Osteoporosis Quiz
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Questions and Answers

What is the primary cause of primary osteoporosis?

  • Infection
  • Genetic factors (correct)
  • Lack of exercise
  • Excessive calcium intake

    • Osteoporosis is characterized by a reduction of bone mass per unit of bone volume.

    True

    What vitamin deficiency is associated with osteomalacia?

    Vitamin D

    Which of the following factors can decrease bone mass?

    <p>Aging</p> Signup and view all the answers

    What is osteopenia?

    <p>A decrease in bone mass that can lead to osteoporosis.</p> Signup and view all the answers

    What is a common complication of osteomyelitis?

    <p>Pathologic fractures</p> Signup and view all the answers

    Osteoarthritis is primarily an inflammatory disease.

    <p>False</p> Signup and view all the answers

    Match the following conditions with their descriptions:

    <p>Osteoporosis = Reduction in bone mass Osteomalacia = Inadequate mineralization of newly formed bone Osteomyelitis = Inflammation of bone due to infection Osteoarthritis = Degenerative joint disease</p> Signup and view all the answers

    Rheumatoid arthritis primarily affects elderly individuals.

    <p>False</p> Signup and view all the answers

    Juvenile rheumatoid arthritis is characterized by the presence of serum rheumatoid factor.

    <p>False</p> Signup and view all the answers

    Rheumatoid arthritis is classified as a degenerative disease.

    <p>False</p> Signup and view all the answers

    Rheumatoid nodules can occur in individuals with rheumatoid arthritis.

    <p>True</p> Signup and view all the answers

    Vasculitis is a common extra-articular manifestation of rheumatoid arthritis.

    <p>True</p> Signup and view all the answers

    Primary osteoporosis is most commonly associated with elderly men.

    <p>False</p> Signup and view all the answers

    Corticosteroids can inhibit osteoblastic activity, leading to secondary osteoporosis.

    <p>True</p> Signup and view all the answers

    Osteomalacia is characterized by excessive mineralization of bone.

    <p>False</p> Signup and view all the answers

    Hyperparathyroidism leads to decreased intestinal calcium absorption.

    <p>False</p> Signup and view all the answers

    A common symptom of rickets includes epiphyseal plates remaining open.

    <p>True</p> Signup and view all the answers

    Secondary hyperparathyroidism can occur as a result of chronic renal failure.

    <p>True</p> Signup and view all the answers

    Osteopenia is defined as normal bone density.

    <p>False</p> Signup and view all the answers

    Alcoholism can lead to reduced absorption of calcium and inhibition of osteoblast activity.

    <p>True</p> Signup and view all the answers

    Rheumatoid arthritis primarily affects the synovial joints bilaterally.

    <p>True</p> Signup and view all the answers

    Limited range of movement and Heberden nodes are typical features of rheumatoid arthritis.

    <p>False</p> Signup and view all the answers

    The presence of rice bodies in the synovial fluid is a histopathological feature of rheumatoid arthritis.

    <p>True</p> Signup and view all the answers

    Rheumatoid arthritis often begins as a cartilage disease.

    <p>False</p> Signup and view all the answers

    Activation of T cells and secretion of cytokines are part of the pathogenesis of rheumatoid arthritis.

    <p>True</p> Signup and view all the answers

    Rheumatoid arthritis is a systemic autoimmune condition that can lead to extra-articular manifestations.

    <p>True</p> Signup and view all the answers

    Decreased calcium absorption in the gastrointestinal tract can lead to hypocalcemia.

    <p>True</p> Signup and view all the answers

    Osteomyelitis is primarily caused by autoimmune disorders affecting the joints.

    <p>False</p> Signup and view all the answers

    Granulation tissue growing over the articular cartilage in rheumatoid arthritis is known as pannus.

    <p>True</p> Signup and view all the answers

    Staphylococcus is one of the organisms that can cause osteomyelitis.

    <p>True</p> Signup and view all the answers

    Mild inflammation and morning stiffness are not symptoms associated with rheumatoid arthritis.

    <p>False</p> Signup and view all the answers

    Osteoarthritis is characterized by the rapid degeneration of articular cartilage.

    <p>False</p> Signup and view all the answers

    Increased thickness of subchondral bone is observed in osteoarthritis.

    <p>True</p> Signup and view all the answers

    Pathologic fractures can be a complication of chronic osteomyelitis.

    <p>True</p> Signup and view all the answers

    Rheumatoid conditions are categorized as primary causes of osteoarthritis.

    <p>False</p> Signup and view all the answers

    Osteophytes are typically found in the distal interphalangeal joints in osteoarthritis.

    <p>True</p> Signup and view all the answers

    Study Notes

    Osteoporosis

    • Reduction of bone mass per unit of bone volume
    • Metabolic bone disease
    • Bone displays normal ratio of mineral to matrix
    • Primary and secondary types

    Primary Osteoporosis

    • Most common
    • Uncertain etiology
    • Postmenopausal women
    • Elderly persons (senile)

    Factors contributing to Primary Osteoporosis

    • Genetics: peak bone mass
    • Estrogens: decline
    • Age
    • Calcium intake: recommended intake of 800mg per day
    • Exercise
    • Environmental factors: smoking leads to estrogen reduction

    Primary Osteoporosis - Osteopenia

    • Decrease thickness of cortex
    • Reduction in the number and size of trabeculae
    • Fractures can be the first sign
    • Compression fractures of vertebrae

    Secondary Osteoporosis

    • Corticosteroids:
      • Inhibition of osteoblastic activity
      • Impairment of vitamin D dependant intestinal calcium absorption (secondary hyperparathyroidism)
    • Hematologic malignancies
    • Malabsorption: Gastrointestinal and liver diseases
    • Alcoholism:
      • Inhibition of osteoblasts
      • Reduced calcium absorption

    Osteomalacia and Rickets

    • Inadequate mineralization of newly formed bone matrix (osteomalacia)
    • Rickets: children, epiphyseal plates open; also problem with cartilage
    • Vitamin D deficiency (dependent)
    • Phosphate deficiency (resistant)
    • Defects in mineralization process

    Osteomalacia and Rickets - Symptoms

    • Beaded appearance of costochondral junctions
    • Pectus carinatum (pigeon chest)
    • Dental abnormalities
    • Osteopenia
    • Exaggeration of osteoid seams
    • Poorly localized pain
    • Pain in femoral neck, pubic ramus, spine, ribs

    Hyperparathyroidism

    • Parathyroid adenoma, hyperplasia, rare malignancy
    • Parathyroid hormone:
      • Promotes excretion of phosphate in the urine and stimulates osteoclastic activity resulting in hypercalcemia
      • Stimulates tubular reabsorption of calcium and excretion of phosphate
      • Stimulates intestinal calcium absorption

    Hyperparathyroidism - Symptoms

    • Stones: Kidney
    • Bones: Brown tumors
    • Psychiatric depression
    • Gastrointestinal tract irregularities

    Secondary Hyperparathyroidism

    • Renal osteodystrophy
    • Chronic renal failure:
      • Decreased filtration of phosphate
        • Hyperphosphatemia
      • Effect on active vitamin D
      • Decreased calcium absorption in GI tract
        • Hypocalcemia
      • Secondary hyperparathyroidism

    Osteomyelitis

    • Inflammation of bone caused by an infectious organism
    • Common organisms include: Staphylococcus, streptococcus, Escherichia coli, Neisseria gonorrhea, Haemophilus influenza, Salmonella
    • Modes of infection:
      • Direct penetration: Wounds, fractures, surgery
      • Hematogenous: Bloodstream, teeth; metaphyses - Knee, ankle, hip

    Osteomyelitis - Complications

    • Septicemia
    • Acute bacterial arthritis
    • Pathologic fractures
    • Squamous cell carcinoma
    • Amyloidosis
    • Chronic osteomyelitis

    Arthritis - Introduction

    • Inflammation of joints - Common
    • Common site for autoimmune injury
      • Heart valves & Joints - damage - Exposure of hidden antigens. Infections. Degeneration - Age/Stress/lifestyle

    Arthritis - Clinical Features

    • Pain: Inflammation - capsule, synovium, periosteum
    • Swelling: Inflammation, effusion, proliferation
    • Restricted movement: Pain, fluid, synovial swelling, damage
    • Deformity: Mal-alignment, erosion, ankylosis

    Osteoarthritis

    • Most common joint disease
    • Slow progressive degeneration of articular cartilage
    • Weight bearing joints
    • Fingers
    • Primary: Defect in cartilage, not an inflammatory disease
    • Secondary: Trauma, crystal deposits, infection
    • Interphalangeal joints, knees, hips, cervical and lumbar spine

    Osteoarthritis - Symptoms

    • Narrowing of joint space (loss of disk)
    • Increased thickness of subchondral bone: Eburnated bone
    • Subchondral bone cysts
    • Osteophytes (Haberden nodes): Fingers, distal interphalangeal joints

    Osteoarthritis - Causes

    • Primary
    • Secondary:
      • Intra articular fracture
      • Previous infective arthritis
      • Rheumatoid
      • 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 as in diabetes mellitus
      • Intraarticular corticosteroid in excess

    Osteoarthritis - Pathology

    • Degenerative end result (ageing) >80% in >65y
    • Progressive erosion and fibrillation of articular cartilage → forms Loose bodies
    • Hardened articular bone – eburnation
    • Subarticular cyst formation in bone
    • Periarticular osteophyte formation
    • Mild inflammation but painful, morning stiffness
    • Limited range of movements
    • Heberden nodes (female)

    Osteoarthritis - Radiologic Features

    • No uniform joint space

    Osteoporosis

    • Reduction of bone mass per unit of bone volume.
    • Metabolic bone disease where the bone displays a normal ratio of mineral to matrix.
    • Can be primary (most common, uncertain etiology, postmenopausal women, elderly) or secondary.

    PrimaryOsteoporosis

    • Factors include:
      • Genetics: peak bone mass.
      • Estrogens: decline.
      • Aging.
      • Calcium intake (800mg/day).
      • Exercise.
      • Environmental factors: smoking leads to estrogen reduction.
    • Osteopenia: decreased thickness of cortex and reduction in the number and size of trabeculae.
    • Fractures can be the first sign, compression fractures of vertebrae are common.

    Secondary Osteoporosis

    • Caused by:
      • Corticosteroids: inhibition of osteoblastic activity and impairment of vitamin D-dependent intestinal calcium absorption (secondary hyperparathyroidism).
      • Hematologic malignancies.
      • Malabsorption: gastrointestinal and liver diseases.
      • Alcoholism: inhibition of osteoblasts and reduced absorption of calcium.

    Osteomalacia and Rickets

    • Inadequate mineralization of newly formed bone matrix.
    • Rickets: children, epiphyseal plates open.
    • Causes:
      • Vitamin D deficiency (dependent).
      • Phosphate deficiency (resistant).
      • Defects in mineralization process.
    • Clinical findings:
      • Beaded appearance of costochondral junctions.
      • Pectus carinatum.
      • Dental abnormalities.

    Hyperparathyroidism

    • Cause: parathyroid adenoma, hyperplasia, rare malignancy.
    • Parathyroid hormone:
      • Promotes excretion of phosphate in the urine and stimulates osteoclastic activity resulting in hypercalcemia.
      • Stimulates tubular reabsorption of calcium and excretion of phosphate.
      • Stimulates intestinal calcium absorption.

    Secondary Hyperparathyroidism

    • Occurs in renal osteodystrophy due to chronic renal failure.
    • Effects:
      • Decreased filtration of phosphate, leading to hyperphosphatemia.
      • Effect on active Vitamin D.
      • Decreased calcium absorption in the gastrointestinal tract, leading to hypocalcemia.
      • Secondary hyperparathyroidism as a consequence of the above.

    Osteomyelitis

    • Inflammation of bone caused by an infectious organism.
    • Common organisms: Staphylococcus, Streptococcus, Escherichia coli, Neisseria gonorrhea, Haemophilus influenza, Salmonella.
    • Routes of infection:
      • Direct penetration: wounds, fractures, surgery.
      • Hematogenous: bloodstream, teeth (metaphyses); knee, ankle, hip.

    Complications of Osteomyelitis

    • Septicemia.
    • Acute bacterial arthritis.
    • Pathological fractures.
    • Squamous cell carcinoma.
    • Amyloidosis.
    • Chronic osteomyelitis.

    Arthritis: Introduction

    • Inflammation of joints.
    • Common site for autoimmune injury.
    • Factors:
      • Heart valves and joints damage: exposure of hidden antigens.
      • Infections.
      • Degeneration: age/stress/lifestyle.

    Arthritis - Clinical Features

    • Pain due to inflammation of capsule, synovium, periosteum.
    • Swelling due to inflammation, effusion, proliferation.
    • Restricted movement due to pain, fluid, synovial swelling and damage.
    • Deformity due to mal-alignment, erosion, ankylosis.

    Osteoarthritis

    • Most common joint disease.
    • Slow progressive degeneration of articular cartilage.
    • Affects weight bearing joints: hips, knees, ankles.
    • Also common in fingers.
    • Two types:
      • Primary: defect in cartilage, not an inflammatory disease.
      • Secondary: trauma, crystal deposits, infection.

    Osteoarthritis - Clinical Features

    • Narrowing of joint space (loss of disk).
    • Increased thickness of subchondral bone.
    • Subchondral bone cysts.
    • Osteophytes (Heberden nodes) on fingers.

    Osteoarthritis - Causes

    • Primary: unknown etiology.
    • Secondary:
      • Intraarticular fracture.
      • Previous infective arthritis.
      • Rheumatoid arthritis.
      • Congenital dislocation of the hip.
      • Abnormal stresses:
        • Paget's disease with deformity.
        • Chronic overuse.
      • Metabolic and endocrine:
        • Hemochromatosis.
        • Gout.
        • Calcium phosphate deposition.
      • Neuropathic disorders:
        • Peripheral neuropathy (eg. diabetes mellitus).
        • Intraarticular corticosteroid excess.

    Osteoarthritis - Radiologic Features

    • Loss of joint space.
    • Osteophyte formation.
    • Cyst formation.
    • Subchondral sclerosis.
    • Sclerosis, ankylosis and deformity.

    Rheumatoid Arthritis

    • Systemic chronic inflammatory disease.
    • Autoimmune disease.
    • Affects diarthrodial joints bilaterally.
    • Starts as a synovial disease.
    • Women are affected three times more often than men.
    • Remissions and exacerbations.
    • Inherited susceptibility and environmental factors like EBV may play a role.

    Rheumatoid Arthritis - Pathogenesis

    • Genetically susceptible patient develops an infection.
    • Formation of antibodies to the infectious agent.
    • Antibodies act as new antigens.
    • Production of rheumatoid factor (IgM anti-IgG).
    • Deposits of immune complexes in the synovium.
    • Activation of complement cascade.
    • Inflammation, activation of macrophages and homing of T cells.
    • Secretion of cytokines.

    Rheumatoid Arthritis - Definition

    • Chronic multisystem autoimmune inflammatory disorder primarily affecting joints producing a proliferative synovitis that often progresses to destruction of articular cartilage and ankylosis.
    • Contributing factors:
      • Genetic susceptibility: HLA DR4 or DR1 in 65% to 80% of cases.
      • Microbial inciting agent: Epstein-Barr virus, Borrelia and Mycoplasma.
      • Autoimmunity: IgM anti IgG (rheumatoid factor) & helper T cell (CD4) against type II collagen and cartilage glycoprotein-39.

    Rheumatoid Arthritis - Pathology

    • Inflammation of the joint and hyperplasia of the synovium.
    • Destruction of the articular structures.
    • Synovium infiltrated with lymphocytes and plasma cells.
    • Fibrin exudation on the synovial fluid forming soft loose bodies called "rice bodies".
    • Neutrophil polymorphs are present.
    • Granulation tissue grows over the surface of the articular cartilage, called "pannus", which interferes with the nutrition of the cartilage leading to permanent joint damage.

    Rheumatoid Arthritis - Histopathological Features

    • Rice bodies.
    • Hyperplastic synovium.
    • Pannus.
    • Allison-Ghormley bodies.
    • Rheumatoid nodules.

    Rheumatoid Arthritis - Extra-articular Manifestations

    • 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).
    • Organizing fibrin (rice bodies).
    • Neutrophils on the joint surface and fluid.
    • Juxta-articular erosions, cysts and osteoporosis.
    • Fibrous ankylosis.
    • Skin: Rheumatoid nodules.
    • Vasculitis (commonly of digital arteries).

    Rheumatoid Arthritis - Clinical Features

    • At least four clinical features for diagnosis:
      • Morning stiffness.
      • Arthritis in 3 or more joint areas.
      • Arthritis of small hand joints.
      • Symmetric arthritis.
      • Rheumatoid nodules.
      • Serum rheumatoid factor.
      • Typical radiographic changes.

    Rheumatoid Arthritis - Extra-articular Features

    • Rheumatoid nodules.
    • Vasculitis.
    • Pleuritis.
    • Pericarditis.
    • Tendonitis.

    Comparison of Rheumatoid Arthritis and Osteoarthritis

    Feature Rheumatoid Arthritis Osteoarthritis
    Age Any age, most common 25-55 Elderly
    Affected joint Symmetrical arthritis: metacarpophalangeal, interphalangeal, wrist, shoulder Hip, knee, ankle
    Synovium Hyperplasia, dense inflammation Mild secondary inflammation
    Articular cartilage Eroded by pannus Loss of weight bearing surface
    Systemic disease Yes No
    Pathogenesis Autoimmune disease Degenerative

    Juvenile Rheumatoid Arthritis

    • Starts below 16 years of age, most common 1-3 years.
    • Clinical features:
      • High spiking fever daily or twice daily.
      • Hepatosplenomegaly.
      • Serosal inflammation (pericarditis).
      • Generally involve knee, wrist, elbow, small joints of hands and feet.

    Juvenile Rheumatoid Arthritis - Pathogenesis

    • Begins before the age of 16.
    • Multisystem involvement: splenomegaly.
    • Systemic involvement at onset, unlike adult RA.
    • No serum rheumatoid factor (seronegative).
    • Antinuclear antibody (ANA) positive, indicating autoimmune nature.

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