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BDS3 BAMS Diseases of Human Systems > Bone diseases > Flashcards

Bone diseases Flashcards

(38 cards)

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1
Q

Arthritis

A

inflammation of joints

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2
Q

arthrosis

A

non-inflammatory joint disease

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3
Q

arthralgia

A

joint pain

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4
Q

rheymatism and rheumatic are

A

not of medical use

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5
Q

bone

A

mineralised connectice tissue

3-6 month cycle

  • load bearing
  • dynamic - always forming and resorbing
  • self repairing and able to adapt to environment

calcium, phophate and vitamin D

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6
Q

3 key components of bone

A

calcium

phosphate

vitamin D

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7
Q

bone turnover cycle

A

3-6 month cycle

osteoclasts - resorb

osteoblasts - lay matrix

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8
Q

bone stores what

A

calcium

  • exchangeable Ca from bone to ECF
  • Ca absorbed from gut into ECF
  • Ca lost through gut and urine

Ca level in blood needs maintained at a very precise level – nerve and muscle function

  • Bone and ECF work together to maintain and the PTH promote the correct location of Ca
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9
Q

exchangeable Ca

A

bone ECF

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10
Q

Ca absorbed

A

from diet (gut) into ECF

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11
Q

Ca lost through

A

urine (via gut)

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12
Q

Ca level in blood

A

needs maintained at a very precise level - needed for nerve and muscle function

bone and ECF work together to maintain and the PTH promotes the correct location of Ca

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13
Q

parathyroid hormone role

A

maintains serum calcium levels - raised if Ca level falls

  • Increases calcium release from BONE
  • Reduces RENAL calcium excretion

located in thyroid gland in neck

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14
Q

hypoparathyroidism

A

deficiecy of PTH

so

low serum calcium

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15
Q

hyperparathyroidism

A

2 types

  • Primary
    • Gland dysfunction – tumour
    • High serum calcium RESULTS
      • Inapp activation osteoclast
  • Secondary
    • low serum calcium CAUSES

Both result in increased bone reabsorption

Radiolucencies & reabsorption – areas or loss cortical surface

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16
Q

vitamin D action

Study These Flashcards
A

it is needed in its biologically active form (kidneys) to absorb Ca

17
Q

vitamin D level problems when (3)

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A
  • Low Sunlight Exposure
    • Housebound
    • Dark Skinned in Northern country – skin absorbs less vit D – often combined with cultural traditions of high clothing coverage
  • Poor GI Absorption
    • Poor nutrition
    • Small intestinal disease - malabsorption
  • Drug interactions
    • Some antiepileptic drugs
      • Carbamazepine, Phenytoin

Often a combination of factors

18
Q

osteomalacia

Study These Flashcards
A

poorly mineralised osteoid matrix - normal amounts of osteoid but not mineralised

  • poorly mineralised cartilage plate growth
19
Q

osteoporosis

Study These Flashcards
A

loss of mineral and matrix - correct formation but wrong amount

  • so reduced bone mass
20
Q

osteomalacia during bone formation called

Study These Flashcards
A

RICKETS

related to calcium deficiency

21
Q

osteomalacia after bone formation

Study These Flashcards
A

called osteomalacia

related to calcium deficiency

22
Q

osteomalacia

occurs

Study These Flashcards
A

during bone formation - rickets

after bone formation completed

related to calcium deficiency

serum calcium preserved at expense of bone

23
Q

osteomalacia investigations (2 main)

Study These Flashcards
A
  • Bone Effects
    • Bones bend under pressure
      • ‘bow legs’
      • Vertebral compression in adults
        • Bones ‘ache’ to touch – pain in nerves of lower limb
  • Hypocalcaemia effects
    • Muscle weakness
    • Trousseau & Chvostek signs positive
      • Carpal muscle spasm
      • Facial twitching from VII tapping
24
Q

bone effects of osteomalacia

Study These Flashcards
A

Bones bend under pressure

  • ‘bow legs’
  • Vertebral compression in adults
    • Bones ‘ache’ to touch – pain in nerves of lower limb
25
hypocalcaemia effects of osteomalacia
Muscle weakness Trousseau & Chvostek signs positive * Carpal muscle spasm * Facial twitching from VII tapping
26
appaerance of rickets
osteomalacia before bone formation complete ## Footnote weak and soft bones, stunted growth, and, in severe cases, skeletal deformities. 'bow legs' rare now
27
3 management techniques of osteomalacia
* Correct the cause * Malnutrition * Control GI disease * Sunlight exposure * 30 mins x 5 weekly * Dietary Vitamin D
28
osteoporosis is
* A REDUCED QUANTITY of normally mineralized Bone An age related change - Inevitable * Usually, many trabeculae and mineralised* * *Reduced total quantity of correctly mineralised with age*
29
6 risk factors for osteoporosis
* AGE * Female sex * Endocrine * Oestrogen & testosterone deficiency * Cushings syndrome – inc corticosteroid levels? * Genetic * Family history * Race – caucasian & asian women * Early menopause * Patient factors * Inactivity * Smoking * Excess alcohol use * Poor dietary calcium * Medical Drugs use * steroids * antiepileptics
30
age and osteoporosis
* Peak Bone Mass is at age 24-35 years Osteoporosis is found in: * 15% women aged 50 * 30% women aged 70 * 40% women aged 80 increases with age women have a lower peak bone mass
31
gender and osteoporosis
* Males have higher Peak Bone Mass * Oestrogen withdrawal increases bone mass loss rate in women – in menopause * Men have similar rate of decline but absolute peak bone mass is higher so takes longer to reach critical level
32
2 main effects of osteoporosis
Increased bone fracture risk * Long bones – femur * Wrists – weaker and more prone to fractire * Vertebrae * Height loss * Kyphosis (bending forward of spine) & Scoliosis (shifting of lateral position of vertebrae?) * Nerve root compression leading to back pain Lifetime risk of hip fracture \>50yrs of age * 17.5% women * 6% men * After osteoporosis related hip fracture * 20% increase in 5yr mortality * Maximal in initial 6 months * 40% unable to walk unaided * 60% unable to live independently
33
2 main ways of osteoporosis prevention
1. Build maximal Peak Bone Mass * Exercise * High dietary calcium intake * Higher initial point means longer to reach clinical risk level 1. Reduce rate of Bone Mass loss * Continue exercise and calcium intake * Reduce hormone related effects * Oestrogen Hormone replacement therapy * MOST effective if early menopause * Reduce drug related effects * Consider ‘Osteoporosis Prevention’ drugs * BISPHOSPHONATES – indicated by strong family history
34
how to build maximal peak bone mass so preventing osteoporosis
* Exercise * High dietary calcium intake Higher initial point means longer to reach clinical risk level
35
how to reduce rate of bone mass loss so preventing osteoporosis
* Continue exercise and calcium intake * Reduce hormone related effects * Oestrogen Hormone replacement therapy * MOST effective if early menopause * Reduce drug related effects * Consider ‘Osteoporosis Prevention’ drugs * BISPHOSPHONATES – indicated by strong family history
36
Hormone replacement therapy * oestrogen only
* Reduces osteoporosis risk * Increases breast cancer risk * Increase endometrial cancer risk * Patients who have NOT had a hysterectory * Combine with a progestogen to reduce risk * May reduce ovarian cancer risk * Increases DVT risk Benefit lost after HRT stops! * 5yrs post treatment BMD ‘normal’
37
biphosphonates
reduce osteoclasts action (poison and reduce numbers) so less bone removed means less bone mass lost Non-Nitrogenous * Etidronate (1) * Clodronate (10) * Tildronate (10) Nitrogenous * Pamidronate (100) * Neridronate (100) * Olpadronate (500) * **Alendronate (500)** * Ibandronate (1000) * **Risedronate (2000)** * **Zoledronate (10000**
38
biphophonates effectiveness
Alendronate or Risedronate in an osteoporosis risk population * Reduce vertebral fracture risk by 50% * Reduce other fractures by 30-50% * benefit lost if drug discontinued * Can be combined with HRT extraction of teeth complication * Benefits and risks in SDCEP

BDS3 BAMS Diseases of Human Systems (13 decks)

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