Bone and Degenerative Disorders Overview

What are the four main types of cells found in bone?

Osteoblasts, osteocytes, osteoclasts, and lining cells.

What are the two types of bone composition?

Compact bone and spongy bone.

What are the classic clinical features of chronic osteoarthritis?

Joint pain, stiffness, swelling, and decreased range of motion.

What are the management strategies for osteoarthritis in adults?

Acute and chronic management strategies include physical therapy, medications, and lifestyle modifications.

What conditions should be compared regarding etiology, prevalence, and clinical features?

Osteogenesis imperfecta, osteomalacia/rickets, and Paget's disease.

What are the risk factors for developing osteopenia and osteoporosis?

Age, gender, family history, low body weight, and certain medical conditions.

What anatomical areas are prone to fractures in osteoporosis?

Wrist, hip, and vertebrae.

What are the radiographic findings of chronic osteoarthritis?

Joint space narrowing, subchondral sclerosis, osteophyte formation, and cysts.

What is the utility of DEXA imaging?

DEXA imaging is used for screening and diagnosing degenerative bone diseases, particularly osteoporosis.

What are the first-line pharmacologic agents for osteoarthritis pain?

Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

What are the risks associated with chronic use of anti-inflammatory medications?

Gastrointestinal bleeding, renal impairment, and cardiovascular risks.

What is teriparatide used for?

It is used for the treatment of osteoporosis to stimulate bone formation.

What are the indications for surgical management in osteoarthritis?

Severe pain, functional impairment, and failure of conservative treatments.

What is the composition of normal cartilage?

Water (65-80%), type II collagen, and proteoglycans.

What is the primary cause of osteoarthritis?

Primary (idiopathic) osteoarthritis is age-related wear and tear with no identifiable underlying cause.

What is a common secondary cause of osteoarthritis?

Previous joint injury or trauma.

What is the leading cause of disability in older adults?

Osteoarthritis.

What is the prevalence of osteoarthritis in adults over age 60?

Affects 10% of men and 13% of women.

What are the common joints affected by osteoarthritis?

Knees, hips, hands (DIP, PIP, first CMC), and spine.

What is the role of chondrocytes in cartilage?

Chondrocytes maintain the extracellular matrix of cartilage.

What are some genetic and demographic risk factors for osteoarthritis?

Genetic predisposition, race/ethnicity (more common in African Americans), congenital joint abnormalities, and obesity.

What are common mechanical stressors contributing to osteoarthritis?

Joint injury or surgery, repetitive joint stress from occupational activities, muscle weakness, and joint malalignment.

What are the typical symptoms of osteoarthritis?

Joint pain with gradual onset, worsens with activity, improves with rest, morning stiffness lasting less than 30 minutes, decreased range of motion, and joint 'gelling' after inactivity.

What physical exam findings are associated with osteoarthritis?

Joint tenderness, bony enlargement, crepitus, decreased range of motion, joint effusion, and muscle atrophy around the affected joint.

What specific findings are noted in the hands of osteoarthritis patients?

Heberden nodes (DIP), Bouchard's nodes (PIP), and square hand deformity (first CMC).

What is the hallmark X-ray finding in osteoarthritis?

Asymmetric joint space narrowing.

What are the first-line nonpharmacological treatments for osteoarthritis?

Weight loss, physical therapy, low-impact aerobic exercise, heat/cold therapy, and assistive devices.

What pharmacological treatments are commonly used for osteoarthritis?

Acetaminophen, topical NSAIDs, and oral NSAIDs at the lowest effective dose.

What are the surgical options for refractory osteoarthritis?

Arthroscopy, osteotomy, and joint replacement (total or partial).

What is osteoporosis?

A systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to increased fracture risk.

What demographic is most affected by osteoporosis?

Primarily postmenopausal women, with 80% of cases occurring in women.

What are the most common sites of osteoporotic fractures?

Hip, vertebral body, and distal radius (Colles fracture).

What is the pathophysiology of osteoporosis?

Imbalance in bone remodeling where bone resorption exceeds bone formation, leading to decreased bone mass and increased fragility.

What are the primary types of osteoporosis?

Primary osteoporosis includes postmenopausal (type I) and age-related (type II) osteoporosis.

What are common risk factors for developing osteoporosis?

Advanced age, female sex, Caucasian or Asian race, low body weight, family history, early menopause, low calcium and vitamin D intake, sedentary lifestyle, smoking, and excessive alcohol consumption.

What role does estrogen play in postmenopausal osteoporosis?

Estrogen deficiency leads to increased osteoclast activity, contributing to bone loss.

What are some medications that can cause secondary osteoporosis?

Glucocorticoids, anticonvulsants, heparin, long-term PPIs, and aromatase inhibitors.

What is the significance of a personal history of fracture after age 50?

It is a risk factor for developing osteoporosis.

What is the relationship between osteoporosis and fractures?

Osteoporosis increases the risk of fractures, particularly in the hip, vertebrae, and wrist.

What is the prognosis for patients with osteoarthritis?

OA is chronic but manageable; symptoms often fluctuate, and joint replacement is highly successful when conservative measures fail.

What is the importance of patient education in managing osteoarthritis?

Patients should understand that OA is manageable, and lifestyle changes such as weight loss and exercise can be as effective as medications.

What are the key imaging findings associated with osteoarthritis?

Loss of joint space, osteophytes, subchondral sclerosis, and subchondral cysts.

What is the role of joint aspiration in diagnosing osteoarthritis?

To analyze synovial fluid for inflammation and rule out other conditions like gout or septic arthritis.

What is the recommended approach for treating osteoporosis?

Focus on lifestyle modifications, including adequate calcium and vitamin D intake, weight-bearing exercises, and fall prevention strategies.

What is the definition of chronic glucocorticoid use in the context of osteoporosis?

Use of ≥5 mg prednisone daily for ≥ 3 months.

What are the common clinical manifestations of osteoporosis?

Often asymptomatic until a fracture occurs, leading to complications like pathologic or fragility fractures.

What does a loss of height greater than 1.5 inches suggest in osteoporosis?

It suggests the presence of vertebral fractures.

What is kyphosis, and how does it relate to osteoporosis?

Kyphosis, also known as 'dowager's hump,' results from multiple thoracic vertebral fractures.

What are some physical exam signs of osteoporosis?

Loss of height >1.5 inches, thoracic kyphosis, decreased rib-to-pelvis distance, protuberant abdomen, and shortened stature.

What is the gold standard for diagnosing osteoporosis?

Dual Energy X-ray Absorptiometry (DEXA/DXA scan) measures bone mineral density.

How is the T-score interpreted for osteoporosis diagnosis?

Normal: T-score ≥ -1.0; Osteopenia: T-score between -1.0 and -2.5; Osteoporosis: T-score ≤ -2.5.

What is the FRAX score used for?

It estimates the 10-year probability of major osteoporotic and hip fractures, guiding treatment.

What are the screening recommendations for osteoporosis according to the USPSTF?

Screen all women ≥65 years, postmenopausal women <65 with risk factors, and men ≥70 years or younger men with risk factors.

What is the recommended daily calcium intake for osteoporosis prevention?

1,000-1,200 mg daily from diet and supplements.

What is the recommended daily vitamin D intake for osteoporosis prevention?

800-1,000 IU daily, aiming for a 25-OH vitamin D level >30 ng/mL.

What are first-line pharmacological treatments for osteoporosis?

Bisphosphonates such as alendronate, risedronate, and zoledronic acid.

What are the side effects of oral bisphosphonates?

Esophagitis, musculoskeletal pain, rare atypical femur fractures, and osteonecrosis of the jaw.

What is the recommended duration for taking oral bisphosphonates?

3-5 years, after which the need for continuation should be reassessed.

What is denosumab and when is it used?

Denosumab (Prolia) is an anti-RANKL monoclonal antibody used if bisphosphonates are not tolerated or contraindicated.

What are anabolic agents used for in osteoporosis treatment?

They are reserved for severe osteoporosis or multiple fractures and have a lifetime maximum use.

What are some alternative pharmacological agents for osteoporosis?

Hormone replacement therapy (HRT) and selective estrogen receptor modulators (SERMs) like raloxifene.

What should be assessed before prescribing bisphosphonates?

Renal function, ensuring CrCl is ≥35 for oral and ≥35 for zoledronic acid.

What is the importance of monitoring BMD during osteoporosis treatment?

BMD should be monitored with DEXA every 12-24 months to assess treatment efficacy.

What is a key consideration when discontinuing denosumab?

Denosumab should never be abruptly stopped due to the risk of rebound vertebral fractures.

What is the primary prevention strategy for osteoporosis?

Regular exercise (weight bearing), adequate calcium/vitamin D intake, and fall prevention.

What is the significance of peak bone density?

Peak bone density occurs in the 20s and 30s, and maintaining it is crucial for preventing osteoporosis.

What is the role of bisphosphonates in osteoporosis treatment?

Bisphosphonates, such as alendronate and zoledronic acid, are first-line treatments that reduce fracture risk by 30-50%.

What is the DEXA T-score range for osteoporosis?

A T-score of < -2.5 indicates osteoporosis.

What are common clinical manifestations of osteogenesis imperfecta?

Multiple fractures with minimal trauma, blue or gray sclera, short stature, and hearing loss.

What is the genetic basis of osteogenesis imperfecta?

Most cases are due to mutations in the COL1A1 or COL1A2 genes affecting type I collagen.

What are the types of osteogenesis imperfecta and their characteristics?

Type I: mild, normal stature; Type II: perinatal lethal; Type III: severe, short stature; Type IV: moderate, variable stature.

What is the incidence of osteogenesis imperfecta?

Approximately 1 in 15,000-20,000 births.

What are some risk factors for osteogenesis imperfecta?

Family history, consanguinity, and advanced paternal age.

What is the prognosis for patients with osteogenesis imperfecta?

Varies by type; Type I has a near-normal lifespan, while Type II is typically fatal in infancy.

What is the most common cause of osteomalacia?

Vitamin D deficiency.

What distinguishes osteomalacia from rickets?

Osteomalacia occurs in adults after growth plate closure, while rickets occurs in children before growth plate closure.

What are the clinical features of rickets?

Widening and irregular growth plates, bone deformities, and soft, weak bones.

What is the importance of fall prevention in osteoporosis management?

Fall prevention strategies help reduce the risk of fractures in individuals with osteoporosis.

What is the role of calcium and vitamin D in osteoporosis management?

Calcium (1,200 mg) and vitamin D (800-1,000 IU) daily are essential for bone health.

What is the significance of the FRAX calculator?

The FRAX calculator helps determine who to treat in the osteopenia range.

What are the common referral needs for osteoporosis patients?

Referrals may include endocrinology for complex cases, orthopedics for fragility fractures, and physical therapy for balance training.

What are the laboratory findings in osteogenesis imperfecta?

Typically normal calcium, phosphate, alkaline phosphatase, PTH, and vitamin D levels.

What is the management approach for osteogenesis imperfecta?

A multidisciplinary team approach including orthopedics, genetics, physical therapy, and psychosocial support.

What is the risk of hip fractures in osteoporosis?

Hip fractures have a 20% mortality rate within one year and often require long-term care.

What are the treatment options for osteogenesis imperfecta?

Bisphosphonates, calcium, and vitamin D supplementation, with a focus on fracture prevention.

What is the significance of genetic counseling in osteogenesis imperfecta?

Genetic counseling is important for family planning and understanding inheritance patterns.

What is the characteristic finding of blue sclera in osteogenesis imperfecta?

Blue or gray sclera is due to thinning sclera showing the underlying choroid.

What is the impact of immobilization in osteogenesis imperfecta?

Immobilization worsens osteoporosis; safe mobility is encouraged.

What are the signs of dentinogenesis imperfecta?

Amber/blue-gray discolored, translucent teeth.

What is the relationship between vitamin D deficiency and osteomalacia?

Vitamin D deficiency leads to decreased calcium absorption, resulting in unmineralized osteoid and weak bones.

What are the common symptoms of osteomalacia?

Bone pain, muscle weakness, and increased risk of fractures.

What is the role of physical therapy in managing osteogenesis imperfecta?

Physical therapy focuses on low-impact exercises to strengthen muscles and improve mobility.

What is the clinical significance of multiple fractures in osteogenesis imperfecta?

Fractures often occur with minimal trauma and can indicate the severity of the condition.

What is osteomalacia?

A condition where new bone formed during remodeling remains unmineralized, leading to fractures and bone pain.

What are common causes of vitamin D deficiency?

Inadequate sunlight exposure, dietary intake, malabsorption disorders, liver disease, chronic kidney disease, and certain medications.

What are the risk factors for vitamin D deficiency?

Limited sun exposure, darker skin pigmentation, elderly age, exclusive breastfeeding without supplementation, strict vegetarian diets, obesity, malabsorptive disorders, and chronic kidney or liver disease.

What are the clinical manifestations of rickets in children?

Delayed motor milestones, bone pain, growth delay, dental problems, seizures, muscle weakness, and irritability.

What are the clinical manifestations of osteomalacia in adults?

Diffuse bone pain, muscle weakness, waddling gait, fatigue, and fragility fractures.

What are the physical exam findings associated with rickets?

Craniofacial abnormalities, rachitic rosary, Harrison groove, bowing deformities, and muscle weakness.

What is Paget's disease?

A chronic, localized disorder of bone remodeling characterized by excessive, disorganized bone remodeling.