Bone Biology for Medical Students

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Questions and Answers

How many bones are typically found in the adult human skeleton?

  • 212
  • 210
  • 205
  • 215
  • 206 (correct)

Identify the smallest bone in the human body.

  • Phalanges
  • Malleus
  • Nasal bone
  • Stapes (correct)
  • Incus

Which type of bone cell is primarily targeted by anti-resorptive medications?

  • Osteocytes
  • Osteoclasts (correct)
  • Osteoblasts
  • Chondrocytes
  • Osteogenic cells

Approximately what percentage of muscle mass is lost per day in patients in the Intensive Care Unit (ICU)?

<p>2% (E)</p> Signup and view all the answers

Over what period is the entire adult human skeleton typically replaced through remodeling?

<p>Every 10 years (C)</p> Signup and view all the answers

Which of the following cells is primarily responsible for building new bone tissue?

<p>Osteoblasts (D)</p> Signup and view all the answers

Identify the primary function of osteoclast cells in bone tissue.

<p>Resorbing or breaking down bone (A)</p> Signup and view all the answers

What is the main role of osteocytes within bone?

<p>Mechanical sensor and signal transducer (E)</p> Signup and view all the answers

What type of tissue are chondrocytes responsible for producing?

<p>Cartilage (A)</p> Signup and view all the answers

Synovial joints in humans are characterized by having a very low coefficient of friction. Which component contributes most significantly to this?

<p>Articular cartilage (A)</p> Signup and view all the answers

Bone remodeling is described as a 'marriage of two cells'. Which pair of cells is being referred to in this context?

<p>Osteoblasts and Osteoclasts (D)</p> Signup and view all the answers

What is the role of Osteoprotegerin (OPG) in bone remodeling?

<p>Blocks RANK-RANK ligand interaction, inhibiting osteoclastogenesis (C)</p> Signup and view all the answers

During bone remodeling, which of the following directly stimulates osteoclast precursor cells to differentiate into mature osteoclasts?

<p>RANK Ligand (RANKL) (A)</p> Signup and view all the answers

What is the term for the process by which bone cells sense and respond to mechanical strain?

<p>Mechanotransduction (E)</p> Signup and view all the answers

Which of the following is a key component released by osteoclasts to resorb bone mineral?

<p>Acid and proteinases (A)</p> Signup and view all the answers

What is the approximate pH within the resorption lacuna created by osteoclasts?

<p>pH ~ 3.75 (E)</p> Signup and view all the answers

Which of the following is the primary mineral component of bone?

<p>Hydroxyapatite (A)</p> Signup and view all the answers

What is the main organic component of bone extracellular matrix?

<p>Collagen type 1 (A)</p> Signup and view all the answers

Which type of bone is characterized by a dense outer layer and forms the protective exterior of bones?

<p>Cortical bone (B)</p> Signup and view all the answers

Identify the type of bone that is spongy in nature and found in the interior of bones, containing marrow.

<p>Cancellous bone (E)</p> Signup and view all the answers

What is the term for bone that is newly formed rapidly, often in fracture repair or pathological conditions, and characterized by a disorganized collagen fiber arrangement?

<p>Woven bone (E)</p> Signup and view all the answers

Which of the following best describes the structural organization of lamellar bone?

<p>Organized collagen fibers in parallel layers or sheets (E)</p> Signup and view all the answers

What is the primary effect of Bisphosphonates (BisP) on bone cells?

<p>Integrate into bone and inhibit osteoclast activity, leading to osteoclast apoptosis (D)</p> Signup and view all the answers

How does Denosumab function as an anti-resorptive medication?

<p>By inhibiting RANKL binding to RANK, thus reducing osteoclast formation and activation (E)</p> Signup and view all the answers

What is a potential risk associated with the abrupt cessation of Denosumab treatment?

<p>Rebound increase in vertebral fracture risk (B)</p> Signup and view all the answers

What is the 'brain-bone-gut axis' referring to in the context of bone biology?

<p>The communication network involving nerves, hormones, and cytokines between the brain, bone, and gut (B)</p> Signup and view all the answers

Which vitamin is crucial for calcium absorption in the gut and plays a significant role in bone health?

<p>Vitamin D (E)</p> Signup and view all the answers

What is the active form of Vitamin D produced in the kidneys?

<p>1,25-dihydroxyvitamin D3 [1,25(OH)2D3] (E)</p> Signup and view all the answers

In Vitamin D deficiency, low serum calcium levels stimulate the release of which hormone?

<p>Parathyroid Hormone (PTH) (B)</p> Signup and view all the answers

Osteomalacia, a condition related to Vitamin D deficiency in adults, is characterized by:

<p>Inadequately mineralized osteoid (C)</p> Signup and view all the answers

Osteopetrosis, also known as 'marble bone disease', is primarily caused by a defect in which cell type?

<p>Osteoclasts (D)</p> Signup and view all the answers

The primary treatment strategy for osteopetrosis focuses on:

<p>Supportive care for fractures and neuropathies (D)</p> Signup and view all the answers

Which of the following is considered a 'pathological fracture'?

<p>Fracture in a bone weakened by disease (E)</p> Signup and view all the answers

In the context of bone tumors, 'lytic lesions' refer to areas of:

<p>Bone destruction or resorption (B)</p> Signup and view all the answers

Which of the following conditions is characterized by inadequately mineralized osteoid in children due to Vitamin D deficiency?

<p>Rickets (A)</p> Signup and view all the answers

In osteoporosis, the primary underlying issue at the cellular level is:

<p>Decreased osteoblast activity compared to osteoclast activity (A)</p> Signup and view all the answers

In an 85-year-old female presenting with a mechanical fall and groin pain, with no prior pain or medications, and no apparent external cause for the fall except 'catching her foot', what is the MOST likely finding on X-ray?

<p>Intertrochanteric fracture of the proximal femur (B)</p> Signup and view all the answers

If the 85-year-old female in the previous question is diagnosed with osteoporosis, how would her T-score be defined?

<p>T-score &lt; -2.5 SD (E)</p> Signup and view all the answers

For the 85-year-old female with osteoporosis and a hip fracture, which of the following treatments could be considered as first-line anti-resorptive therapy?

<p>Bisphosphonates (BisP) (D)</p> Signup and view all the answers

What is the primary mechanism of action of Teriparatide (TeraP) in treating osteoporosis?

<p>Anabolic - stimulates osteoblast activity and bone formation (E)</p> Signup and view all the answers

Which of the following is NOT a known risk factor for developing osteoporosis?

<p>High body mass index (BMI) (C)</p> Signup and view all the answers

Which of the following conditions is NOT typically associated with increased risk of pathological fractures?

<p>Osteoarthritis (B)</p> Signup and view all the answers

Which of the following statements is TRUE regarding 'woven bone' compared to 'lamellar bone'?

<p>Woven bone is characterized by a disorganized collagen matrix and is formed rapidly. (B)</p> Signup and view all the answers

Considering the bone-brain-gut axis, which neurotransmitter produced in the gut has been shown to influence bone metabolism?

<p>Serotonin (C)</p> Signup and view all the answers

Which of the following minerals constitutes the primary inorganic component of the bone extracellular matrix, providing rigidity and strength?

<p>Hydroxyapatite (D)</p> Signup and view all the answers

Compared to woven bone, how is lamellar bone structurally characterized?

<p>Parallel arrangement of collagen fibers in distinct layers or sheets. (A)</p> Signup and view all the answers

In the context of bone remodeling, what is meant by 'coupling' between bone resorption and formation?

<p>The coordinated and sequential activity of osteoclasts and osteoblasts at the same site to maintain bone homeostasis. (D)</p> Signup and view all the answers

What is the primary site of synthesis for 1,25-dihydroxyvitamin D, the hormonally active form of Vitamin D that is crucial for calcium homeostasis?

<p>Kidneys (A)</p> Signup and view all the answers

What is considered the principal function of osteocytes within bone tissue?

<p>Acting as mechanosensors to detect and respond to mechanical loading. (A)</p> Signup and view all the answers

Flashcards

How many bones?

The number of bones in the human body is 206.

What is the smallest bone?

Stapes is the smallest bone in the human body.

Targeted bone cell?

Osteoclasts are the primary target for medicines.

ICU muscle loss?

2% of muscle mass is lost per day in ICU.

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All skeleton bone replaced?

All skeleton bone mass is replaced every 10 years.

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Osteoblast function?

Osteoblasts build bone.

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Osteoclast function?

Osteoclasts cut/resorb bone.

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Osteocyte function?

Osteocytes are mechanical sensors in bone.

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Chondrocyte function?

Chondrocytes form cartilage.

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Bone remodeling process?

Bone remodeling involves a marriage of osteoblasts and osteoclasts.

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What is bone coupling?

Bone resorption-formation coupling involves a coordinated process.

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Osteoclast resorption method?

Osteoclasts resorb bone using proteinases and acid.

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What is bone structure?

Bone consists of cortical (compact) and cancellous (spongy) structure.

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Bone composition?

Bone is composed of type 1 collagen and hydroxyapatite.

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What is lamellar bone?

Lamellar bone is a mature bone with organized collagen.

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What is woven bone?

Woven bone is immature bone with disorganized collagen; can be found after fractures occur.

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Osteocytes Function?

Osteocytes sense strain and stress and vibrate bone to strengthen it

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Problems from Osteoporosis?

Dysregulation of bone can cause 'dead bone', and can lead to ONJ (osteonecrosis of the jaw) and atypical fractures

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BisP and Denosumab Both?

Bisphosphonates and Denosumab both decouple bone remodeling and inhibit OC

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Denosumab problem

Only Denosumab causes rebound in vertebral fractures

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Gut Health?

Gut Microbiota can greatly affect bone

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How is Vitamin D activated?

Vitamin D activates with UVB light.

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What does vitamin D help?

Vitamine D increases Bone mineralisation.

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What is osteomalacia?

Osteomalacia is bone demineralization.

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How does bisphosphonates work?

Bisphosphonates integrate in bone and kill OC

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Study Notes

Bone Biology Overview

  • Dr. Sebastien Stephens presents bone biology for medical students.
  • The presentation covers bone structure, function, dysregulation, and treatment.

Bone Structure

  • Bones contain four cell types: osteoblasts, osteoclasts, osteocytes, and chondrocytes.
  • Bone structure is either cortical or cancellous.
  • Bone remodeling involves endochondral and intramembranous ossification, important for healing.
  • Bone development includes embryology.

Bone Function

  • The bones metabolic functions include mineral reservior and erythropoiesis.
  • Mechanically, bones facilitate movement, offer protection, and transduce sound.
  • The brain-bone-gut axis plays a role in bone function.

Bone Composition and Turnover

  • The adult skeleton contains 206 bones.
  • The stapes is the smallest bone.
  • Medicines often target osteoclasts.
  • Osteoclasts are targeted because they are anti-resorptive.
  • Medicines targeting osteoclasts are used in cases of osteoporosis, Paget's disease, osteolytic lesions, hypercalcemia, chronic kidney disease (CKD), diabetes, autoimmune disorders, and periprosthetic lysis.
  • Muscle mass loss in the ICU averages 2% per day.
  • ICU patients can lose 50% of their bone mass in 2/52 (presumably weeks).
  • The entire skeleton bone mass is replaced approximately every 10 years.

Bone Cells

  • Osteoblasts build bone.
  • Osteoclasts cut bone.
  • Osteocytes are mechanosensors that respond to mechanical strain.
  • Chondrocytes produce cartilage.

Bone Remodeling

  • Bone remodeling involves osteoblasts and osteoclasts.
  • Osteocytes act as central orchestrators of bone mass via mechanical forces.
  • Osteocytes sense vibration, strain, and stress which helps strengthen bone.
  • Mechanotransduction in ICU patients can result in 50% bone loss in 2/52.
  • Bone remodeling is coupled, involving bone resorption and formation.

Osteoclast Function

  • Osteoclasts resorb bone by releasing proteinases and acids.
  • Optimal function of osteoclasts relies on a pH of approximately 3.75.

Bone Structure Details

  • Bone includes cortical and trabecular (cancellous) components.
  • Key components include:
    • Periosteum
    • Endosteum
    • Medullary cavity
  • Bone consists of Type 1 collagen and hydroxyapatite.
  • Blood supply is mainly through the periosteum and intramedullary vessels.
  • Types of bone include lamellar, woven, cortical, and cancellous.

Dysregulation and Disease

  • Dysregulation can occur when osteoblast and osteoclast activity is decoupled.
  • Decoupling can be caused by antiresorptive treatments.
  • Can result in "dead bone", osteonecrosis of the jaw (ONJ), and atypical fractures.
  • Osteocytes decrease in number.
  • Bisphosphonates and Denosumab both decouple bone remodeling and inhibit osteoclasts.
  • Denosumab can cause a rebound effect that increases the risk of vertebral fractures.

Bone-Brain-Gut Axis

  • The bone-brain-gut axis involves communication between these systems
  • Includes nerves, hormones, and cytokines.
  • The gut has the largest influence on the immune system and affects bone mass.
  • Bone to brain is linked via VPN.

Vitamin D

  • Vitamin D formation begins with UVB exposure.
  • Vitamin D affects parathyroid hormone (PTH) synthesis, renin expression, microbicidal activity and more.
  • Vitamin D deficiency can lead to hypocalcemia, osteomalacia, and osteoporosis.
  • PTH increases when the body needs to raise calcium levels.
  • Osteomalacia occurs when bone is inadequately mineralized.

Disease States

  • Primary and secondary hyperparathyroidism can affect bone.
  • Lytic bone disease includes primary and secondary malignant tumors.
  • Old age can result in bone loss and osteoporosis.
  • Osteoporosis can be linked to decreased levels of estrogen.
  • Osteopetrosis, or marble bone disease, is a rare condition where osteoclasts cannot resorb bone.

Treatments

  • Treatments address the underlying cause (e.g., mets, diet).
  • Medications are primarily antiresorptive.
    • Bisphosphonates integrate into bone and kill osteoclasts.
    • Denosumab inhibits REANL binding to REANK.
    • Teriparatide is a pulsed recomb-PTH anabolic agent.
    • Calcium and Vitamin D, along with a healthy diet and exercise, are beneficial
  • Bisphosphonates and Denosumab should not be combined.

Quiz Scenarios,

  • An 85-year-old patient with a mechanical fall and groin pain may present with an atypical fracture of the proximal femur.
  • A patient with osteoporosis would have a T score of less than -2.5 SD.
  • 6 months later with thoracic back pain, could be treated with Bisphosphonates.
  • Stopping Denosumab has a risk of rebound fracture.

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