Podcast
Questions and Answers
How many bones are typically found in the adult human skeleton?
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.
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?
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)?
Approximately what percentage of muscle mass is lost per day in patients in the Intensive Care Unit (ICU)?
Over what period is the entire adult human skeleton typically replaced through remodeling?
Over what period is the entire adult human skeleton typically replaced through remodeling?
Which of the following cells is primarily responsible for building new bone tissue?
Which of the following cells is primarily responsible for building new bone tissue?
Identify the primary function of osteoclast cells in bone tissue.
Identify the primary function of osteoclast cells in bone tissue.
What is the main role of osteocytes within bone?
What is the main role of osteocytes within bone?
What type of tissue are chondrocytes responsible for producing?
What type of tissue are chondrocytes responsible for producing?
Synovial joints in humans are characterized by having a very low coefficient of friction. Which component contributes most significantly to this?
Synovial joints in humans are characterized by having a very low coefficient of friction. Which component contributes most significantly to this?
Bone remodeling is described as a 'marriage of two cells'. Which pair of cells is being referred to in this context?
Bone remodeling is described as a 'marriage of two cells'. Which pair of cells is being referred to in this context?
What is the role of Osteoprotegerin (OPG) in bone remodeling?
What is the role of Osteoprotegerin (OPG) in bone remodeling?
During bone remodeling, which of the following directly stimulates osteoclast precursor cells to differentiate into mature osteoclasts?
During bone remodeling, which of the following directly stimulates osteoclast precursor cells to differentiate into mature osteoclasts?
What is the term for the process by which bone cells sense and respond to mechanical strain?
What is the term for the process by which bone cells sense and respond to mechanical strain?
Which of the following is a key component released by osteoclasts to resorb bone mineral?
Which of the following is a key component released by osteoclasts to resorb bone mineral?
What is the approximate pH within the resorption lacuna created by osteoclasts?
What is the approximate pH within the resorption lacuna created by osteoclasts?
Which of the following is the primary mineral component of bone?
Which of the following is the primary mineral component of bone?
What is the main organic component of bone extracellular matrix?
What is the main organic component of bone extracellular matrix?
Which type of bone is characterized by a dense outer layer and forms the protective exterior of bones?
Which type of bone is characterized by a dense outer layer and forms the protective exterior of bones?
Identify the type of bone that is spongy in nature and found in the interior of bones, containing marrow.
Identify the type of bone that is spongy in nature and found in the interior of bones, containing marrow.
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?
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?
Which of the following best describes the structural organization of lamellar bone?
Which of the following best describes the structural organization of lamellar bone?
What is the primary effect of Bisphosphonates (BisP) on bone cells?
What is the primary effect of Bisphosphonates (BisP) on bone cells?
How does Denosumab function as an anti-resorptive medication?
How does Denosumab function as an anti-resorptive medication?
What is a potential risk associated with the abrupt cessation of Denosumab treatment?
What is a potential risk associated with the abrupt cessation of Denosumab treatment?
What is the 'brain-bone-gut axis' referring to in the context of bone biology?
What is the 'brain-bone-gut axis' referring to in the context of bone biology?
Which vitamin is crucial for calcium absorption in the gut and plays a significant role in bone health?
Which vitamin is crucial for calcium absorption in the gut and plays a significant role in bone health?
What is the active form of Vitamin D produced in the kidneys?
What is the active form of Vitamin D produced in the kidneys?
In Vitamin D deficiency, low serum calcium levels stimulate the release of which hormone?
In Vitamin D deficiency, low serum calcium levels stimulate the release of which hormone?
Osteomalacia, a condition related to Vitamin D deficiency in adults, is characterized by:
Osteomalacia, a condition related to Vitamin D deficiency in adults, is characterized by:
Osteopetrosis, also known as 'marble bone disease', is primarily caused by a defect in which cell type?
Osteopetrosis, also known as 'marble bone disease', is primarily caused by a defect in which cell type?
The primary treatment strategy for osteopetrosis focuses on:
The primary treatment strategy for osteopetrosis focuses on:
Which of the following is considered a 'pathological fracture'?
Which of the following is considered a 'pathological fracture'?
In the context of bone tumors, 'lytic lesions' refer to areas of:
In the context of bone tumors, 'lytic lesions' refer to areas of:
Which of the following conditions is characterized by inadequately mineralized osteoid in children due to Vitamin D deficiency?
Which of the following conditions is characterized by inadequately mineralized osteoid in children due to Vitamin D deficiency?
In osteoporosis, the primary underlying issue at the cellular level is:
In osteoporosis, the primary underlying issue at the cellular level is:
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?
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?
If the 85-year-old female in the previous question is diagnosed with osteoporosis, how would her T-score be defined?
If the 85-year-old female in the previous question is diagnosed with osteoporosis, how would her T-score be defined?
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?
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?
What is the primary mechanism of action of Teriparatide (TeraP) in treating osteoporosis?
What is the primary mechanism of action of Teriparatide (TeraP) in treating osteoporosis?
Which of the following is NOT a known risk factor for developing osteoporosis?
Which of the following is NOT a known risk factor for developing osteoporosis?
Which of the following conditions is NOT typically associated with increased risk of pathological fractures?
Which of the following conditions is NOT typically associated with increased risk of pathological fractures?
Which of the following statements is TRUE regarding 'woven bone' compared to 'lamellar bone'?
Which of the following statements is TRUE regarding 'woven bone' compared to 'lamellar bone'?
Considering the bone-brain-gut axis, which neurotransmitter produced in the gut has been shown to influence bone metabolism?
Considering the bone-brain-gut axis, which neurotransmitter produced in the gut has been shown to influence bone metabolism?
Which of the following minerals constitutes the primary inorganic component of the bone extracellular matrix, providing rigidity and strength?
Which of the following minerals constitutes the primary inorganic component of the bone extracellular matrix, providing rigidity and strength?
Compared to woven bone, how is lamellar bone structurally characterized?
Compared to woven bone, how is lamellar bone structurally characterized?
In the context of bone remodeling, what is meant by 'coupling' between bone resorption and formation?
In the context of bone remodeling, what is meant by 'coupling' between bone resorption and formation?
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?
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?
What is considered the principal function of osteocytes within bone tissue?
What is considered the principal function of osteocytes within bone tissue?
Flashcards
How many bones?
How many bones?
The number of bones in the human body is 206.
What is the smallest bone?
What is the smallest bone?
Stapes is the smallest bone in the human body.
Targeted bone cell?
Targeted bone cell?
Osteoclasts are the primary target for medicines.
ICU muscle loss?
ICU muscle loss?
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All skeleton bone replaced?
All skeleton bone replaced?
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Osteoblast function?
Osteoblast function?
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Osteoclast function?
Osteoclast function?
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Osteocyte function?
Osteocyte function?
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Chondrocyte function?
Chondrocyte function?
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Bone remodeling process?
Bone remodeling process?
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What is bone coupling?
What is bone coupling?
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Osteoclast resorption method?
Osteoclast resorption method?
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What is bone structure?
What is bone structure?
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Bone composition?
Bone composition?
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What is lamellar bone?
What is lamellar bone?
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What is woven bone?
What is woven bone?
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Osteocytes Function?
Osteocytes Function?
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Problems from Osteoporosis?
Problems from Osteoporosis?
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BisP and Denosumab Both?
BisP and Denosumab Both?
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Denosumab problem
Denosumab problem
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Gut Health?
Gut Health?
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How is Vitamin D activated?
How is Vitamin D activated?
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What does vitamin D help?
What does vitamin D help?
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What is osteomalacia?
What is osteomalacia?
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How does bisphosphonates work?
How does bisphosphonates work?
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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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