • Hip and vertebra fractures (compression fractures can be asymptomatic)
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15
Q

what is the percentage of individuals that will experience orthopedic problems related to osteoporosis?

A

1/3 will experience orthopedic problems related to osteoporosis

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16
Q

what is type 1 osteoporosis?

A

postmenopausal osteoporosis, caused by a deficiency in estrogen

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17
Q

what is type 2 osteoporosis

A

senile osteoporosis, vitamin D deficiency and decreased ability to absorb calcium

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18
Q

what issues are associated with type 2 osteoporosis?

A

Endocrine issues: hyperplasia of the parathyroid, diabetes mellitus
Gastrointestinal issues: malnutrition
Drug issues: steroids, heparin

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19
Q

what are the non-modifiable risk factors for Osteoporosis?

A

Age➔ decreased ability to make new bone
Gender
Body Size
Ethnicity
Genetics

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20
Q

what are the modifiable risk factors for Osteoporosis?

A

Smoking
Alcohol
Decreased Estrogen or Androgens ➔ menopause or hypogonadism
Low BMI
Low Dietary Calcium and Vitamin D
Lack of Weight Bearing Exercise➔ decreased PA
Medication

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21
Q

what are the morphological risk factors for Osteoporosis?

A

Thin cortex
Thin Trabeculae

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22
Q

how do you diagnose osteoporosis? (what machine do you use)

A

DEXA scans for bone density measurements

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23
Q

what are the risk factors for osteonecrosis?

A
  • Corticosteroids
  • Trauma
  • Radiation
  • Smoking
  • Alcohol
  • Idiopathic
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24
Q

what are the clinical presentation of osteonercrosis

A

Epiphysis of the femur most common
Progressive joint pain

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25
osteonecrosis can lead to what
fractures and trauma to the bone
26
osteomalacia is characterized as a deficiency of what vitamin?
due to a deficiency in vitimin D
27
osteomalacia is known as?
soft bone disease
28
what are the symptoms of osteomalacia?
severe pain fractures weakness deformities
29
what are the diagnostic tests for osteomalacia
x-ray urinalysis/CBC bone scans bone biopsy
30
what are the two types of osteomyelitis
pyogenic and tuberculous
31
how does infection occur with osteomyelitis
infection of the bone via blood stream or bone directly
32
what patient population is osteomyelitis most seen?
more common in children and immunosuppressed children
33
how can diabetes be connected to osteomyelitis?
foot ulcers and neuropathy
34
what are the symptoms of osteomyelitis
1. fever 2. swelling 3. warmth 4. redness 5. pain 6. fatigue
35
what bones show pyogenic osteomyelitis the most?
long bones and vertebral bones
36
what is the morphology of pyogenic osteomyelitis?
infection can lift the periosteum impair blood flow - ischemia necrotic bone fragments called sequestrum
37
what are the normal laboratory findings associated with osteomyelitis?
leukocytosis
38
what do the radiographic findings show for osteomyelitis?
bone destruction
39
tuberculous osteomyelitis mostly effects what?
spine most commonly affected knees and hips
40
what patient population is at a high risk for fractures
OLDER ADULTS
41
why is there a higher risk of fractures in older adults?
osteoporosis co morbidities dementia poly pharmacy age
42
how many are hospitalized by hip fractures a year?
300,000 older adults 65+ hospitalized per year
43
when talking about falls will the patient return to the full function that they had before the fall?
NO the patient will not return to the function they had before the fall
44
what are some risk factors for patients with hip fractures?
95% due to falls 75% women mortality 20% associated with medical complications 50 5 will not regain functional baselines majority will be treated by surgery
45
what is the red flag when treating a patient with fractures?
PAIN MEDICATION CAN CAUSE DISORIENTATION OR SEDATION AND INCREASE FALL RISK
46
Vetebral compression fractures are caused by?
osteoporosis risk factors: postmenopausal women advanced age for males and females
47
what are the clinical manifestations seen in patients with Vetebral compression fractures?
typically causes severe pain decreased ability to perform ADL's often due to bending, lifting, and standing from a chair.
48
red: what does a complete fracture mean
extends through the bone
49
red: what does a incomplete fracture mean
does not extend through the bone
50
red: what does a closed fracture mean
intact overlaying skin
51
red: what does a compound fracture mean
lacerated skin, exposed bone
52
red: what does a comminuted fracture mean
bone is broken into many smaller fragments
53
red: what does a displaced fracture mean
edges of the fractured bone are no longer aligned
54
red: what does a pathologic fracture mean
fracture at the site of pathology ie. tumor
55
red: what does a spiral fracture mean
along the shaft of the bone
56
what is the timeline for the inflammation phase of a fractures healing?
0-2 weeks site protection and clearance
57
what is the timeline for the callus formation phase of a fractures healing?
2-3 weeks scaffold for new bone soft to hard fluffy opacity on x-rays
58
what is the timeline for the union phase of a fractures healing?
4- 6 weeks bridging by cartilage immature bone feature is stable but weak
59
what is the timeline for the consolidation phase of a fractures healing?
6-8 weeks all callus replaced by bone immature bone- la cellar bone bone is secure
60
what is the timeline for the remodeling phase of a fractures healing?
1-2 years continued osteoblast and osteoclast activity reshaping to best density and shape
61
what type of diseases is osteoarthritis?
degenerative joint disease
62
what is the patient population for OA
gradual onset of symptoms after 40 years of age 65+ 50% diagnosed with OA
63
how many people in the us have OA
30 million
64
who gets OA more women or men
women
65
how does OA occur
occurs as a result of degeneration of the articular cartilage
66
what is the pathogensis of OA
Normal articular cartilage undergoes turnover of bone➔ in osteoarthritis this turnover does not occur Due to wear and tear and genetic factors Can also be secondary➔ due to trauma or poor biomechanics
67
what joints are involved with OA
Weigh bearing joints➔ hips and knees Lower lumbar vertebrae Cervical vertebrae Interphalangeal joints
68
what might you see in a patients hand that has OA
bouchards nodes (in the pip) Heberdens nodes (dip )
69
what is primary osteoarthritis
no identifiable reason for arthritis development
70
what is secondary osteoarthritis
a likely cause for osteoarthritis exists joint injury in professional athletes
71
what are the risk factors for OA
Age Joint Injury Obesity Genetics Anatomic Factors Gender
72
what are the clinical manifestations of OA
Aching pain ➔ progressively worse Decreased mobility Morning stiffness Joint crepitus Advanced stages ➔ bone on bone
73
what do most OA patients report?
43% report functional limitations Associated with depression
74
what is rheumatoid arthritis?
An autoimmune disorder with an unknown antigen–antibody combination
75
what is rheumatoid arthritis associated with?
hypersensitivity of immune systems and synovial inflammation
76
what joints are affected by RA?
Metacarpophalangeal Interphalangeal Feet Wrist Ankle Elbows Knees
77
what is the morphology of RA?
Edematous and thick synovium with rough surface projections
78
what are the radiological findings for RA?
Osteopenia Narrow joint space with bony erosions
79
what are the clinical presentations of RA
Morning stiffness 3+ joints affected. (systemic) Symmetric involvement of joint on the hand Weight loss Fatigue Fever Warm tender joints Radial deviation of wrist Ulnar deviation of phalanges Stiffness after activity
80
what is the key clinical presentation of RA
wrist collapse end-stage RA complete destruction of the carpal bones and radioulnar joint
81
morning stiffness for RA will last for
30 minutes
82
morning stiffness for OA will last for
>1 hr
83
give an overview for the differences between OA and RA
OA vs RA Osteoarthritis is degeneration of articular cartilage, and is often associated with wear and tear; therefore, symptoms will improve with rest. Rheumatoid arthritis, the disease is caused by the formation of a pannus, which causes fusion of the joint. Rest allows the fusion to progress and causes the joint to become stiffer; thus, conversely, use will keep the joint more mobile and decrease stiffness.
84
morphological of OA
Articular cartilage ➔ collagen network damage = water absorption = chondrocyte activation = inflammatory response
85
what is Eburnation seen in OA
thickened and polished subchondral bone
86
what is Subchondral cysts seen in OA
synovial fluid leaks through defective cartilage into subchondral bone
87
what is Osteophytes seen in OA
bony outgrowths at the interphalangeal joints
88
what is Joint mice seen in OA
loose fragments of cartilage and bone in the joint

clin med (19 decks)

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