Osteoporosis Overview and Types

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Questions and Answers

Which factor is NOT associated with primary osteoporosis?

Corticosteroid use (correct)

Genetic factors

Aging

Decline in estrogens

What may be the first sign of osteoporosis?

Poorly localized pain

Compression fractures of vertebrae (correct)

Osteopenia

Dental abnormalities

Which of the following conditions can lead to secondary osteoporosis?

Corticosteroids (correct)

Genetic predisposition

Exercise limitations

Peak bone mass

How does hyperparathyroidism affect phosphate levels in the urine?

Promotes excretion of phosphate Signup and view all the answers

Which symptom is NOT typically associated with rickets?

Hypercalcemia Signup and view all the answers

What is a common characteristic of osteomalacia?

Inadequate mineralization of bone matrix Signup and view all the answers

What outcome can result from chronic renal failure related to bones?

Hyperphosphatemia Signup and view all the answers

What is a potential effect of alcoholism on bone health?

Inhibition of osteoblasts Signup and view all the answers

What is a common characteristic of osteoarthritis as seen in radiologic features?

Subchondral sclerosis Signup and view all the answers

What is the primary defect in primary osteoarthritis?

Defect in cartilage Signup and view all the answers

Which condition is characterized by the formation of Heberden nodes?

Osteoarthritis Signup and view all the answers

Which of the following is a primary feature of rheumatoid arthritis?

Proliferative synovitis Signup and view all the answers

Which of the following is NOT a complication of osteomyelitis?

Rheumatoid arthritis Signup and view all the answers

What causes narrowing of joint space in osteoarthritis?

Loss of cartilage Signup and view all the answers

The presence of which cells is characteristic of the synovium in rheumatoid arthritis?

Lymphocytes and plasma cells Signup and view all the answers

What is one of the main genetic factors associated with increased susceptibility to rheumatoid arthritis?

HLA DR4 Signup and view all the answers

Which joints are most commonly affected by osteoarthritis?

Small finger joints Signup and view all the answers

Which organism is commonly associated with osteomyelitis due to direct penetration?

E. coli Signup and view all the answers

What is a significant outcome of hyperplasia of the synovium in rheumatoid arthritis?

Formation of granulation tissue Signup and view all the answers

Which symptom is NOT typically associated with osteoarthritis?

Severe systemic inflammation Signup and view all the answers

What is a common feature of chronic osteomyelitis?

Presence of pus and necrotic tissue Signup and view all the answers

What is the role of osteophytes in osteoarthritis?

Result from progressive erosion of cartilage Signup and view all the answers

Which of the following is a secondary cause of osteoarthritis?

Intra-articular fracture Signup and view all the answers

What histopathological feature is characterized by organizing fibrin in joint fluid?

Rice bodies Signup and view all the answers

What is the primary morphological characteristic of pannus in rheumatoid arthritis?

Hyperplastic synovium Signup and view all the answers

What are 'Rice bodies' in the context of rheumatoid arthritis?

Soft loose bodies in synovial fluid Signup and view all the answers

Which of the following extra-articular manifestations is NOT commonly associated with rheumatoid arthritis?

Rheumatic fever Signup and view all the answers

Which clinical feature is specifically needed to establish a diagnosis of rheumatoid arthritis?

Symmetric arthritis Signup and view all the answers

Which deformity is associated with rheumatoid arthritis due to joint damage?

Swan neck deformity Signup and view all the answers

Study Notes

Osteoporosis

Decrease in bone mass per unit bone volume
Normal ratio of mineral to matrix
Classified as primary and secondary types
Primary osteoporosis: Most common, uncertain etiology, postmenopausal women, elderly persons
- Genetic factors: Peak bone mass
- Estrogen levels: Decline with age
- Aging: Factors in disease progression
- Calcium intake: 800mg/day recommended
- Exercise: Essential for bone health
- Environmental factors: Smoking lowers estrogen levels
Osteopenia: Key characteristic of primary Osteoporosis, thinner cortex and reduction in the size and number of trabeculae
Fractures: Often the first sign of Osteoporosis, compression fractures common in vertebrae
Secondary osteoporosis: Corticosteroids, hematologic malignancies, malabsorption (GI and liver disease), alcoholism
- Corticosteroids: Inhibit osteoblastic activity, impair vitamin D dependent intestinal calcium absorption (secondary hyperparathyroidism)
- Hematologic malignancies: Affect bone health
- Malabsorption: Can lead to mineral deficiencies
- Alcoholism: Inhibits osteoblasts, lowers calcium absorption

Osteomalacia and Rickets

Inadequate mineralization of newly formed bone matrix (osteomalacia)
Rickets: Occurs in children with open epiphyseal plates
Cartilage problems contributing to rickets
Vitamin D deficiency: Main cause of Osteomalacia
Phosphate deficiency: Can cause "resistant" Osteomalacia
Clinical features: Beaded appearance of costochondral junctions, Pectus carinatum (pigeon chest), dental abnormalities
Radiologic features: Osteopenia, exaggerated osteoid seams, poorly localized pain
Locations of Osteomalacia pain: Femoral neck, pubic ramus, spine, ribs

Hyperparathyroidism

Characterized by an overactive parathyroid gland, can be caused by adenoma, hyperplasia, or malignancy
Parathyroid hormone (PTH): Promotes phosphate excretion in urine, stimulates bone resorption (osteoclastic activity), resulting in hypercalcemia
PTH effects on calcium: Stimulates tubular reabsorption of calcium, excretion of phosphate, and intestinal calcium absorption
Clinical features: Stones (kidney), bones (brown tumors), psychiatric depression, GI tract irregularities

Secondary Hyperparathyroidism

Often caused by renal osteodystrophy (chronic renal failure)
Mechanism: Decreased filtration of phosphate (hyperphosphatemia), effect on active vitamin D, decreased calcium absorption in GI (hypocalcemia), leading to secondary hyperparathyroidism

Osteomyelitis

Inflammation of bone, caused by an infectious organism
Common pathogens: Staphylococcus, Streptococcus, Escherichia coli, Neisseria gonorrhea, Haemophilus influenza, Salmonella
Routes of infection: Direct penetration (wounds, fractures, surgery), hematogenous spread (bloodstream, teeth, metaphyses)
Common locations: Knee, ankle, hip

Complications of Osteomyelitis

Septicemia (blood poisoning)
Acute bacterial arthritis
Pathologic fractures
Squamous cell carcinoma
Amyloidosis
Chronic osteomyelitis

Arthritis: Introduction

Inflammation of joints – common
Common site for autoimmune injury
- Heart valves and joints: Damage can result from exposure to hidden antigens, infections, or degeneration

Arthritis: Clinical Features

Pain: Inflammation of capsule, synovium, and periosteum
Swelling: Due to inflammation, effusion, and proliferation
Restricted movement: Caused by pain, fluid, synovial swelling, and damage
Deformity: Resulting from mal-alignment, erosion, and ankylosis

Osteoarthritis

Most common joint disease
Slow progressive degeneration of the articular cartilage
Affects weight-bearing joints and finger joints
Primary OA: Defect in cartilage, not an inflammatory disease
Secondary OA: Trauma, crystal deposits, infection
Common locations: Interphalangeal joints, knees, hips, cervical and lumbar spine
Radiographic features: Narrowing of joint space, increased subchondral bone thickness, subchondral bone cysts, osteophytes (Heberden nodes – fingers, distal interphalangeal joints)

Osteoarthritis - Causes

Primary OA: Unknown cause
Secondary OA: Intra articular fracture, previous infective arthritis, rheumatoid arthritis, congenital dislocation of hip
Abnormal stresses: Paget’s disease with deformity, chronic overuse
Metabolic and endocrine: Hemochromatosis, gout, calcium phosphate deposition
Neuropathic disorders: Peripheral neuropathy (diabetes mellitus), intraarticular corticosteroid excess
Degenerative end result: Progressive erosion and fibrillation of articular cartilage, loose bodies, eburnation (hardening of articular bone), subarticular cyst formation, osteophyte formation, mild inflammation, morning stiffness, limited range of motion.

Rheumatoid Arthritis

Systemic chronic inflammatory disease
Autoimmune disease, affecting diarthrodial joints bilaterally
Starts as a synovial disease
Female predominance (3:1 women)
Remissions and exacerbations
Hereditary component, possible role of EBV (Epstein-Barr Virus)

Theory of Pathogenesis for Rheumatoid Arthritis

Genetically susceptible patient
Infection (possible trigger)
Formation of antibodies
Antibodies act as new antigens
Production of rheumatoid factor
Deposition of immune complexes in the synovium
Activation of complement cascade
Inflammation
Activation of macrophages
Homing of T cells
Secretion of cytokines

Rheumatoid Arthritis Definition

Chronic, multisystem, autoimmune, inflammatory disorder primarily affecting joints
Produces proliferative synovitis that progresses to destruction of articular cartilage
Leads to ankylosis (joint stiffness and immobility)

Rheumatoid Arthritis - Etiology

Genetic Susceptibility: HLA DR4 or DR1 in 65-80% of cases
Microbial inciting agent: Epstein-Barr virus, Borrelia, Mycoplasma
Autoimmunity: IgM anti-IgG (rheumatoid factor), helper T cells (CD4) against type II collagen and cartilage glycoprotein-39

Rheumatoid Arthritis - Pathology

Inflammation of the joint and hyperplasia of the synovium
Destruction of articular structures
Synovium infiltrated with lymphocytes, plasma cells
Fibrin exudation on synovial fluid forms soft, loose bodies (Rice bodies)
Neutrophil polymorphs also present

Rheumatoid Arthritis - Pathologic progression

Initial changes are reversible
As granulation tissue grows over articular cartilage (pannus), it interferes with cartilage nutrition, leading to permanent damage

Rheumatoid Arthritis - Histopathological Features

Rice bodies
Hyperplastic synovium
Pannus
Allison-Ghormley bodies
Rheumatoid nodules

Rheumatoid Arthritis - Extra-Articular Manifestation

Rheumatoid nodules
Vasculitis
Cardiac disease
Pulmonary disease
Serosal inflammation
Amyloidosis
Anemia
Eye involvement

Rheumatoid Arthritis - Morphology

Proliferative synovitis with lymphocytes (CD4), plasma cells, and macrophages
Pannus formation
Organizing fibrin (rice bodies)
Neutrophils on the joint surface and fluid
Juxta-articular erosions, cysts, and osteoporosis
Fibrous ankylosis
Rheumatoid nodules in the skin
Vasculitis (commonly in digital arteries)

Rheumatoid Arthritis - Clinical Features

Morning stiffness
Arthritis in 3 or more joint areas
Small hand joint involvement
Symmetrical arthritis
Rheumatoid nodules
Serum rheumatoid factor
Typical radiographic changes
Diagnosis: At least 4 of these clinical features required

Differentiating features between Rheumatoid Arthritis and Osteoarthritis

Rheumatoid arthritis: Young, small joints, autoimmune, synovial inflammation, synovium, cartilage
Osteoarthritis: Old, larger joints, degenerative, cartilage degeneration.

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Description

Explore the key features of osteoporosis, including its primary and secondary types. Understand the causes, risk factors, and the importance of calcium and exercise for maintaining bone health. This quiz will help you identify the characteristics and implications of osteoporosis.