Term
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Definition
•Bone integrity depends on a process of ***bone resorption and formation*** or bone remodeling which is continuous thru life
•***25% of cancellous bone replaced each year*** and 3% or compact bone; proceeds in cycles that can take 4 months
Impair ability to remodel bones:
•Mechanical stress, extracellular calcium and phosphate levels and hormones, local growth factors and cytokines influence
•RANK ligand may play role as chemical messenger
•***Osteopenia is a condition that is common to all metabolic bone disease***
-reduction in bone mineral density greater than expected for age, race or gender. Link between bone marrow density.
-***Women bone density lower than mens. More predisposed to osteoporosis and is a metabolic bone disorder.*** |
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Term
T/F?
People who have osteoporosis(a metabolic bone disease caused by reduction of bone mineral density) also have osteopenia. |
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Definition
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Term
Osteoporosis:
Who is at risk?
Should everyone take hormones to prevent? |
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Definition
•Classified as primary Gonna get it because: ***(postmenapausal women or elderly)***
or secondary (endocrine or genetic disorder)-imbalance between bone resorption and formation |
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Term
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Definition
•Enhanced bone resorption relative to bone formation; varies with age, sex, nutritional status and genetic predisposition
•Maximal bone mass achieved at 30; loss is 1%/year in menopausal women; |
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Term
Osteoporosis:
How is bone mass impacted by skin pigmentation and race |
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Definition
| •***AA less prone*** than Caucasians/Asians |
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Term
Osteoporosis:
What bones are predominantly impacted? |
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Definition
| •Greatest losses occur in areas containing abundant cancellous bone such as ***spine and femoral neck *** |
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Term
Osteoporosis:
Role of alcohol |
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Definition
| •Alcohol is a direct inhibitor of osteoblasts and may also inhibit ***calcium absorption***. |
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Term
Osteoporosis:
Role of Calcium |
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Definition
•***Prolonged use of medication that increases calcium excretion such as antacids and anticonvulsants***
•Premature and low birth weight infants at risk |
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Term
Osteoporosis:
Why do female athletes develop? |
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Definition
•***Female athletes - poor nutrition(don’t eat properly cut out meat), amenorrhea(periods stop), estrogen decreases lack.***
•Changes occur in the diaphysis and metaphysis of the bone; diameter of bone enlarges causing the outer supporting cortex to thin; resembles porcelain vase
•First manifestations are pain accompanied by skeletal fractures-vertebral compression, hip, pelvis, humerus
•Fractures represent end stage of disease
•Wedging and collapse of vertebrae causes height loss and kyphosis (hump)
•Monitor with bone mass density studies |
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Term
Osteoporosis:
Is mechanical stress or weight bearing important in ***prevention***? |
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Definition
-early detection critical:
-***Regular exercise*** |
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Term
Osteoporosis:
What Vitamin affects? |
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Definition
•***1500 mg calcium*** in post menopausal women.
Take Vit D if healthy kidney to absorb CA |
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Term
Rheumatoid arthritis-
Pathophysiology. |
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Definition
•***Systemic inflammatory*** disease that attacks joints by producing proliferative synovitis that leads to destruction of articular cartilage and underlying bone
•0.3-1.5% of population; women 2-3X |
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Term
Rheumatoid arthritis-
What causes the disease? |
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Definition
| not established, no cure, all bad things; genetic predisposition and immunologically mediated=can’t turn off. |
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Term
Rheumatoid arthritis-
• Pathogenesis |
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Definition
| is an aberrant ***immune response*** that leads to *synovial inflammation* and *destruction of joint architecture=hands* |
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Term
Rheumatoid arthritis-
Do CD4+ helper cells have a role? |
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Definition
•***May be initiated by activation of CD+4 helper T cells, release of cytokines and antibody formation=Do more cause inflammation, excess grandulation, pannus, distrups function of joing effect hand***.
FYI-HIV is absent of CD+4 T cells.
•Blood test=70-80% have rheumatoid factor (RF) autoantibody. Can have RA without antibodies.
•Joint and extra-articular manifestations |
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Term
Rheumatoid arthritis-
What is pannus? |
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Definition
| abnormal helaling response. Lay down excess granulation tissue. |
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Term
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Definition
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Term
| Systemic Lupus description |
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Definition
•Chronic inflammatory disease affecting any organ system including musculoskeletal system.
•1 in 2000, higher incidence in females, AA, Latins, and Asians |
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Term
Systemic Lupus
Role of autoantibodies, |
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Definition
| characterized by formation of autoantibodies and immune complexes; |
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Term
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Definition
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Term
Systemic Lupus
Do B cells play a role?
Blood test? |
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Definition
•***B cell hyperactivity and increased antibodies against self***
oAutoantibodies include:
o***Antinuclear antibodies (ANA)***.
Blood test: ANA testing with history and exam
oAntibodies against *RBCs*
oAntibodies against *platelets*
oAntibodies against *coagulation* factors |
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Term
Systemic Lupus
Genes, hormonal environmental? |
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Definition
| •Genetic, hormonal, immunologic and environmental(drug induced such as hydralazine and procainamide) |
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Term
Systemic Lupus
General manifestations |
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Definition
| •Great imitator: musculoskeletal, skin, cardiovascular, lungs, kidneys, CNS, RBC and platelets |
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Term
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Definition
Butterfly frash on cheeks only unlike
Rosasa also on cheeks and forehead and chin as well. |
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Term
Systemic Lupus
What factors affect? |
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Definition
| Multiple body systems, cause glomularnephritis, endo & myocrnitis, butterfly rash, seriouitis inflammation of serious membrane & organs, plueritis=pain, inflammation around lungs, anemic, decreased RBC, platelets, WBC, coagulation. Not making cells properly can come back from, reactive process on bone marrow and autoimmune and attached to lupus. When pt is on chronic steroids they damage tissue and slow bone healing. Treatment worse than disease. |
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Term
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Definition
| Formerly DJD; most prevalent form and leading cause of disability and pain in elderly |
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Term
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Definition
| • Progressive loss of articular cartilage and synovitis result from inflammation caused when cartilage attempts to repair itself |
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Term
| Osteoarthritis- Role of osteophytes |
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Definition
| •Creates ***osteophytes*** or spurs which cause joint pain, stiffness, and loss of motion |
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Term
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Definition
•Resides in the homeostatic mechanism that maintains the articular cartilage
Plays two roles:
•(1) smooth weight bearing surface and
•(2) transmits the load down to the bone dissipating mechanical stress
•Composition and mechanical properties of cartilage are changed
•Chemical messengers such as cytokines stimulate production and release of proteases that are destructive to joint structure, more injury results and repair mechanism is inadequate; portions become completely eroded and synovial membrane inflammation |
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Term
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Definition
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Term
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Definition
-***Increased serum uric acid*** (end product of purine metabolism)
•Monosodium urate ***crystals precipitate in the joint***; synovial fluid poor solvent-cooler areas
•***Inflammation*** results
•*Tophi* are deposits containing monosodium urate crystals=*large bumps on joints*
Primary (90%) may result from enzyme defect that results in an overproduction of uric acid or inadequate elimination by kidney |
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Term
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Definition
| • Secondary gout hyperuricemia may be caused by increased breakdown of nucleic acids as occurs with rapid tumor cell lysis during Rx for lymphoma or leukemia, CKD, or thiazide diuretics. |
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Term
| What is the risk of having gout? |
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Definition
| •Higher risk of kidney stones from it. |
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