Bones and Joints

Question 1

why is bone continuously remodeling

Answer 1

based on our body’s need to maintain homeostasis

Question 2

what are involved in bone remodeling

Answer 2

osteoblasts and osteoclasts

Question 3

what are osteoblasts

Answer 3

create bone formation

Question 4

what are osteoclasts

Answer 4

create bone resorption

Question 5

when does peak bone mass occur

Answer 5

in early 20s

Question 6

what is peak bone mass highly determined by

Answer 6

genetics

Question 7

what are the 2 prominent modifiable predictors of peak bone mass

Answer 7

physical activity level and nutrient intake

Question 8

what is age-related bone loss tightly linked to

Answer 8

sex-hormone decline

Question 9

what causes the decline in sex-hormones

Answer 9

the decrease production of sex-hormones causing a decrease in osteoblasts and an increase in osteoclast activity

Question 10

what are the intrinsic effects of aging on bone

Answer 10

impaired osteoblast production from osteogenic stem cells and a decerased ability for cells to sense and respond to mechanical forces

Question 11

what are the morphological changes of bone with age

Answer 11

loss of bone mass and mineral content, altered bone shape and geomtry, and an increase in yellow bone marrow/decrease in red bone marrow

Question 12

what percent of red bone marrow do we have at birth vs at 70 years old

Answer 12

~90% at birth and ~30% at 70 years old

Question 13

what is the pattern of age-related bone loss in men

Answer 13

theres a steay decline of cortical and trabecular bone

Question 14

what is the pattern of age-related bone loss in women

Answer 14

over 10 year menopausal time period there is ~30% loss of trabecular bone mass and ~10% loss of cortical bone loss

Question 15

what is osteoporosis

Answer 15

when theres trabecular bone loss and thinning and cortical bon becomes porous and this

Question 16

what percentage of men and women who suffer a hip fracture will die within one year

Answer 16

37% of men and 28% of women

Question 17

what are the non-modifiable risk factors of osteoporosis

Answer 17

age (>65YO), genetics, sex, and caucasian or asian decent

Question 18

what are the modifiable risk factors of osteoporosis

Answer 18

low Ca2+ and/or vitamin D, tabacco use, alcohol inake, inactivity/sedentary lifestyle, prolonged use of certain drugs

Question 19

falls are the leading cause of what among older adults

Answer 19

hip fractures

Question 20

what are spinal compression fractures

Answer 20

source of chronic pain and are difficult to rehabilitate

Question 21

what are ways to rehab spinal compression fractues

Answer 21

back brace, osteoporosis meds to strengthen bone, cement injections, spinal fusion surgery

Question 22

what are signs/symptoms of osteoporosis

Answer 22

abnormal curvature of the pine, height decrease, and fragility/spontaneous fractures of the spine

Question 23

what are fragility fractures

Answer 23

any falls from standing height or less that resukt in a fracture

Question 24

what are treatment options for osteoporosis

Answer 24

dietary supplements, exercise, and pharmaceuticals that inhibis bone resorption or promotes bone formation

Question 25

what are ways to diagnose osteoporosis

Answer 25

bone mineral density testing like a DXA scan usually of the femur or spine

Question 26

what are the 2 fracture risk calculator assessments

Answer 26

CAROC and FRAX

Question 27

what is CAROC

Answer 27

the Canadian Association of Radiologist & Osteoporosis Canada that assesses any fracture after 40, that includes age, sex and BMD measurement

Question 28

what is FRAX

Answer 28

the Fracture Risk Assessment System that is a computer-based questionnarie

Question 29

what is the vicious cycle

Answer 29

when there is muscle and bone loss, and visceral fat accumulation with aging, comboned with an increase of total adiposity resulting in chronic inflammation

Question 30

what can the vicious triad lead to

Answer 30

osteosarcopenic obesity sydrome

Question 31

what is the osteosarcopenic obesity syndrome

Answer 31

a multimorbid state that predisposes an individual to morbidity

Question 32

what are the increase risks of osteosarcopenic obesity syndrome

Answer 32

weakness and imbalance, falls, fracutres, further decline in function, frailty and disease

Question 33

what exercise would prevent/treat osteoporosis

Answer 33

weight-bearing activity, resistance training, balance training, and functional training

Question 34

what are the 4 F-words when prescribing exercise for someone with osteopososis

Answer 34

Functional (movements that reflect ADL), Fun (enjoyable activities), Free (or low cost if applicable) and Fall (consider the fall risk)

Question 35

what joints our our weight-bearing joints

Answer 35

knees, hips, spine, and big toes are the most prone to wear and tear

Question 36

what occurs to joints with age

Answer 36

articular cartilage thins, decreases tensile stiffnes, reduced water content, and an increase in fibrous growth

Question 37

what is osteoarthrisis

Answer 37

a progressive degradation of articular cartilage along with synovitis and bone remodeling

Question 38

what areas are the most common for osteoarthritis to occur

Answer 38

hands, knees, hips, and spine

Question 39

what are the primary risk factors of osteoathritis

Answer 39

age, family history, inflammation, overuse/disuse, overweight and obesity

Question 40

what is the pathophysiology of osteoarthritis

Answer 40

1. articular cartilage is structuraly damaged and eroted 2. proteolytic enzymes are released from chondrocyctes which further degrades the cartilage 3. bone becomes exposed and damaged causing cracks to form 4. cysts and osteophytes develop 5. pieces of osteophytes and damaged cartilage break off and float around in the synovil cavity

Question 41

what are signs/symptoms of osteoartheritis

Answer 41

pain with movement and weight bearing, swelling, limtied ROM, crepitus may be heard, deformity, and can affect other joints and body alignment

Question 42

how can osteoarthritis be diagnosed

Answer 42

seeing inflammation or changes in the joint with an X-Ray

Question 43

what is the osteoarthritis treatment regime

Answer 43

1. surgery (top of pyramid) 2. COX2 inhibitors, high dose NSAIDs, corticosteriods, hyaluronic acid, DMOADs 3. simple analegsics, low dose Non-steroidal anti-inflammatory drugs (NSAIDs) 4. exercise, weight loss, diet, physiotherapy, brace (bottom of pyramid)

Question 44

what are exercises to prevent/treat osteroarthritis

Answer 44

low impact exercises, flexibility/strength/aerobic exercises, and muslce strengthening exercuses