Osteoporosis and Osteoarthritis Quiz

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Questions and Answers

Which age group has the highest prevalence of fractures related to osteoporosis?

Adults aged 30 and above

Children under 18

Women aged 50 and above (correct)

Men aged 60 and below

What is the primary mechanism by which low Vitamin D levels lead to increased bone resorption?

Increased availability of calcium in the blood

Enhanced bone mineralization

Elevated levels of parathyroid hormone (PTH) (correct)

Inhibition of osteoclast activity

Which type of fracture is commonly associated with osteoporosis and is often the result of reduced bone density?

Greenstick fracture

Stress fracture

Colles' fracture (correct)

Compound fracture

What is the main diagnostic method used to measure bone mineral density in osteoporosis patients?

Dual-energy x-ray absorptiometry (DXA) Signup and view all the answers

Which region has the highest prevalence of knee osteoarthritis?

European countries Signup and view all the answers

What change occurs in the bone marrow related to increased plasma cells in osteoporosis?

Increase in space within the marrow Signup and view all the answers

What is the expected increase in the burden of osteoporosis-related fractures by 2050 worldwide?

Double to triple Signup and view all the answers

What is the primary mechanism by which bisphosphonates help treat Paget's disease?

They inhibit the function of osteoclasts. Signup and view all the answers

What is the primary pathological change observed in osteoarthritis?

Degeneration of articular cartilage Signup and view all the answers

Which treatment option is considered the first-line for rapid normalization of alkaline phosphatase in Paget's disease?

IV zoledronic acid. Signup and view all the answers

What effect does estrogen have on bone mineralization in women?

Inhibits bone resorption Signup and view all the answers

Which component of the cartilage matrix is primarily degraded in osteoarthritis?

Aggrecan Signup and view all the answers

What type of imaging is typically performed to assess the severity of osteoarthritis?

Plain X-ray Signup and view all the answers

Which of the following skeletal sites is least likely to be affected by osteoporosis-related fractures?

Sternum Signup and view all the answers

In the context of Paget's disease, what is the significance of microfractures?

They represent areas of compromised bone strength. Signup and view all the answers

What characteristic is NOT typically associated with osteoarthritic joint tissues?

Increased cartilage thickness Signup and view all the answers

What differentiates Paget's disease from rheumatoid arthritis?

Paget's disease shows alternating areas of osteosclerosis and radiolucency. Signup and view all the answers

Which characteristic is indicative of osteomalacia or rickets seen in radiographic images?

Looser’s zones Signup and view all the answers

What histological feature is observed in bone biopsies of patients with osteomalacia?

Thick osteoid seams Signup and view all the answers

What feature seen on X-ray is indicative of osteoarthritis?

Osteophytes Signup and view all the answers

What does the typical female-to-male ratio of rheumatoid arthritis suggest?

It predominantly affects women. Signup and view all the answers

Which of the following reflects a false statement about abnormal chondrocyte behavior in osteoarthritis?

Chondrocytes stop dividing completely Signup and view all the answers

What is the most common clinical presentation of Paget’s disease?

Pathological fractures Signup and view all the answers

Which of the following is NOT a common symptom of osteoarthritis?

Rapid joint recovery Signup and view all the answers

Which skeletal sites are most commonly affected by Paget’s disease?

Pelvis and femur Signup and view all the answers

What biochemical marker is typically increased in patients with Paget’s disease?

Alkaline phosphatase Signup and view all the answers

Which of the following features is less commonly associated with Paget’s disease?

High incidence of osteosarcoma Signup and view all the answers

Which population is most commonly affected by Paget's disease?

People over 55 years old in Europe Signup and view all the answers

Which symptom is not typically associated with Paget’s disease?

Joint stiffness Signup and view all the answers

What primarily causes the accelerated phase of bone loss in women after menopause?

Estrogen deficiency Signup and view all the answers

What is the fundamental defect in both osteomalacia and rickets?

Inability to mineralize osteoid Signup and view all the answers

Which vitamins or supplements are recommended for those with osteoporosis who have deficiencies?

Vitamin D and Estrogens Signup and view all the answers

Which bone disorder occurs in children with open growth plates?

Rickets Signup and view all the answers

What might cause ineffective vitamin D activation in the body?

Liver or kidney dysfunction Signup and view all the answers

What is a characteristic feature of osteomalacia pathology?

Thick osteoid accumulation Signup and view all the answers

What could be a potential consequence of excessive treatment in osteomalacia and rickets?

Softer bone structure Signup and view all the answers

Which of the following describes a hallmark physical feature of rickets?

Bowing of weight-bearing bones Signup and view all the answers

What type of joint fluid is typically found in a joint affected by osteoarthritis?

Viscous with low cell count Signup and view all the answers

Which feature is characteristic of advanced osteoarthritis seen on X-ray?

Almost complete loss of joint space Signup and view all the answers

Which condition is NOT considered a part of spondyloarthropathies?

Rheumatoid arthritis Signup and view all the answers

What is a hallmark lesion of spondyloarthritis?

Enthesitis Signup and view all the answers

Which of the following describes the radiographic features of reactive arthritis?

Coarse asymmetrical non-marginal syndesmophytes Signup and view all the answers

Which symptom is most likely associated with dactylitis?

Inflammation of an entire finger or toe Signup and view all the answers

What genetic marker is commonly associated with spondyloarthropathies?

HLA-B27 Signup and view all the answers

Which condition is characterized by inflammation of a whole finger or toe?

Dactylitis Signup and view all the answers

Study Notes

Approach to the Patient with Metabolic Bone Disease & Rheumatic Disease

This presentation outlines an approach to patients with metabolic bone disease and rheumatic disease.
A roadmap is presented, highlighting key areas like general approach, osteomalacia/rickets, osteoporosis, rheumatoid arthritis, and spondyloarthropathies.

Clinical Examination of the Musculoskeletal System

Hands: Swelling, deformity, nail changes, tophi, Raynaud's, rheumatoid nodules, nail dystrophy in psoriatic arthritis.
Face: Rash, alopecia, mouth ulcers, butterfly rash, scleritis.
Trunk: Kyphosis, scoliosis, tender spots (fibromyalgia, enthesitis).
Legs: Deformity, swelling, restricted movement, synovitis, Heberden and Bouchard nodes.
Feet: Deformity, swelling (gout, dactylitis), redness, acute gout.
General observation: includes gait, deformity, swelling, redness, and rash are all examined.

Structure of Major Musculoskeletal Tissues

Bone: Calcified zone, hypertrophic zone, proliferative zone, trabecular bone, cortical bone, osteoblasts, osteocytes, osteoclasts, epiphyseal plate.
Muscle: Myofilament, myofibril, fascicle.
Articular cartilage: Chondrocytes, calcified cartilage, subchondral bone, synovium, synovial lining cells, joint capsule, haversian system, blood vessels, collagen lamellae, osteocytes.
Calcium phosphate travels through blood and goes into kidney.

Bone Remodelling Cycle

Bone-lining cells, microdamage, osteoclasts (eat old bone), osteocytes (new bone), osteoblasts (formation of new bone), apoptotic osteoclast, resorption, reparation of the bone, osteoclasts dead in 12 days, reversal.

Example of Double Tetracycline Labelling

Evaluates the creation of new bone.
Using a double tetracycline marker, the progress of new growth is measured by the disparity between the markers

Cellular and Molecular Regulators of Bone Remodelling

Renal phosphate excretion, bone marrow stromal cells, FGF23, SOST, Wnt, osteoblast, osteocyte, OPG, M-CSF, RANKL, osteoclast precursor, osteoclast.

Key Regulators of Bone Remodelling

Mediator: RANKL, Osteoprotegerin, Wnt, Sclerostin, Parathyroid hormone, Thyroid hormone, Oestrogen, Glucocorticoid.
Source: Osteocytes, stromal cells, activated T cells, lymphocytes, stromal cells, osteocytes, parathyroid glands, thyroid gland, ovaries, adrenal glands, exogenous.
Effects: Stimulates bone resorption, inhibits bone resorption, stimulates bone formation, activates LRP receptors, blocks effect of Wnt, increases bone resorption and formation, increases bone resorption and formation, inhibits bone resorption, inhibits bone formation.

Investigations of Musculoskeletal Disease

Imaging: Plain X-rays, bone scintigraphy, MRI, ultrasonography, computed tomography, dual x-ray absorptiometry
Blood tests: Haematology, biochemistry, immunology
Other: Tissue biopsy, electromyography, joint aspiration

MRI & Ultrasound Image Showing Synovitis

Images showing inflammation of the synovial membrane.

Typical Biochemical Abnormalities in Various Skeletal Diseases

Charts showing the presence and absence of abnormalities in a variety of bone disorders.

Patterns of Joint Involvement in Different Forms of Polyarthritis

Diagrams showing the areas of the skeleton affected in various forms of arthritis.

Osteoporosis

Most common bone disease, more than 8.9 million fractures annually.
One-third of women and one-fifth of men age 50 and above.
Fracture risks increase over time.
Common fracture sites include the forearm, spine, humerus, and hip.

Dual-Energy X-ray Absorptiometry (DXA)

Measures bone density.
Scores show bone density as T and Z scores.

Risk Factors for Osteoporosis

Genetic factors: single-gene disorders, receptor mutations, endocrine disease.
Inflammatory disease: inflammatory bowel disease, ankylosing spondylitis.
Drugs: glucocorticoids, gonadotrophin releasing hormone agonists, levothyroxine.
Gastrointestinal disease: malabsorption.
Lung disease: chronic obstructive pulmonary disease.
Myeloma, homocystinuria, anorexia nervosa, highly trained athletes, HIV, Gaucher's disease, polygenic inheritance, hyperparathyroidism, Cushing's syndrome.
Rheumatoid arthritis, aromatise inhibitors, thiazolidinediones, anticonvulsants, alcohol intake, heparin, chronic liver disease, cystic fibrosis, systemic mastocytosis, immobilisation, body mass index <18, smoking.
Data on Vit D intake and calcium ingestion affect bone reabsorption.
Osteoporosis occurs due to an imbalance between bone reabsorption osteoblast, and creation of new bone osteoclast.

Fractures

Tables and diagrams showing fracture rates across different age groups and areas of the body.

Vertebral Fractures

Data on cumulative survival with and without vertebral fractures.

Pathophysiology of Osteoporosis

Reduced bone density leads to micro-architectural deterioration and fracture risk, increased risk of falling with age, bone mass increase during growth, fall afterward, bone loss accelerates post-menopause due to estrogen deficiency ,and imbalance in bone remodelling cycle.

Investigations in Osteoporosis

Lists of investigations to perform to diagnose osteoporosis.

Drug Treatments for Osteoporosis

Tables comparing various drug treatments' regimens, daily doses, and other factors.

Osteomalacia and Rickets

OM and rickets are similar; the difference is that rickets occurs in children, OM in adults.
Disturbed mineralization of osteoid, causing thick osteoid, stress fractures, bow-leggedness, and other skeletal issues.

Causes of Osteomalacia and Rickets

Deficiency in vitamin D, lack of sunlight exposure, poor diet, malabsorption, familial hyperphosphatemia, kidney damage, and loss-of-function mutations.
Defects in phosphate and pyrophosphate metabolism, mutations, tumour-induced hypophosphataemic osteomalacia, hypophosphatasia, and high fluoride in water.

Osteomalacia and Rickets (radiographs)

Radiographic examples illustrating the conditions, particularly pseudofractures and bowing.

Paget's Disease

Focal areas of increased and disorganized bone remodeling involving one or more skeletal sites.
Increased bone resorption by abnormal osteoclasts, followed by rapid formation of poorly organized, structurally weak bone.
Plain radiographs show increased uptake of radionuclide, increased serum levels of alkaline phosphatase, a hallmark sign of the disease.

Clinical Features of Paget's disease

Axial skeleton is predominantly affected.
Bone pain and pathological fracture.
Many patients are asymptomatic.
Bone deformity and expansion, increased warmth over affected bone.
Neurological problems: deafness, cranial nerve defects, nerve root pain, spinal cord compression, and spinal stenosis.
Osteosarcoma, a rare and serious complication.

Paget's disease (radiographs)

Radiographic image highlighting the intense tracer uptake and deformity of the affected femur, and areas of osteosclerosis and radiolucency with pseudofractures.

Treatment for Paget's disease

Combination of nonpharmacological (physical therapy) and pharmacological therapy (antiresorptive agents, analgesics).
Bisphosphonates inhibit osteoclast activity.
IV zoledronic acid leads to rapid, sustained normalization of alkaline phosphatase.
Surgery may be needed for impending or complete fractures, joint realignment, and total arthroplasty in severe cases.

Rheumatoid Arthritis

Common inflammatory arthritis affecting all ethnic groups worldwide.
Prevalence: 0.8-1.0% in Europe and the Indian subcontinent (lower in Asia).
Chronic disease with exacerbations and remissions.

Pathophysiology of Rheumatoid Arthritis

Environmental triggers, genetic predisposition, and immune response lead to inflammation, immune complexes, activation and proliferation of T cells, macrophages and B cells.
Leading to synovial inflammation, bone erosion, and cartilage destruction.

Criteria for Diagnosis of Rheumatoid Arthritis

Scoring system based on joint involvement, presence of rheumatoid factors/anti-CCP antibodies, symptoms duration and acute phase reactants.

Clinical Presentation of Rheumatoid Arthritis

Morning stiffness, symmetrical joint swelling affecting hands, wrists (proximal interphalangeal and metacarpophalangeal joints, and metatarsophalangeal joints), bony erosion and cartilage damage.
Extra-articular features: rheumatoid nodules, interstitial lung disease, vasculitis, pleuropericarditis, scleritis, episcleritis, leg ulcers, Felty syndrome.

Investigations and Monitoring for Rheumatoid Arthritis

Clinical criteria, erythrocyte sedimentation rate, C-Reactive protein, ultrasound or MRI, and tests for rheumatoid factor and anti-citrullinated peptide antibodies.
Monitor disease activity, monitor damage with x-rays, and monitor drug safety.

Calculation of the Disease Activity Score and Algorithm for Management (rheumatoid arthritis)

Measurement to assess the severity of disease activity and adapt treatment strategies accordingly.
Factors such as number of swollen and tender joints, erythrocyte sedimentation rate, patient self assessment (on a scale of 0 -100), and are used to categorise patients into a specific category of disease activity.

Osteoarthritis

Most common type of arthritis, characterised by pain and disability in older adults.
Focal loss of articular cartilage, subchondral osteosclerosis, osteophyte formation, joint margin remodeling, and affected joint enlargement.
Increased prevalence with age (45% knee OA, 25% hip OA).

Pathophysiology of Osteoarthritis

Cartilage degeneration is the defining feature.
Chondrocytes start dividing and producing nests of metabolically active cells.
Increased degradation of cartilage matrix components (aggrecan and type II collagen).
Reduced concentration of aggrecan, making cartilage vulnerable to injury.

Pathologic Features of Osteoarthritic Joint Tissues

Diagrams illustrating normal vs. osteoarthritic joints, including synovial membrane, cartilage, and subchondral bone.

Risk Factors and Pathological Changes in Osteoarthritis

Genetic factors, adverse biomechanics, meniscectomy, ligament ruptures, Paget's disease, obesity, trauma, hormonal factors (estrogen deficiency) and aromatase inhibitors, can all lead to osteoarthritis.
Abnormal nests of proliferating chondrocytes, cartilage fibrillation, osteophytes formation, subchondral sclerosis, and subchondral cysts are all hallmarks of osteoarthritis.

Symptoms and Signs of Osteoarthritis

Insidious onset, variable, intermittent pain related to movement and weight-bearing, relieved by rest, brief morning stiffness.
Restricted movement, palpable/audible crepitus, bony swelling, deformation, joint line/periarticular tenderness, muscle weakness, and minimal synovitis.

Investigations for Osteoarthritis

Plain X-ray of the affected joint, which shows osteophytes and joint space narrowing.
MRI can be performed to look for nerve compression.
Biochemical, haematological, and rheumatological tests.
Synovial fluid analysis is usually normal.

X-Ray Appearances in Knee Osteoarthritis

Radiographic findings showing almost complete loss of joint space, sclerosis of subchondral bone, and lateral displacement of the patella.

Typical Varus Knee Deformity

Radiographic image illustrating varus deformity of the knee related to osteoarthritis.

Spondyloarthropathies

Group of related inflammatory musculoskeletal diseases with shared immunogenetic association with HLA-B27.
Includes axial spondyloarthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease.

Spondyloarthropathies (Clinical Features)

Axial skeleton is predominantly affected.
Non-synovial musculoskeletal lesions (inflammatory in nature).
Hallmarks is enthesitis (inflammation of a ligament or tendon being inserted into a bone).
Dactylitis is also possible.

Spondyloarthropathies (Pathophysiology)

Environmental triggers, genetic predisposition, and immune responses lead to an inflammatory process along ligaments, tendons, and periosteum.
Key components to look at are the gut flora, microbial products, dendritic cell, antigen, T-cell activation and cytokine production (IL-22, TNF-α, IL-17).

Comparison of Spondyloarthropathies

Table comparing the characteristics of different types of spondyloarthritis, including sacroiliitis involvement, peripheral arthritis, presence of HLA-B27, extra-articular features, and other names for the condition.

Radiographic Changes in Spondyloarthritis

X-ray images illustrating typical radiographic changes in ankylosing spondylitis (symmetrical marginal syndesmophytes) and psoriatic spondylitis (coarse, asymmetrical, non-marginal syndesmophytes).
Sacroiliac joint fusion, and generalised osteopenia.

Reactive Arthritis

Clinical description of reactive arthritis, including skin changes (keratoderma blennorrhagicum), penile lesions (balanitis circinata), and ocular involvement.

Psoriatic Arthropathy

Clinical description and appearance of dactylitis and distal interphalangeal pattern, along with accompanying nail dystrophy (pitting and onycholysis).

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Description

Test your knowledge on osteoporosis and osteoarthritis with this comprehensive quiz. Explore key concepts such as fracture prevalence, diagnostic methods, and treatment options. Discover the mechanisms behind bone health and the impact of vitamin D and estrogen.