MS: Disorders of Bone

Question 1

What are metabolic bone diseases?

Answer 1

osteoporosis and osteomalacia

bone is not strong as it should be

Question 2

What is an infectious bone disease?

Answer 2

osteomyelitis

Question 3

What is a viability of bone disease?

Answer 3

osteonecrosis

Question 4

What is the definition of osteoporosis?

Answer 4

a multifactoral skeletal disorder that leads to decreased bone density and organization, which leads to reduced bone strength

Question 5

What are osteoporosis and osteopenia based off of?

Answer 5

bone mineral density or BMD

Question 6

What are cut off levels for BMD?

Answer 6

normal- within 1 SD

osteopenia- within 1-2.5 SD

osteoporosis- more than 2.5 SD

Question 7

How many people are affected by osteoporosis?

Answer 7

10 million diagnosed, 18 mill undiagnosed

Question 8

What are the non modifiable risk factors for osteoporosis?

Answer 8

age- over 50

female, genetics, caucasian/Northern European

long periods of immobilization

arthropometric- small stature, thin build

Question 9

What are additional risk factors for osteopo?

Answer 9

hormonal- early menopause, absence of menses

dietary- low calcium, excess sodium, high caffine?

lifestyle- sedentary, smoking, alcohol

Concurrent illness- RA, CVA, parkinsons, spinal cord injury

Question 10

What endocrine disorders can be risk factors?

Answer 10

hyperparathyroidism, hyperthyroidism, male hypogonadism

Question 11

What medications can be risk factors for osteopo?

Answer 11

if taken longer than 6 months

corticosteroids- pt feels better but bone weak as it strips bone of Ca+

immunosuppressants, anticoagulants

antacids with aluminum- AL replaces Ca in bone

Question 12

What organic compound is scaffold for bone?

Answer 12

collagen contributes to bones flexibility and tensile strength

resist twisting and stretching

Question 13

What inorganic compound?

Answer 13

calcium phosphate gives bone hardness which resists compression

Question 14

What two things equal bone strength?

Answer 14

bone quality and bone density (BMD)

Question 15

What are prime years for bone deposition?

Answer 15

birth to 30

Question 16

What two hormones are important in bone health

Answer 16

parathyroid hormone and Calcatonin

Question 17

Why is PTH?

Answer 17

in early osteoporosis HYPER-PTH will remove Ca from bone in put into bloodstream

activates osteoclasts to break down bone

Question 18

Why calcitonin?

Answer 18

coming from thyroid gland it will counteract PTH

leads to building of bone

Question 19

What vitamin is important for bone growth?

Answer 19

Vitamin D

allows for reabsorption of Ca through small intestines

Question 20

Why is Wolff’s law so important to osteoporosis prevention or healing?

Answer 20

bone grows and remodels in response

it is important as PT to walk a fine line between good stress and bad stress

Question 21

What two ways can stress be provided?

Answer 21

Gravity- weight bearing

muscle pull- activity or exercise

Question 22

So why does osteoporosis occur?

Answer 22

1. low calcium and possibly magnesium intake
2. decreased estrogen- decreases sensitivity of osteoclasts to PTH
3. inactivity- wolff’s law
4. smoking- tobacco has anti estrogen effect leading to bone resorption
5. Diet high in phosphorus- same affect as AL

Question 23

What are clinical manifestations of osteoporosis?

Answer 23

often silent- major problem

usually discovered with fx ( femur, humerus, vertebrae, distal radius)

can cause radicular symptoms due to bone collaspe

Question 24

How to diagnose osteopo?

Answer 24

Bone density measures

1. dual energy xray
2. ultrasound
3. CT scan- sees bone better than MRI and Xray
4. lab tests- calcium levels, phosphate

Question 25

What is an osteoporotic posture?

Answer 25

kyphosis in Thoracic region weight moves to anterior portion of IV discs bc thinner head moves forward to compensate with can shut off blood flow to brain (OTN)

Question 26

How to manage osteoporosis?

Answer 26

reduce risk factors, nutrition is huge (calcium and magnesium)

Question 27

PT management of osteopo?

Answer 27

education exercise- wolffs law balance focus on back extensors for posture

Question 28

What type of medications can be used for osteopo?

Answer 28

1. bisphosphonates 2. hormone replacement therapy 3. calcitonin

Question 29

What is osteomalacia and rickets?

Answer 29

disorder where there is insufficient mineralization of bone matrix, resulting from calcium or phosphate deficiency rickets- bowed femurs

Question 30

Risk factors for osteomalacia and rickets?

Answer 30

lack of vitamin D this leads to hypocalcemia which will then activate increased PTH secretion taking Ca out of bone

Question 31

Clinical Manifestations of osteomalacia and rickets?

Answer 31

bone pain and tenderness, softening of cranium in children, proximal myopathy (waddling gait due to weak glute med and max

Question 32

Management of osteomalacia and rickets?

Answer 32

address cause, increased vitamin D and calcium PT- joint protection, progressive loads, positioning

Question 33

What is osteomyelitis? (OM)

Answer 33

mostly a bacterial infection of bone- Staph aureus most common can be viral, parasitic or fungal but less common

Question 34

What are two types of OM?

Answer 34

exogenous and endogenous (hematogenous)

Question 35

What is exogenous OM?

Answer 35

occurs from outside of body (cut in skin, surgery, open fracture) soft tissue to bone

Question 36

What is endogenous OM?

Answer 36

occurs from inside body and is harder to diagnose from ear infection etc.

Question 37

What is acute OM?

Answer 37

looks very inflammed either exo or endo with infection lasting less than one month

Question 38

What is chronic OM?

Answer 38

low level infection, usually an extension from acute case, last more than 4 weeks

Question 39

Pathophysiology of OM?

Answer 39

if invading pathogen is in bone then there is an inflammation response in bone this can cause part of bone to be cut off from blood supply can lead to necrosis of bone if infection not caught and treated in time

Question 40

Clinical manifestations of OM?

Answer 40

warmth, swelling, tenderness, delayed pain fever present in more endogenous OM infection will go from local to systemic effects as time goes on

Question 41

Diagnosis of OM?

Answer 41

Lab values of WBC count, imagining

Question 42

Treatment of OM?

Answer 42

acute- antibiotics chronic- cut bad part of bone out, hyberbaric chamber to help fight infection

Question 43

PT implications?

Answer 43

universal precautions, clarify WB precautions, use vitals and lab results to guide exercise progression

Question 44

What is osteonecrosis? (ON)

Answer 44

death of bony tissue as result of lack of blood supply common in 20-50 year olds

Question 45

Common sites for ON?

Answer 45

``` femoral head ( Bo jackson) scaphoid, talar dome, lunate, proximal humerus ```

Question 46

Pathogenesis of ON?

Answer 46

compromise of precarious blood supply causes flattening collapse of femoral head, common to be bilateral and with repeated traumas

Question 47

Causes of ON?

Answer 47

idiopathic- genetic trauma- sports? associated with steroid use and high alcohol intake sickle cell anemia- cuts off blood flow to distal areas

Question 48

Clinical manifestations of ON?

Answer 48

pain, loss of motion, painful or antalgic gait, degenerative changes

Question 49

Intervention of ON?

Answer 49

activity modification surgical- create microtraumas or total joint replacement to increase blood flow to joint