What is the definition of arthritis?
Inflammation of Joints
What is the definition of arthrosis
non-inflammatory joint disease
what is arthralgia
joint pain
Describe Bone
(also,what does bone require to repair)
- mineralised connective tissue
- load bearing
- dynamic (constantly remodelling and self repairing)
- requires calcium, phosphate and vitamin D to repair
How do bone and calcium interact>
- if systemic calcium is low, bone will resorb to release calcium into blood
- caused by an increase in parathyroid hormone
What is the relation between parathyroid hormone and bone?
- maintains serum calcium level (raised if calcium levels fall)
- increases calcium release from bone
- reduces renal calcium excretion
What is primary hyperparathyroidism and what is its effect?
-gland dysfunction (often caused by a tumour)
- increased secretion of PTH
- inappropriate activation of osteoclasts
- increased bone resorption
What does hypoparathyroidism result in ?
low serum calcium
What is secondary hyperparathyroidism and what is its effect?
- low serum calcium triggers
- increased secretion of PTH
- appropriate activation of osteoclasts
- regulates serum calcium
What causes low levels of vitamin D?
low sunlight exposure (housebound or dark skinned in northern country)
poor GI absorption (poor nutrition, small intestinal disease (malabsorption)
drug interactions (anti-epileptics)- Carbamazepine
What is an osteomalacia
- poorly mineralised osteoid matrix
- poorly mineralised cartilage growth plate
- bone is plaible and soft
- normal amount of formation of bone
What is osteoporosis?
- loss of mineral and matrix
(formation is correct but reduced quantity) - REDUCED bone mass
What is rickets?
osteomalacia that forms during bone formation
What are the bone effects of osteomalacia ?
bones bend under pressure
- ‘bow legs’ in children
- vertebral compression in adults
What are the affects of hypocalaemia?
- muscle weakness
- carpal muscle spasm
- facial twitching from VII tapping
How does osteomalacia present in a blood test?
- serum calcium DECREASED
- serum phosphate DECREASED
- alkaline phosphatase HIGH
- plasma creatine INCREASE (if renal cause)
- plasma parathyroid hormone INCREASE (if secondary hyperparathyroidism)
What is osteoporosis and who would it generally effect?
a reduced quantity of normally mineralized bone
- age related change
- inevitable
How do you manage osteomalacia?
- correct the cause
malnutrition (control GI disease)
Sunlight exposure (30min x5 weekly)
Dietary - Vitamin D
What are the key risk factors for osteoporosis?
- age
- female
- endocrine (oestrogen/testosterone deficiency, cushings)
- genetic (FH, race (caucasian and asian woman), early menopause)
- patient factors, (inactivity, smoking, alcohol abuse, poor dietary calcium)
- medical drugs use (steroids and antiepileptics)
What age is peak bone mass
24-35 years old
Why is osteoporosis more common in woman?
- males have higher peak bone mass
- oestrogen withdrawal (menopause) increases bone mass loss rate in woman
What are the noticeable effects of osteoporosis ?
- increases bone fracture risk (long bones- femur)
- vertebrae (height loss, scoliosis/kyphosis, nerve root compression resulting in back pain)
What are the effects of osteoporosis STATS
How can osteoporosis be prevented?
- build maximal peak bone mass (exercise, high calcium diet)
- reduce rate of bone mass loss
reduce hormone related effects (eostrogen hormone replacement therapy, effective if early menopause)
reduce drug related effects
consider osteoporosis prevention drugs
- BISPHOSPHONATES
