Paget's Disease and Osteomalacia

second most common metabolic bone disease

Paget's disease

describe the bones that form with Paget's disease

new bone formation abnormal

bones are enlarged but weak

___ occurs in bone marrow of paget's bones

fibrosis

Paget's pathogenesis

unknown

Paget's demographic

over age 50

men and women

risk factors for paget's

environment

virus

genetics

phases of paget's

1. osteoclastic

2. osteoblastic sclerotic phase

phase 1: osteoclastic (resorptive stage)

bone resorption occurs too quickly for osteoblasts to keep ip

causes lytic areas of bone

phase 2: osteoblastic sclerotic phase

heavily calcified and enlarged bone made

not well organized

weak bones

commonly affected sites of paget's

skull

spine

pelvis

femur

tibia

paget's symptoms

asymptomatic (80%)

hypercalcemia

affected bone changes shape and size

skull involvement

tumors (osteosarcoma)

diagnosis of paget's

x ray

bone scan

labs - alkaline phosphatase

bone biopsy

treatment of paget's

anti-inflammatory medications

bisphosphonates

surgery for fx

no cure

exercise

prognosis of paget's

varies

osteosarcoma occurs in 1% of pts

compare osteoporosis and paget's disease

x

osteomalacia

failure or deficiency of normal calcification/mineralization of bone matrix

leads to soft and weakened bones

2 common causes of osteomalacia

1. insufficient calcium absorption

2. increased renal phosphorus loss

risk factors of osteomalacia

inadequate diet

lack of sunlight

intestinal malabsorption

renal failure

children can get osteomalacia because

breast fed infants of malnourished women

not vitamin D fortified milk in diet

dietary cause of osteomalacia largely being eradicated in the US

vitamin D enriched milk

regulates calcium absorption in body

vitamin D

2 sources of vitamin D

diet

sun exposure

t/f: vitamin is not active until it reaches the stomach or skin

false

not active until it is processed in the liver and kidney

osteomalacia pathogenesis

bone matrix intact

decrease in calcification (matrix is uncalcified)

osteoid formed

bones bend/deform because they are soft

diagnosis of osteomalacia

mimics other conditions

diffuse aching/fatigue

proximal muscle weakness

weight loss

testing for osteomalacia

bone biopsy

blood work

urinalysis

treatment of osteomalacia depends on

cause

treatment for osteomalacia

Vitamin D, calcium supplementation

braces/sx

osteomyelitis risk factors

recent sx/joint replacement

direct penetrating trauma

IV drug users

immunocompromised

medications

other infectious diseases present

common bacteria of osteomyelitis

staphylococcus aureus

concerns with osteomyelitis

antibiotic resistance

sx to drain joint, remove tissue

can lead to AVN and eventually joint replacement

osteomyelitis

acute or chronic inflammation of bone secondary to an infectious organism

exogenous osteomyelitis

direct extension into bone

from wound, trauma, sx

hematogenous osteomyelitis

spread of organisms via blood

acute/chronic hematogenous osteomyelitis is more common in children

acute

acute/chronic osteomyelitis is more common in adults and immunocompromised individuals

chronic

symptoms of osteomyelitis

erythema/edema over site

pain

fever, malaise

diagnosis of osteomyelitis

history

cultures

imaging

biopsy

treatment of osteomyelitis

IV antibiotics

surgery

if osteomyelitis is untreated for more than 1 week to 10 days

permanent loss of bone structure can occur

permanent loss of bone growth (children_

t/f: osteomyelitis is only an acute condition

false

can be acute or chronic

#1 cause of prosthetic failure

infection

80% of prosthetic infections are

staph

most infections following a joint replacement occur because of:

a. wound infection or operative contamination

b. dental, skin, respiratory, UTI

a

why is it hard to identify an infection following a joint replacement?

swelling, redness, increased temperature are signs of infection but also normal following sx

when do prosthetic/implant infections most commonly occur?

within first year

risk factors for prosthetic infections

prior surgery at site

RA

immunosuppression

diabetes mellitus

t/f: even when an incision is closed, patient's joint can still become infected

true

with a severe infection of a prosthetic, the prosthetic will be

removed

joint replacement infection treatment

remove implant

debride tissue

antibiotic cement

IV antibiotics for at least 6 weeks

new joint replacement

diskitis

bacterial infection of disk space between vertebrae

t/f: diskitis does not usually occur in children

false

in children, diskitis might occur because of

respiratory infection

UTI

In adults, diskitis might occur because of

post-op complication

post-injection

UTI

URI

diskitis (may/may not) be relieved by rest

may not

red flags in children relating to diskitis

inability/refusal to flex spine

LBP*

fever*

wont WB or walk

hip extension pain

diskitis diagnosis

x ray

MRI

cultures

bloodwork

diskitis treatment

rest antibiotics

diskitis prognosis

good but pain may persist

infectious (septic) arthritis

bacterial infection in joint

causes inflammation of synovial membrane, which destroys cartilage, and causes pain/arthritis

infectious (septic) arthritis

reactive arthritis

acute, asceptic inflammation arising after infection but at a site remote from primary infection

causes joint to have inflammatory response, causes pain/arthritis

reactive arthritis

septic arthritis common causes

staph

gonorrhea

fluid aspiration must be done with

septic arthritis

primary risk factor for septic arthritis

pre-existing abnormal joint

common joints for septic arthritis

hip

knee

ankle

elbow

prognosis is good for septic arthritis if treatment is initiated during what time frame?

5-7 days

t/f: any infection in a joint is not considered a medial emergency

false

when can articular cartilage and subchondral bone be destroyed within?

17 days

commonly infected bursa

olecranon bursa

tendon can be infected by

spread of infection along synovial sheaths

reiter syndrome demographic

male, 30, sexually active

reiter syndrome symptoms

cant see, cant pee, cant climb a tree

risk factors for AVN

alcoholism

decompression sickness

hip dislocation