Path2: Metabolic disorders of the musculoskeletal system

AS Quizlet

Clinical disorders with Increased bone resorption or decreased ossification:

-osteoporosis

-rickets and osteomalacia

-osteolytic neoplasms

Clinical disorders with reduced bone resorption or increased ossification:

-acromegaly

-osteopetrosis

What is the most serious, potentially life threatening, and costly complication of metabolic bone disease?

Fractures

Combination of decreased bone mass and micro damage to the bone structure resulting in susceptibility to fracture

Osteoporosis

1. Primary osteoporosis (over 95%)

2. Secondary osteoporosis (under 5%)

What are two kinds of osteoporosis?

Primary osteoporosis

-often follows menopause

-occurs later in life of men

Testosterone, Lack of estrogen

What protects male from osteoporosis?

-prolonged administration of prednisone

-diabetes

-inadequate intake of calcium and vitamin C

-mal-absorption syndrome

-prolong immobilization

-anticonvulsant drugs

-anticoagulants

-some tumors

What are causes of the secondary osteoporosis?

1. Post menopausal/estrogen-deficient

2. Age-related/senile

What are the two types of primary osteoporosis?

Primary osteoporosis

Most common metabolic bone disease. The cause is unknown

Osteopenia

In US, 10 million people are affected by primary osteoporosis, 34 million suffer from _________________

Women (especially post menopausal)

Primary osteoporosis is much more common in ___________

2

Men usually have type _____ osteoporosis

Women

1 in every 2 _________ older than 50 will experience fractures secondary to osteoporosis

Men

1 in 4 _______ experience osteoporosis-related fracture, but later in life (after 70)

-50 or older

-Caucasian/asian

-north European

-Menopausal

-family history

-depression

-diet and nutrition

What are other risk factors for osteoporosis?

-loss height

-postural changes

-back pain

-fracture

What are clinical manifestations of osteoporosis?

"Silent" compression

Osteoporotic fractures are often ____________________ fractures. May occur without injury or fial

Vertebral body (VCF)

Osteoporotic fracture occurs most frequently in ___________

-Vitamin D (helps absorption, synthesis, and transport of calcium in the body)

-Calcium

Medical management of osteoporosis:

bone mineral density (BMD) testing

What is recommended for every women 65 or older?

Osteoarthritis

Osteoporosis may be misdiagnosed with ______________ by X-ray only

Osteomalacia (soft bone)

Progressive disease characterized by lack of mineralization of new bone matrix in the adult resulting in softening of bone without loss of the present bone

-calcium

-vitamin D

-phosphate

Osteomalacia is related to the deficiency of:

1. Insufficient calcium absorption in the intestines

-lack of calcium

-vitamin D deficiency

-resistance to action of vitamin D

2. Increase phosphorus loss in the kidney

- renal dysfunction

What are two primary causes of osteomalacia?

What are some other causes of osteomalacia?

-Hyperparathyroidism ( removing excessive calcium from bone tissue)

-Aluminum containing anti-acids (Maalox) may prevent the intestinal absorption

-Housebound and institutionalized individuals at higher risk

-Malabsorption conditions

-Pancreatic insufficiency

-Greater incidence in colder geographic regions

-Deficient vitamin D in the diet (some Asian countries, aged adults, avoidance of sunlight)

-Medication (Anticonvulsants; Anti-acids)

What are some incidence and risk factors of osteomalacia?

1. Stimulates intestinal absorption of calcium and phosphorus

2. Essential for mineralization of the osteon and mobilization of calcium from the calcified bone

3. Stimulates the parathyroid-hormone-dependent resorption of calcium in the kidney

What are 3 basic functions of the vitamin D?

Initially, diffuse, generalized aching and fatigue

-anorexia and weight loss

-pain in the spine, ribs, pelvis, and proximal extremities

-postural deformities

-bowing femur and tibia

-muscle weakness (due to lack of calcium)

What are clinical manifestations of osteomalacia?

Rickets

Generalized condition of growing bone characterized by a failure of proper deposition of calcium in the epiphyseal plates with abnormal bone formation seen primarily in infancy and childhood

-caused by the deficiency of vitamin D

Soft bones causing deformities:

-bowlegs and knock-knees

-craniotabes

-delayed and abnormal dentition

-nodular enlargements of the end and sides of bones

-chest deformities (rachitic rosary)

What are clinical manifestations of rickets?

Paget's disease (Osteitis deformans)

-Second most common metabolic disorder after osteoporosis

-Chronic, progressive disorder of the adult skeleton characterized by abnormal bone remodeling in one or more sites

1. Excessive, unorganized (weakened) new bone formation (activated osteoclasts)

-deformity, fractures, pain, arthritis

2. The eventual replacement of normal bone marrow by vascular and fibrous tissue

Paget’s disease is characterized by the increased bone resorption paired with:

Aging adult

Paget's disease is common in _________________ population

35

Paget's disease is rare before the age of ___________

Men

Prevalence of the Paget's disease has been declining, but it's slightly more prevalent in _______

Asian, African, South America

Paget’s disease is almost non-existent in:

Britons and their descendants in US and Australia

Paget's disease has highest prevalence in:

-unknown cause (slow viruses may play a role)

-Often inherited (autosomal dominant)

What's the etiology of Paget's disease?

Osteosarcoma

___________________may develop as late complication of Paget’s disease

X-ray

-Honeycomb or cotton-wool appearance of bone

-Fracture and deformities

How can we diagnose Paget's disease?

Insidiously; slowly

Paget's disease begins _______________ and progresses ___________

-Bone pain and deformity are common presentation

-Multifocal disease that may release calcium into the blood causing weakness, fatigue, loss of appetite, abdominal pain, constipation

-Pathological fracture may occur

-mental deterioration

What are clinical manifestations of Paget's disease?

1. Destructive phase

2. Mixed phase

3. Osteosclerotic phase

Three phases of Paget's disease:

Destructive phase of Paget's disease

Bone resorption

Mixed phase of Paget's disease

New bone formation

Osteosclerotic phase of Paget's disease

-Normal compact bone is replaced by sclerotic, dense bone

-Normal trabecular bone is thickened

-Histologic (tissue) mosaic appearance

Osteosarcoma

People with Paget's disease have a increased risk of developing __________

Endocrine disorder

Musculoskeletal symptoms and signs may be the initial presentation of an __________________

Excessive secretion of the growth hormone by the hypophysis gland (pituitary gland)

Both Gigantism and Acromegaly are the result of:

Gigantism

-develops abruptly in children

-Overgrowth of the long bones

Acromegaly

-develops slowly in adults

-increased in bone thickness

-hypertrophy of soft tissue (internal organ also grow)

Osteopetrosis (marble bone)

Inherited disorder characterized by a generalized increased in bone density

Faulty bone resorption resulting from deficiency of the osteoclasts

Osteopetrosis is probably caused by:

Autosomal recessive disorder

Osteopetrosis can be transmitted as an ___________________

Marrow cavity

In osteopetrosis, the ___________________ is obliterated, causing anemia (lack of blood)

-deformities of the skull

-compression of cranial nerves (blindness, deftness, early death)

Osteopetrosis causes: