Bone Diseases Flashcards
(18 cards)
Osteoporosis
A metabolic bone disease that presents with DEC bone mass (density) & microarchitectural deterioration (quality)
F>M
Typically post-menopause
OP: Classification
Types
- Primary Osteoporosis
Type 1: Postmenopausal (typically women 50-70 yo)
Type 2: Senile (men & women > 70 yo) - more associated with older age - Secondary Osteoporosis
- May be due to another primary condition or from treatment of another condition (corticosteriods - prolonged)
OP: Risk Factors: Non-Mod & Mod
Non-Mod
- Age
- Gender (F>M)
- Race (whites and asian decent)
- Menopause
- Family history
- Small skeletal frame
- Amenorrhea (depending on cause) - absence of menstraution (++ periods)
Non-mod = hormonal disorder that cannot be cured
Mod:
- Sedentary lifestyle (inadequate loading the bone) - Wolf’s Law
- Diet (deficient in calcium & Vit D)
- Smoking
- Caffeine (slightly INC Ca loss in urine)
- Alcohol abuse
- Amenorrhea
Mod = poor nutrition, anorexia, etc
Diagnosis (WHO Criteria)
Dx by measuring bone mineral density (BMD) using dual energy e-ray absorptiometry (DEXA) & is expressed in T-scores
Dexa T-score: Compares bone density of the patient with tht of normative data of an average adult of the same sex
T-score refers to how many standard deviations above or below the average for young adults (of the same sex) an individal’s BMD is
T-Score Classifications
> -1 = Normal
-1 to -2.5 = Osteopenia
< -2.5 = Osteoporosis
<-2.5 & history of at least one osteoporotic fracture = Severe Osteoporosis
Impact of Osteoporosis
(5)
- Fractures
46% - vertebral (anterior wedge # & can be as simple as flexing the spine), 16% hip (fall - # first or fall?), 16% radial (Smith or Colles - FOOSH), & 22% others - Compression #
DEC in height - Postural Changes
INC kyphosis - as a result of anterior wedge #
Dowagers Hump - an excessive curvature of the spine - Back pain
- DEC mobility
Osteomalacia
Defintion & Cause
A metabolic bone disease which results in softening of bones d/t decalcification of bones
May be d/t inadequate intestinal absorption of calcium, INC renal excretion of phosphorus (mineral that combines with Ca to help harden bones) OR Vit D deficiency (helps absorb Ca)
Osteomalacia: S/S
(7)
- Pain
- Aching
- Fatigue - b/c it is metabolic
- Weight loss
- Weakness
- Possible deformities
INC thoracic kyphosis
Bowing of L/E - High risk for fractures
Osteomalacia: Interventions
(3)
- Pharmacological &/or nutritional interventions to address underlying etiology (MAIN INTERVENTION)
- Strength Training
- Bone Protection Strategies
Paget’s Disease
(Osteitis Deformans)
Definition & Epidem
A metabolic bone disease involving abnormal osteoclast & osteoblast activity followed by disorganized remodeling (cause it to not be as strong)
- Leads to enlarged & misshapen bones
- Bones appear large, but lack structural integrity & strength
** If a bone is curved - structural integrity is NOT as strong as a straight bone
M>F
Typically age > 40 yo
Paget’s Disease (Osteitis Deformans): Characteristics
(4)
- Pain
- Misshapen bones
- Fractures
- Arthritis
More severe S/S: headache, vertigo, hearing loss, fatigue, & INC CO leading to heart failure
Paget’s Disease (Osteitis Deformans): Intervention
(3)
- Pharmacological interventions for pain control & limiting osteoclast activity (not in scope)
- Postural Re-education
- Exercise Therapy
Strengthening - AVOID high- impact& aggressive forward bending or twisting
Swimming is one of the best exercises for this pop.
Stretching
Aerobic exercise
Osteomyelitis
Definition & Cause
Inflammation within bone caused by an infection
- May be infected through the blood stream, open fracture, or surgery
Cut - INC risk in pop w/ immunosuppresion - are immunocompromised - Most causes due to bacterial infection
Osteomyelitis: S/S
(6)
- Fever
- Tenderness in area of infection
- Redness in area of infection
- Warmth in area of infection
- Swelling in area of infection = INC pressure in area = DEC ROM
- Loss of ROM in affected joints
Osteomyelitis: Interventions
(3)
- Antibiotics - first through IV -> pills
- Surgery - severe or chronic - may need to do an amputation of that bone
- ROM - at a tolerable range
Prevent stiffening in other areas (adjacent)
** Most important PT intervention
Osteogenesis Imperfecta (Brittle Bone Disease)
Definition & Epidem
A genetic bone disorder characterized by fragile bones
- Confirmed by genetic testing - congenital disease
Affects Type I Collagen (low collagen production & abnormal collagen produced)
- Not enough collagen & what is produced is abnormal
Type I - creates bones, skin, organs & Type II - creates cartilage
OI: Characteristics
(10)
- Frequent # (frequency DEC after puberty)
From little to no trauma - can be as simple as lifting the leg during diaper change - Bone deformity & bone pain
- Low bone density - may also be a result of deconditioning
- Short stature (DEC bone growth length)
- Scoliosis
- Ligament laxity
- Muscle weakness
- Fatigue
- Cardiac & respiratory issues - may be related to chest wall deformities
- Dental, vvision, and hearing problems
** Presentation can vary a lot depending on disease severity
Very severe cases will often lead to death - most will die in infancy (< 1 yo)
Precautions when treating people w/ OI
(3) + 5
- Never pull or push on limb, or bend it into an awkward position
- When # is suspected, minimize handling of the affected limb
- Handle babies with extra care
- Lift babies with OI by placing one hand under the buttocks & legs, and the other hand under the shoulder, neck, and head
- Do not lift from under the arm pits
- Do not lift by ankles to change a diaper, slide hand under the buttocks instead
- Encourage babies to explore independent movement (do not need ot be kept on soft surface)
- Support infants in a variety of positions (ie tummy time, side lying) to help develop mm.
** Problems with motor development (delay) d/t mm weakness
- not d/t neurological factor rather weakness is preventing them from developing typically
