Osteoporosis Overview and Types

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Questions and Answers

What characterizes primary osteoporosis?

It is solely caused by age-related calcium deficiency

Reduction of bone mass primarily due to genetic factors

It is typically seen in postmenopausal women (correct)

It affects only men over 60 years of age

What is a common consequence of secondary osteoporosis?

Increased bone density

Inhibition of osteoblastic activity due to corticosteroids (correct)

It is primarily genetic in origin

Always leads to osteomalacia

What is a distinguishing feature of osteomalacia?

Low calcium intake is the only cause

It leads to elevated bone density

Exaggerated osteoid seams (correct)

Primarily affects elderly men

Which condition is associated with renal osteodystrophy?

Hyperparathyroidism effects due to chronic renal failure Signup and view all the answers

What is the relationship between hyperparathyroidism and calcium levels?

It promotes elevated calcium values and decreased phosphate levels Signup and view all the answers

What is a possible effect of chronic alcoholism on bones?

Impaired absorption of calcium and inhibition of osteoblasts Signup and view all the answers

In which population is rickets primarily observed?

Children with open epiphyseal plates Signup and view all the answers

Which factor may lead to secondary hyperparathyroidism?

Chronic renal failure causing hyperphosphatemia Signup and view all the answers

What is one of the common causes of osteomyelitis?

Direct penetration from wounds Signup and view all the answers

Which complication is NOT associated with osteomyelitis?

Eburnation of bone Signup and view all the answers

Which joints are primarily affected by osteoarthritis?

Fingers and weight-bearing joints Signup and view all the answers

What is a defining characteristic of primary osteoarthritis?

It has a defect in cartilage without inflammation. Signup and view all the answers

Which of the following is NOT considered a cause of secondary osteoarthritis?

Genetic predisposition Signup and view all the answers

What is a common clinical feature of arthritis?

Swelling around the joint Signup and view all the answers

Which of the following conditions can lead to abnormal stresses resulting in osteoarthritis?

Paget's disease Signup and view all the answers

What is the primary pathological change in the joints due to osteoarthritis?

Degeneration of articular cartilage Signup and view all the answers

What is a common histopathological feature found in rheumatoid arthritis?

Rice bodies Signup and view all the answers

Which of the following is considered an extra-articular manifestation of rheumatoid arthritis?

Rheumatoid nodules Signup and view all the answers

Which clinical feature is characteristic of rheumatoid arthritis?

Morning stiffness Signup and view all the answers

What distinguishes the morphology of rheumatoid arthritis from osteoarthritis?

Synovial inflammation Signup and view all the answers

Which of the following correctly pertains to the diagnosis of rheumatoid arthritis?

Presence of serum rheumatoid factor Signup and view all the answers

Which of the following radiologic features is typically absent in osteoarthritis?

Joint space loss Signup and view all the answers

What condition is characterized by periarticular osteophyte formation and morning stiffness?

Osteoarthritis Signup and view all the answers

In rheumatoid arthritis, the primary cause of the joint inflammation is related to which process?

Autoimmune response Signup and view all the answers

Which of the following best describes the typical inflammatory changes seen in the synovium of rheumatoid arthritis?

Infiltration of neutrophils and plasma cells Signup and view all the answers

What is a common genetic factor associated with increased susceptibility to rheumatoid arthritis?

HLA DR4 Signup and view all the answers

What consequence follows the formation of a pannus in rheumatoid arthritis?

Nutritional interference of the cartilage Signup and view all the answers

Rice bodies, often found in rheumatoid arthritis synovial fluid, are associated with which type of exudation?

Fibrin exudation Signup and view all the answers

Which of the following terms refers to the loose bodies that can develop within the synovial fluid of joints affected by inflammatory diseases?

Joint mice Signup and view all the answers

Study Notes

### Osteoporosis

Reduction of bone mass per unit of bone volume
Metabolic bone disease
Osteoporosis displays a normal ratio of mineral to matrix
Two types: Primary and Secondary

Primary Osteoporosis

Most common type
Uncertain etiology (cause)
Postmenopausal women are susceptible
Elderly people (senile) are also susceptible
Genetic factors contribute to Peak Bone Mass
Estrogen decline plays a huge role
Aging is a factor
Calcium intake is essential (800mg/day)
Exercise is crucial
Environmental factors like smoking contribute to lowered estrogen levels.

### Osteopenia

Decrease in the thickness of the cortex (outer layer of bone)
Fewer and smaller trabeculae (inner, supporting network of bone)
Fractures are often the first sign
Compression fractures of vertebrae are typical

### Secondary Osteoporosis

Corticosteroids can cause osteoporosis
- Inhibit osteoblastic activity (bone building)
- Impair Vitamin D dependent intestinal calcium absorption (secondary hyperparathyroidism)
Hematologic malignancies (cancers of blood cells) can lead to osteoporosis
Malabsorption caused by GI and liver diseases can cause osteoporosis
Alcoholism can also cause osteoporosis
- Inhibition of osteoblasts
- Decreased calcium absorption

### Osteomalacia and Rickets

Inadequate mineralization of newly formed bone matrix
Osteomalacia affects adults, Rickets affects children
Rickets is marked by open epiphyseal plates (growth plates)
Rickets also affects cartilage
Beaded appearance of costochondral junctions
Pectus carinatum (pigeon chest)
Dental abnormalities
Vitamin D deficiency
Phosphate deficiency
Defects in the mineralization process

### Osteomalacia and Rickets (cont.)

Osteopenia (low bone density)
Exaggeration of osteoid seams ( areas where new bone is formed)
Poorly localized pain (pain in multiple areas)
Pain in the femoral neck, pubic ramus, spine, ribs
Osteomalacia and rickets can lead to secondary hyperparathyroidism

### Hyperparathyroidism

Caused by parathyroid adenoma (tumor), hyperplasia (overgrowth), or rarely malignancy (cancer)
Parathyroid hormone:
- Promotes excretion of phosphate in urine
- Stimulates osteoclastic activity (bone breakdown), leading to hypercalcemia (high calcium levels)
- Stimulates tubular reabsorption of calcium and excretion of phosphate
- Stimulates intestinal calcium absorption

### Hyperparathyroidism (cont.)

Stones in kidneys (kidney stones)
Brown tumors (bone lesions)
Psychiatric depression
GI tract irregularities

### Secondary Hyperparathyroidism

Renal osteodystrophy (bone problems in kidneys)
Chronic renal failure:
- Decreased filtration of phosphate, leading to hyperphosphatemia (high phosphate levels)
- Affects active Vitamin D, decreases calcium absorption in the GI tract, resulting in hypocalcemia (low calcium levels)
- Secondary hyperparathyroidism is then triggered.

### Osteomyelitis

Inflammation of bone caused by an infectious organism
Common infectious organisms include Staphylococcus, Streptococcus, Escherichia coli, Neisseria gonorrhea, Haemophilus influenza, Salmonella
Two ways in which the infection can occur:
- Direct penetration: wounds, fractures, surgery
- Hematogenous: bloodstream, teeth (metaphyses - area between the ends of long bones and the shaft)
- Common areas affected: knee, ankle, hip

### Complications of Osteomyelitis

Septicemia (blood poisoning)
Acute bacterial arthritis (infection of a joint)
Pathologic fractures
Squamous cell carcinoma (skin cancer)
Amyloidosis (build-up of an abnormal protein)
Chronic osteomyelitis

### Arthritis - Introduction

Inflammation of joints, common
Frequent sites for Autoimmune Injury
- Heart valves and joints are susceptible, causing exposure of hidden antigens.
- Infections, Degeneration (caused by age/stress/lifestyle)
Arthritis can be caused by injury, overuse, and autoimmune disorders

### Arthritis – Clinical Features:

Pain
Swelling due to inflammation, effusion (fluid buildup), or proliferation (increase in cell numbers)
Restricted movement
Deformity

### Osteoarthritis

Most common joint disease
Slow progressive degeneration of articular cartilage (cartilage that covers the ends of bones in joints)
Affects weight bearing joints - (hips, knees)
Affects fingers
Primary: defect in cartilage (non-inflammatory)
Secondary: trauma, crystal deposits, infection
Interphalangeal joints, knees, hips, cervical and lumbar spine are most commonly affected.

### Osteoarthritis (cont.)

Narrowing of joint space (loss of disk)
Increased thickness of subchondral bone (bone below cartilage)
- Eburnated bone (hard, polished bone)
Subchondral bone cysts
Osteophytes (Haberden nodes)
- Fingers, distal interphalangeal joints (joints at the tips of fingers)

### Causes of Osteoarthritis

Primary
Secondary:
- Intra articular fracture (fracture within the joint)
- Previous infective arthritis
- Rheumatoid arthritis
- Congenital dislocation of the hip
Abnormal stresses:
- Paget's disease with deformity
- Chronic overuse
Metabolic and endocrine:
- Hemochromatosis (iron overload)
- Gout (excess uric acid)
- Calcium phosphate deposition
Neuropathic disorders:
- Peripheral neuropathy as in diabetes mellitus
- Intraarticular corticosteroid in excess

### Osteoarthritis: Degenerative End Result

Ageing: more than 80% of those over 65 years old suffer from osteoarthritis
Progressive erosion and fibrillation (splitting) of articular cartilage
Loose bodies form within the joint
Large weight-bearing joints are most affected
Hardened articular bone (eburnation)
Subarticular cyst formation in bone
Periarticular osteophyte formation (bone spurs)
Mild inflammation but painful
Morning stiffness
Limited range of movements
Heberden nodes (common in finger OA)

### Rheumatoid arthritis

Systemic chronic inflammatory disease
Autoimmune disease (body's immune system attacks its own tissues)
Affects diarthrodial joints (freely-moving joints) bilaterally (both sides)
Starts as a synovial disease
Affects women more than men (3:1)
Periods of remission (no symptoms) and exacerbations (flareups) are common
Hereditary factors contribute
Epstein-Barr Virus (EBV) suspected as a cause
Rheumatoid arthritis can affect the heart, lungs, and other organs due to inflammation
Rheumatoid arthritis is characterized by inflammation in the synovium (lining of the joints) and the surrounding tissues.

### Theory of Pathogenesis (Development) of Rheumatoid Arthritis

Genetically susceptible patient
Infection (EBV or other)
Formation of antibodies
Antibodies act as new antigens
Production of rheumatoid factor (antibodies that react with other antibodies)
Deposits of immune complexes in the synovium
Activation of the complement cascade (a series of proteins involved in inflammation)
Inflammation
Activation of macrophages (immune cells)
Homing of T cells (immune cells)
Secretion of cytokines (chemicals that promote inflammation)

### Rheumatoid Arthritis - Definition:

Chronic, multisystem (affecting multiple organs), autoimmune, inflammatory disorder
Primarily affects joints
Causes proliferative synovitis (inflammation and thickening of the synovium)
Often progresses to destruction of the articular cartilage and ankylosis (stiffening of a joint)

### Etiology (Causes) of Rheumatoid Arthritis:

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

### Pathology of Rheumatoid Arthritis

Inflammation of the joint
Hyperplasia of the synovium (thickening of the synovium)
Destruction of the articular structures
Synovium is infiltrated with lymphocytes, plasma cells, and macrophages
Fibrin exudation (leakage of fibrin, a protein involved in blood clotting) on the synovial fluid
Soft loose bodies called Rice bodies can form
Neutrophil polymorphs (white blood cells) are present
These early changes can be reversed before permanent damage occurs.

### Permanent Joint Damage

When granulation tissue grows over the surface of the articular cartilage called Pannus
Panus interferes with the nutrition of the cartilage leading to permanent joint damage

### Rheumatoid Arthritis Histopathological Features

Rice bodies
Hyperplastic synovium
Pannus
Allison-Ghormley bodies (small masses of debris in the joint fluid)
Rheumatoid nodules (lumps of tissue that can form under the skin)

### Extra Articular Manifestations (Outside of Joints) of Rheumatoid Arthritis

Rheumatoid nodules
Vasculitis (inflammation of blood vessels)
Cardiac disease
Pulmonary disease
Serosal inflammation (inflammation of the lining of body cavities)
Amyloidosis (build-up of an abnormal protein)
Anemia
Eye involvement

### Rheumatoid Arthritis Morphology

Proliferative synovitis with lymphocytes (CD4), plasma cells, and macrophages
Pannus
Organizing fibrin (rice bodies)
Neutrophils on the joint surface and fluid
Juxta-articular erosions (erosion near the joints)
Cysts
Osteoporosis
Fibrous ankylosis (stiffening of a joint)
Skin: Rheumatoid nodules
Vasculitis (commonly of digital arteries)

### Early Destruction in Rheumatoid Arthritis

Swan Neck Deformity

### Rheumatoid Arthritis - Clinical Features

Morning stiffness
Arthritis in 3 or more joint areas
Arthritis of small hand joints
Symmetrical arthritis
Rheumatoid nodules
Serum rheumatoid factor
Typical radiographic changes

### Rheumatoid Arthritis Diagnosis

At least 4 features are required for diagnosis

### Rheumatoid Arthritis - Pannus

Hyperplastic (overgrowth), inflamed synovium

### Extra-Articular Rheumatoid Arthritis

Rheumatoid Nodules
Vasculitis
Pleuritis (inflammation of the pleura, lining of the lungs)
Pericarditis (inflammation of the pericardium, lining of the heart)
Tendonitis (inflammation of a tendon)

### Rheumatoid Nodules

Found in the skin
Consist of palisading macrophages (arranged like a fence)
Central fibrinoi necrosis (death of tissue)

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Description

This quiz covers the fundamentals of osteoporosis, including its definition, types (primary and secondary), and conditions like osteopenia. It explores risk factors, underlying causes, and the biological importance of calcium and exercise in bone health.