Fall, Bone Structure, Osteoporosis (PDF) - Medical Lecture Slides

Fall dr.Samin Garmian university / collage of medicine Fall Fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level and it is a huge problem for the elderly in particular. elderly people are more likely to fall. Most falls...

Fall dr.Samin Garmian university / collage of medicine Fall Fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level and it is a huge problem for the elderly in particular. elderly people are more likely to fall. Most falls in the elderly are multifactorial. Bone Structure Bone contains a relatively small number of cells in a matrix of collagen fibers that provide a surface for inorganic salt crystals to adhere. Four types of cells are found within bone tissue. Osteogenic cells are undifferentiated and develop into osteoblasts. When osteoblasts get trapped within the calcified matrix, their structure and function changes, and they become osteocytes. Osteoclasts develop from monocytes and macrophages and differ in appearance from other bone cells. Bone Cells  The osteoblast is the bone cell responsible for forming new bone. Osteoblasts, which do not divide, synthesize and secrete the collagen matrix and calcium salts. As the secreted matrix surrounding the osteoblast calcifies, the osteoblast become trapped within it; as a result, it changes in structure and becomes an osteocyte, the primary cell of mature bone and the most common type of bone cell. Each osteocyte is located in a space called a lacuna and is surrounded by bone tissue. Osteocytes maintain the mineral concentration of the matrix via the secretion of enzymes. Like osteoblasts, osteocytes lack mitotic activity. They can communicate with each other and receive nutrients via long cytoplasmic processes that extend through canaliculi channels within the bone matrix.  osteogenic cells are undifferentiated with high mitotic activity and they are the only bone cells that divide. Immature osteogenic cells are found in the deep layers of the periosteum and the marrow. They differentiate and develop into osteoblasts.  The dynamic nature of bone means that new tissue is constantly formed, and old, injured, or unnecessary bone is dissolved for repair or for calcium release. The cell responsible for bone resorption, or breakdown, is the osteoclast. They are found on bone surfaces, are multinucleated, and originate from monocytes and macrophages, two types of white blood cells, not from osteogenic cells. Osteoclasts are continually breaking down old bone while osteoblasts are continually forming new bone.  Calcium concentration in blood is critical. ▪ too low ca cause uncontrolled muscle contractions occur (‘tetany’) which can be fatal. ▪ too high ca nervous function is suppressed, and calcium salts tend to precipitate in unfortunate places. Calcium absorption from food requires vitamin D, which must either be ingested from foods or made in the skin by the action of sunlight. Osteoporosis Osteoporosis is a condition when bone strength weakens and is susceptible to fracture. It usually affects hip, wrist or spine. Osteoporosis is very common , It characterized by reduction in bone mass characteristic changes in the micro-architecture of bone. making it much less strong, and so prone to fracture. Osteoporosis is mostly manifest in older people. It is More common in women than men. Osteoporosis causes bones to become weak and brittle – so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when low levels of calcium, phosphorus and other minerals in the bones and results as low bone density.  SYMPTOMS I. Back pain, which can be severe if fractured or collapsed vertebra. II. Loss of height over time, with an accompanying stooped posture. III. Fracture of the vertebrae, wrists, hips or other bones. CAUSES The strength of the bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals that bones contain. When the bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure. RISK FACTORS Female gender. Increase age Race. Greatest risk – white or of Southeast Asian. Family history. Frame size.(thin or small body frames tend to have higher risk). Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. Long term treatment with steroid drugs - stimulate bone reabsorption Diets low in calcium and vitamin D. Immobilization Smoking Alcohol.  Osteoporosis is often undetected until a fracture occurs. In older patients fracture may occur during daily activities without obvious trauma. Most common site of fracture : distal radius (a ‘Colles’ fracture). neck of the femur (a ‘hip’ fracture). vertebra Manegment Bone density scan for individuals who might be at risk. If a patient is found to be osteoporotic then the reduction of bone density may be reduced by drugs. Bisphosphonates can inhibiting the action of osteoclasts Hormone replacement therapy :Oestrogen replacement therapy Dietary calcium supplements with vitamin D are also important. Management of complication ( fracture) Prevention 1. Do exercise such as walking, running, skipping rope regularly. 2. Add soy in diet – plant estrogens found in soy helps to maintain bone density and reduce the risk of fractures. 3. Avoid smoking, it can reduce the levels of estrogen and increase bones Loss. 4. Avoid excessive alcohol. 5. Avoid caffeine, which is very harmful. 6. Consider hormone therapy. 7.Maintain good posture – Good posture which involves keeping the head held high, chin in, shoulders back, upper back flat and lower spine arched – helps to avoid stress on the spine. When sit or drive, place a rolled towel in the small of the back. Don't lean over while reading or doing handwork. When lifting, bend at the knees, not the waist keeping the upper back straight. 8.Prevent falls.