index cards for chapter 53 osteo

7/27/2019 Index Cards for Chapter 53 Osteo

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What findings can be identified with

the use of a x-ray of the spine?


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X-ray of the spine may demonstrate

a fracture, dislocation, infection,

osteoarthritis or scoliosis.


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Bone scan and blood studies


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disclose infections, tumors, and

bone marrow abnormalities.


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Computed tomography


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useful in identifying soft tissue

lesions adjacent to the vertebral

column


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Electromyogram


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used to evaluate spinal nerve root

disorder


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Osteoporosis


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Chronic metabolic disease, in whichbone loss causes decreased density andpossible fracture


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Osteopenia (low bone mass),


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When osteoclastic (bone resorption) activity is

greaterthan osteoblastic (bone building) activity.Result is decrease bone mineral density

Osteopenia is present when the T scoreis at -1 and above -2.5


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Diagnosis of osteoporosis


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based on Bone Mineral Density testingthat gives a T score.

The T score is a number of standarddeviations above or below the average

BMD. (bone marrow density)Osteoporosis T score is at or lower than

-2.5


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OsteoporosisManifistations


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Normal homeostatic bone turnover is altered and therate of bone resorptionis greater than the rate of bone

formation,

resulting in loss of total bone mass Bone becomes porous, brittle, and fragile, and break

easily under stress

Frequently result in compression fractures of the spine,fractures of the neck or intertrochanteric region of the

femur, and Colles fractures of the wrist


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OsteoporosisRisk factors


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Occurrence of osteopenia and osteoporosis Family history Previous fractures Dietary consumption of calcium Exercise patterns Onset of menopause Use of corticosteroids as well as alcohol, smoking,

and caffeine intake

Small frame/white females


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Classification ofOsteoporosis


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Generalized osteoporosisoccurs most commonly inpostmenopausal women and men in their 60s and 70s

Secondary osteoporosisresults from an associatedmedical condition such as hyperparathyroidism, long-

term drug therapy, long-term immobility(Table 53-1 p

1120)

Regional osteoporosisoccurs when a limb isimmobilized


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Causes of

Secondary osteoporosisDiseases/Conditions


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a. Diabetes mellitusb. Hyperthyroidismc. Hyperparathyroidismd.

Cushing syndrome

e. Growth hormone deficiencyf. Metabolic acidosisg. Female hypogonadismh. Pagets diseasei. Osteogenesis imperfecta

j. Rheumatoid arthritisk. Prolonged immobilizationl. Bone cancerm. Cirrhosisn. HIV/AIDSo. Chronic airway limitation


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Causes of

Secondary osteoporosisCHRONIC USE OF DRUGS


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a. Corticosteroidsb. Heparinc. Anticonvulsants

1. Phenobarbital2. Phenytoin

d. Ethanol (alcohol)e. Drugs that induce hypogonadism (decreased levels of sex hormonef. High levels of thyroid hormoneg. Cytotoxic agenth. Immunosuppressantsi. Loop diuretics

j. Aluminum-based antacids


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Assessmentosteoporosis


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Physical assessment-assess for fall risk, assess for kyphosis Psychosocial assessment-asses for pain, depression, body image Laboratory assessment-assess biochemical markers Imaging assessment

DXA-means of measuring bone mineral density (BMD),assessment for spine and hip

QCT-(measure volumetric bone mineral density)-assesschange in vertebral column. More expensive than DXA

scan

QUS(bone density test using sound waves-test heel, tibia,and patella for osteoporosis


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Osteomalacia


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Loss of bone related to vitamin D deficiency Bone softens because of inadequate deposits of

calciumand phosphorusin the bone matrix Rickets or Vitamin D deficiency in children


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Osteomalacia


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A metabolic bone disease characterized by inadequate bonemineralization

Softening and weakening of the long bonescauses pain,tenderness, and deformities caused by the bowing of bonesand

pathologic fractures

Deficiencyof activated vitamin Dcauses lack of bonemineralization and low extracellular calcium and phosphate

Causes include gastrointestinal disorders, severe renalinsufficiency, hyperparathyroidism, and dietary deficiency (Table

53-3 p 1128)

Assessment-assess GI problems (IBD, etc) The major treatment for osteomalacia is vitamin D


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OsteomalaciaCauses


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a. Vitamin D disturbance1. Inadequate production2. Lack of sunlight exposure3. Dietary deficiency4.

Abnormal metabolism5. Durg therapy1. PHENYTOIN (DILANTIN)2. FLUORIDE3. BARBITURATES

b. Live diseasec. Renal diseased. Inadequate absorption

1. Postgastrectomy2. Malabsorption syndrome

e. Inflammatory bowel diseasef. Chronic kidney diseaseg. Acute tubular disorders

1. Acidosis2. Hypophosphatemia

e. familial metabolic error1. hypophosphatemia


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Comparison of

Osteoporosis to Osteomalacia


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Osteoporosis

a. decreased bone massb. lack of calciumc. osteopenia, fractured. calcium level (low/normal)e. phosphate level (normal)f. parathyroid hormone (normal)g. alkaline Phosphatase (normal)

Osteomalacia

a. demineralized boneb. lack of vitamin Dc. pseudo fractures, Loosers zones, fracturesd. calcium level (low or normal)e. phosphate level (low or normal)f. parathyroid hormone (high or normal)g. alkaline phosphatase (high)


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Pagets Disease of the

Bone


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Chronic metabolic disorder in which bone is excessively broken down andreformed

AKA osteitis deformans Disorder of localized bone turnover Incidence:2-3% of population older than age 50 More common in men and risk increases with aging; familial predisposition has

been noted

Pathophysiology: excessive bone resorption by osteoclasts is followed byincreased osteoblastic activity. Bone structure disorganized, weak and highly

vascular

Patients are at risk for fractures, arthritis, and hearing loss


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Pagets disease

Manifestations


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Clinical Manifestations include skeletal deformities, mild to moderateaching pain, and tenderness and warmth over bones

Symptoms may be insidious and may be attributed to old age or arthritis Most patients do not have symptoms Some do c/o pain. Sites involved are usually hip and pelvis. Described as

aching, poorly defined, deep and worse with pressure. Mostly at night.

Pathologic fracture may be first symptom of disease. One complicationis osteogenic sarcoma


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Osteomyelitis


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Infection of the bone Occurs due to:

Extension of soft tissue infection Direct bone contamination Blood-board spread from another site of infection-this typically

occur in an area of bone that has been traumatized or has

lowered resistance

Causative organisms Staphylococcus aureus (70-80%) Other: Proteus and Pseudomonas species, E. coli


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Benign Bone Tumors


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Often asymptomatic and may be discovered on routine x-ray or asa curse of pathologic fracture.

Classification of tissues: Chrondrogenictumors-from cartilage Osteogenictumors-from bone Fibrogenic tumors-from fibrous tissue; most commonly

found in children


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Bone Tumors


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Primary tumors Benign tumorsare more common and generally are slow

growing and present few symptoms

Malignant-prognosis depends upon type and whether thetumor has metastasized.

Osteogenic sarcoma is the most common, and most often fatal,primary malignant bone tumor

Metastatic bone tumors more common than primary tumors


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Dupuytrens Contracture


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Slowly progressive contracture of

the palmar fascia resulting in flexionof the fourth or fifth digit of the

hand.


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Ganglion


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Round, benign cyst often foundon a wristor foot jointortendon.

Painless when touched but causejoint discomfort.


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Foot disorders


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Mortons neuroma-small tumor grows in a digital nerveof the foot. Pain involves 3

rd-4

thtoesand web between

toes.

Plantar Fascitis-inflammation of tissue involving area ofarch of foot. Severe pain especially when getting out of

bed.

Tarsal tunnel syndrome-pain and numbness in the sole

of the foot. Can be caused by ankle fracture that

compresses the posterior tibial nerve


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Pagets Disease of the

Bone

Key features


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a. Bone and joint pain (may be in single bone)1. Bone is aching2. Poorly described3.

Aggravated by walkingb. Low back and Sciatic nerve pain

c. Bowing of long bonesd. Loss of normal spinal curvaturee. Enlarged thick skullf. Pathologic fracturesg.

Osteogenic sarcoma (bone cancer)h. Flushed/Warm Skin

i. Apathy, lethargy, fatiguej. Hyperparathyroidismk. Goutl. Urinary or Renal Stonesm.

Heart failure from fluid overload

index cards for chapter 53 osteo

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