Bones and Joints Learning Objectives (L34-35)

Question 1

What hormonal conditions causes a decrease in bone mass?

Answer 1

Menopause, amenorrhoea, andropause

Question 2

What nutritional and environmental factors can increase bone mass?

Answer 2

– Calcium
– Vitamin D
– Sun exposure

Question 3

More activity is associated with __________ bone mass

Answer 3

Higher

Question 4

What types of exercise have the greatest effect on peak bone mass?

Answer 4

Weight-bearing exercise

Question 5

During resistance training, why do we observe increases in site-specificity bone mass?

Answer 5

Exercise acts by local mechanical stimulation of bone
* Mechanical stress stimulates osteoblasts
* Osteoblasts increase calcium uptake
* Bone rebuilds and becomes denser

Question 6

If you wanted to increase site-specific bone accrual of the upper torso, how would you do it as safely and as quickly as possible?

Answer 6

• Increase the magnitude of mechanical force
• Increase the frequency of exposure
• Aim to increase strength and local muscle mass of upper torso specifically

Question 7

What is age-related reduction in bone mass called?

Answer 7

Osteopenia

Question 8

What are the %ages of bone loss for males and females over the age of 30?

Answer 8

Males lose ~ 0.4% pa after age 30
Females lose ~ 0.8% pa after age 30

Question 9

Bone mass slowly declines with age. What will determine bone mass in older adults?

Answer 9

Bone mass in older age influenced by:
* Peak bone mass achieved
* Age of menopause (in females)

Question 10

What characterises osteoporosis?

Answer 10

– Loss of bone mass (mineral density)
– Deterioration of bone architecture
– Increased bone fragility (fracture risk)

Question 11

What is the best method of preventing osteoporosis?

Answer 11

– Maximise bone mass in childhood & early adulthood
– Maintain bone mass into older age

Question 12

What are the non-modifiable risk factors of osteoporosis?

Answer 12

Genetic, age, sex

Question 13

What are the modifiable risk factors of osteoporosis?

Answer 13

Hormonal status (amenorrhoea synonymous with decreases in oestrogen), smoking, medication use (Corticosteroids), diet/nutrition, PA

Question 14

What are the PA risk factors for osteoporosis?

Answer 14

Sedentary lifestyle & low muscle mass
Prolonged bed-rest

Question 15

What are the PA protective factors for osteoporosis?

Answer 15

An active lifestyle is protective against osteoporosis

Question 16

What are some good preventative forms of PA against osteoporosis in childhood and adolescence

Answer 16

Vigorous weight-bearing exercise in childhood & adolescence
* Jumping on the spot; skipping; netball/basketball

Question 17

What are some good preventative forms of PA against osteoporosis in adulthood?

Answer 17

Regular WB
Specific resistance exercise programs recommended

Question 18

What are some good preventative forms of PA against osteoporosis women

Answer 18

Resistance training. Indicated when young and continued throughout lifespan.

Question 19

Generally, if you have more muscle, you have ______ bone.

Answer 19

More

Question 20

What are the incidences of fractures in females and males over 60?

Answer 20

2 in 3 women, and 1 in 3 men over the age of 60 will suffer an osteoporotic fracture in their remaining lifetime

Question 21

What is the common concern in female patients with history of fracture(s) and osteoporosis?

Answer 21

Secondary thromboembolism

Question 22

What is the nutritional management of osteoporosis?

Answer 22

Calcium and Vit D supplements

Question 23

What is the pharmacological management of osteoporosis?

Answer 23

– Biphosphonates
– Selective Estrogen Replacement Therapy
– Hormone Replacement Therapy

Question 24

What is the exercise management of osteoporosis?

Answer 24

– Maintain muscle leg strength to reduce risk of falls
– Balance exercises to reduce falls risk
– Deconditioning common at diagnosis
(Low intensity program initially)

Question 25

What exercises should be avoided in the management of osteoporosis?

Answer 25

Activities that twist, bend or compress the spine

Question 26

During the progression of osteoarthritis, which comes first: damage or inflammation?

Answer 26

Damage, then inflammation

Question 27

How is OA classified?

Answer 27

Chronic disease involving deterioration of joint cartilage & formation of bone (spurs) at margins of joints

Question 28

Athletes engaging in what types of sports would typically see OA develop sooner?

Answer 28

Often presents earlier in athletes from contact sports

Question 29

At what age is OA present in most people?

Answer 29

Present in most people by 70 yrs

Question 30

List the S&S of OA

Answer 30

* Pain during joint use is key symptom * Deep aching joint pain – Worse after weight-bearing or exercise – Relieved by rest * Joint swelling * Limited movement * Morning stiffness * Joint grating with motion * Joint pain varies with weather

Question 31

List the biomechanical factors that may initiate joint degradation in the progression of OA

Answer 31

* Joint trauma * Occupational overuse * Obesity * Mal-alignment of joints – E.g., bow-legs or knock-knees – Congenital abnormalities * Rheumatoid arthritis

Question 32

What is often linked to OA in the upper limbs?

Answer 32

Occupation

Question 33

Which joints are very often associated with OA in most people?

Answer 33

Weight bearing joints

Question 34

What are the joints that can develop OA?

Answer 34

Any synovial joint

Question 35

What is the aim in exercise intervention for OA?

Answer 35

Increase strength around joints – Pain relief – Maintain or improve joint mobility – Minimise ADL disability * Improve body awareness – Joint position sense (proprioception), especially after joint replacement surgery – Posture, balance, coordination

Question 36

What improves the prognosis of OA after joint replacement surgery?

Answer 36

Prehab and rehab

Question 37

What are the current methods of pain relief from OA

Answer 37

NSAIDS COX-2 inhibitors Corticosteroids (local injections) Glucosamine & chondroitin sulphate Artificial joint fluid injections (e.g., Synvisc)

Question 38

How would you determine the best type of exercise for someone with OA?

Answer 38

Whichever is associated with less pain (cycling normally better tolerated)

Question 39

What characterises RA?

Answer 39

Autoimmune Chronic systemic inflammatory disease Disease onset gradual Pain, swelling & stiffness Periods of exacerbation and remission

Question 40

List the S&S of RA

Answer 40

– Fatigue – Stiffness in morning (> 1 hr) or after inactivity – Diffuse muscle aches – May have low-grade fever – Loss of appetite (tissue catabolism) – Weakness

Question 41

What is the significant markers that are found in the blood that indicates RA?

Answer 41

Rheumatoid factor Elevated ESR (Erythrocyte Sedimentation Rate) CRP (C-Reactive Protein)

Question 42

A patient is complaining of episodic periods of joint pain. You notice local joint deformities like ulnar deviation. What might they have?

Answer 42

RA

Question 43

RA doesn't just affect joints. List other structures that RA can affect

Answer 43

May cause inflammation of lungs, blood vessels, pericardium, eye May lead to neuropathies May lead to anemia & stomach bleeds

Question 44

How does RA shorten life expectency?

Answer 44

CVD