Bone Disorders

Question 1

Paget’s Disease Definition

Answer 1

Localized abnormal and excessive bone remodeling (bone formation and resorption) which eventually enlarges and softens the affected bone; Paget’s Disease commonly affects the vertebrae, skull, sacrum, sternum and pelvis.

Question 2

Paget’s Disease Etiology

Answer 2

 Unknown (may follow inflammation, virus bone tumors, autoimmune dysfunction)

Question 3

Functions of Bones

Answer 3

Bones have three major functions:

1. to give form to the body,
2. to support tissues, and
3. to permit movement.

Question 4

Fractures Definition

Answer 4

A break in a bone due to a force that exceeds the strength of the bone

Question 5

Fractures Incidence

Answer 5

The highest incidence is in young males (trauma) and the elderly (osteoporosis); the upper femur, upper humerus, vertebrae and hip (femoral neck) are the most common sites.

Question 6

Fractures Pathophysiology

Answer 6

 Bleeding of broken ends of bones
 Hematoma (clot) -> fibrous network
 Osteoblasts (bone forming cells), collagen strands and deposit calcium
 Callus formation (new bone)
 “Remodeling” (excess callus is resorbed and mature bone formed)

Question 7

Fractures Manifestations

Answer 7

	Abnormal alignment 
	Immediate pain 
	Loss of function/sensation 
	Swelling/spasm 
	Blood loss 
	Crepitus (audible clicking sounds of fractured bone with movement)

Question 8

Fractures Management

Answer 8

 Return the bone to normal alignment using these techniques:
 Closed reduction/open reduction/traction (reduction = realigning bone fragments to their normal position)
 Cast, splint
 External traction

Question 9

Fractures Complications

Answer 9

 Nonunion/Malunion (failure of bone ends to heal together)
 Delayed growth (children)
 Osteomyelitis (bone infection, especially with open fx)
 Fat emboli – a potentially lethal problem after long bone fracture (fat globules are released from bone marrow and travel in the blood and lodge in the lung).

Question 10

Paget’s Pathophysiology

Answer 10

 Excessive resorption of spongy bone
 Fibrous tissue replace bone marrow
 Abnormal new bone forms

Question 11

Paget’s Manifestations

Answer 11

 Bone deformity (barrel chest, bowing of legs, kyphosis)
 Bone pain
 Fractures

Question 12

Paget’s Management

Answer 12

 Pain management
 Prevention of deformity/fracture and loss of function
 Drugs to slow bone resorption

Question 13

Gout Definiton

Answer 13

 A disorder that disrupts the body’s control of uric acid production or excretion; gout may follow traumatic injury or joint strain.

Question 14

Gout Etiology

Answer 14

 Excessive serum uric acid (lack of excretion or excessive production)
 Increased production of uric acid
 Increased rate of purine (end product of nucleoprotein digestion) synthesis
 purines break down to uric acid
 Increased production of uric acid
 Decreased excretion of uric acid
 renal failure (decreased excretion of uric acid)–urate crystals
 form and deposit in kidneys

Question 15

Gout Pathophys

Answer 15

 When uric acid reaches a certain concentration, it crystalizes
 Urate crystals cause joint inflammation and renal stones

Question 16

Gout Manifestations

Answer 16

 Increased serum uric acid (urate)

 Hot, red, tender joint (usually peripheral)

Question 17

Gout Management

Answer 17

 Medications to help excrete uric acid
 Ice on area
 No weight bearing
 Low purine (protein) diet and increased fluids

Question 18

Osteomyelitis Definition

Answer 18

 Bacterial, fungal, parasitic or viral bone infection

Question 19

Osteomyelitis Etiology

Answer 19

 Open bone from surgery, trauma

 Blood borne from other sites of infection

Question 20

Osteomyelitis Patho

Answer 20

 Pathogen in bone causes inflammatory response
 Abscesses form (lifts periosteum off underlying bone)
 Pressure from abscess causes decreased blood supply to bone - necrosis
 Osteoblasts form new bone

Question 21

Osteomyeltitis Manifestations

Answer 21

 Acute: fever, chills, bone pain, weight loss

 Chronic: if inadequate antibiotics, drug-resistant bacteria

Question 22

Osteomyelitis Management

Answer 22

 Antibiotics
 Irrigation and drainage
 Difficult to cure:
 bone has multiple microscopic channels; impermeable to blood cells (decreased phagocytosis)

Question 23

Osteoporosis Definition

Answer 23

 Reduced bone density

Question 24

Osteoporosis Incidence

Answer 24

 Most common metabolic bone disease
 Incidence increases with age
 Most common in caucasian females (as bone mass is not very dense to start with)

Question 25

Osteoporosis Etiology

Answer 25

 Decreased estrogen after menopause (estrogen normally inhibits bone resorption)  Decreased dietary calcium and vitamin D (decreased absorption of these in elderly)  Increased caffeine, nicotine, alcohol (causes loss of calcium from bone)  Renal Failure (nephrons unable to remove excess PO4) - Increased PO4 (PO4 binds with calcium) - Decreased calcium - stimulates increased production of parathyroid hormone (PTH) - PTH overstimulates osteoclasts to remodel (loss of CA++ from bone)

Question 26

Osteoporosis Patho

Answer 26

 Increased rate of resorption by osteoclasts  Decreased rate of bone formation by osteoblasts  Net decrease in bone density

Question 27

Osteoporosis Manifestations

Answer 27

 Bone pain  Bone deformity (kyphoscoliosis - hunchback)  Fractures  Loss of height

Question 28

Osteoporosis Management

Answer 28

 Weight bearing exercise  Estrogen (Also increases cancer risk and deep vein thrombosis risk)  Dietary calcium and vitamin D  Prevention is best treatment (50% of people with osteoporosis and fracture never walk again)

Question 29

Osteoarthritis Definition

Answer 29

 Degeneration and loss of articular surfaces in synovial joints

Question 30

Osteoarthritis Etiology

Answer 30

 Mechanical joint stress, trauma, age, wear and tear

Question 31

Osteoarthritis Patho

Answer 31

 Loss of articular cartilage (flakes off and becomes thin or absent)  Bone become dense and hard  Bone spurs form (grow outward from bone)

Question 32

Osteoarthritis Manifestation

Answer 32

 Joint pain and stiffness  Swelling  Decreased range of motion of joint  Deformity

Question 33

Osteoarthritis Management

Answer 33

 Weight loss  Non-steroid anti-inflammatory analgesic (ASA, Motrin)  ROM exercise  Cane/crutches to decrease weight bearing  Joint replacement surgery

Question 34

Osteogenic Sarcoma Definition

Answer 34

(1/3 of all bone tumors)  Large, destructive malignant bone tumor found in the metaphyses of long bone (femur); osteogenic sarcoma can be rapidly fatal with lung metastasis.

Question 35

Osteogenic Sarcoma Incidence

Answer 35

 adolescent (often overlooked as a sports injury)

Question 36

Osteogenic Sarcoma Patho

Answer 36

 Bone marrow - moth-eaten pattern of destruction  Anaplastic cells - atypical, abnormal cells  Tumor destroys bone  Tumor breaks through periosteum & can form soft tissue mass

Question 37

Osteogenic Sarcoma Manifestations

Answer 37

 Bone pain (worsens at night) |  Increased alkaline phosphatase (enzyme produced by osteoblasts)

Question 38

Osteogenic Sarcoma Management

Answer 38

 Chemotherapy, radiation  Limb sparing surgery (used to be amputation)  Survival rate: improved with combination therapy--currently the 5 year survival rate is 60%.

Question 39

Scoliosis Definition

Answer 39

 An S or C curve to the entire spine in which the vertebrae twist

Question 40

Scoliosis Etiology

Answer 40

```  Congenital skeletal disorders  Neuromuscular disease (e.g., muscular dystrophy)  Trauma  Rickets  Idiopathic ```

Question 41

Scoliosis Incidence

Answer 41

Can occur between ages 4-14, during growth spurts, commonly in girls

Question 42

Scoliosis Patho

Answer 42

 Muscles, ligaments, and other soft tissues become shortened (on concave side of curve)  Progressive deformities of vertebral column and limbs develop  Curve increases most rapidly during periods of rapid skeletal growth

Question 43

Scoliosis Manifestation

Answer 43

 Spinal curvature  Prominance of shoulder and hip  Advanced disease can lead to restricted expansion of the lungs (atelectasis, hypoxemia) and pressure on heart eventually leading to heart failure.

Question 44

Scoliosis Management

Answer 44

 Braces |  Surgery if curvature greater than 40 degrees

Question 45

Osteomalacia/Rickets Definition

Answer 45

 Mineral calcification and deposition in mature compact and spongy bone does not occur; results in "SOFT" bones:  Osteomalacia refers to adult bones  Rickets refers to growing bones of children (new bone at growing ends fails to ossify)

Question 46

Osteomalacia/Rickets Etiology

Answer 46

 Deficiency of vitamin D; dietary and malabsorptive disease of small bowel  Normal A& P: Vitamin D normally facilitates calcium absorption in the intestine

Question 47

Osteomalacia/Rickets Patho

Answer 47

 Decreased Vitamin D - Decreased serum calcium levels  Decreased Calcium - stimulate increased secretion of parathyroid hormone (PTH)  Loss of CA++ and Po4 from bones  Mineralization of bone decreased

Question 48

Osteomalacia/Rickets Manifestation

Answer 48

 Skeletal pain and tenderness  Bone deformities (bowing of bones)  Pathological fractures

Question 49

Osteomalacia/Rickets Treatment

Answer 49

Vitamin D and calcium supplements