Common Bone Disorders Bone and cartilage deterioration is a natural process as we age: Skeletal Cartilage -- “bluish-flexible” skeletal cartilage becomes “yellowish-brittle” cartilage with age due to calcification. Articular Cartilage -- becomes brittle and does not function as a shock absorber in the joints as well resulting in arthritis. Bone -- osteoclasts start breaking bone down faster than osteoblasts build it up after we turn 50.

Slowing Down the Natural Loss of Bone Density Healthy Living – weight-bearing exercise sufficient intake of dietary calcium sufficient intake of Vitamin D allows the body to absorb the dietary calcium Things to Avoid – caffeine (> 2 cups of coffee/day) cigarette smoking (8% higher loss in bone density than non-smokers) alcohol use inactivity

Congenital Bone Disorders Abnormal Curvature of the Spine Kyphosis Lordosis Scoliosis

Congenital Bone Disorders Cleft Palate a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined Occurs in about 1 out of every 600 births

Congenital Bone Disorders Club Foot the most common congenital disorder of the lower extremity; occurs in 1 out of 1000 births. one or both feet turn downward and inward. genetic and environmental factors in the development of the fetus are the apparent causes. surgically repaired

Congenital Bone Disorders Osteogenesis Imperfecta (“Brittle Bone Disease”) People with OI are born without the proper collagen, or the ability to make it. People with OI either have less collagen than normal or the quality is poorer than normal. this impairment causes those with the condition to have weak or fragile bones. 8 types; differing levels of severity no cure; bone fractures are common.

Degenerative Bone Disorders Osteoporosis a decrease in bone density due to natural aging and possibly unhealthy living Men lose less than 25% of their bone density with aging Women lose ~ 35% of their bone density with aging One reason for the discrepancy between men and women in the natural loss of bone density is due to the reduction of estrogen levels following mentopause

Low-power scanning electron microscope image of normal bone architecture in the 3rd lumbar vertebra of a 30 year old woman. (marrow and other cells have been removed to reveal thick, interconnected plates of bone)

Low-power scanning electron microscope image of osteoporotic bone architecture in the 3rd lumbar vertebra of a 71 year old woman. (marrow and other cells have been removed to reveal eroded, fragile rods of bone)

Normal Osteoporosis

(note extensive pitting and fragility of the bone) Detail of a trabecular bone (spongy bone) element eroded by osteoclasts. (note extensive pitting and fragility of the bone)

Osteoporetic vertebrae (marrow removed) Shows a compression fracture                                                         

Bone Infection Osteomyelitis an infection of bone or bone marrow in children, the long bones are usually affected. in adults, the vertebrae and the pelvis are most commonly affected. microorganisms move to bone: via the blood stream spread to bone from local areas of infection, such as cellulitis be introduced by penetrating trauma such as joint replacements, fractures, or root-canalled teeth Treatment involves prolonged IV antibiotics over weeks or months Can result in necrotic bone tissue (tissue death)

Bone Disorders Due to Nutritional Deficiencies Vitamin D Deficiency: Rickets (in children) Osteomalacia (in adults) a softening of the bones due to a calcium deficiency, potentially leading to greenstick fractures and deformity Vitamin D is required for proper calcium absorption from the gut. In the absence of vitamin D, dietary calcium is not properly absorbed. sources of Vitamin D include sunlight and fortified milk those at higher risk for developing rickets include: breast-fed infants whose mothers are not exposed to sunlight breast-fed infants who are not exposed to sunlight individuals not consuming fortified milk, such as those who are lactose intolerant

Vitamin D Deficiency: Rickets (in children) Osteomalacia (in adults)

Bone Disorders Due to Nutritional Deficiencies Vitamin C Deficiency: Scurvy a deficiency disease that results from insufficient intake of vitamin C, which is required for correct collagen synthesis Untreated scurvy is fatal. However, since all that is required for a full recovery is the resumption of normal vitamin C intake, death from scurvy is rare in modern times sources of Vitamin C include fruits and vegetables skeletal effects of the disease, including bowed legs, stunted bone growth, and swollen joints Other symptoms include: Dark purplish spots on skin, especially legs. Spongy gums, often leading to tooth loss. Bleeding from all mucous membranes. Opening of healed scars and separation of knitted bone fractures. Pallor Bleeding gums Sunken eyes Nosebleeds

Vitamin C Deficiency Scurvy Scurvy is now frequently observed among: elderly persons alcoholics malnourished adults. In addition, smokers have higher requirements for vitamin C, and are therefore more at risk.

Secondary Bone Disorders Endocrine System Dysfunctions: Gigantism: results from excess of growth hormone secreted from pituitary gland growth plates remain open so growth does not stop normally Pituitary Dwarfism: results from inadequate pituitary gland function

Bone Cancers Osteosarcoma cancerous tumor of the bone osteo – bone sarcoma – connective tissue tumor cancerous tumor of the bone the most common primary bone cancer most often occurs in young people between the age of 10 and 30, about 10% of cases develop in people in their 60s and 70s more males than females get this cancer tumors develop most often in bones of the arms, legs, or pelvis prognosis depends on the stage of metastasis

Bone Cancers Chondrosarcoma cancer of cartilage cells chondro – cartilage sarcoma – connective tissue tumor cancer of cartilage cells 2nd most common primary bone cancer uncommon in people younger than 20 grade I tumors are not likely to spread (most common) grade II tumors may spread grade III tumors are most likely to spread (least common) wide range of prognoses – good to bad

Bone Cancers Myeloma myelo – bone marrow oma – tumor cancer of the plasma cells contained in the bone marrow (not usually classified as a bone cancer) the 5-year relative survival rate for is around 34%. survival is higher in younger people and lower in the elderly. Treatment usually involves radiation and chemotherapy

Joint Disorders Sprain: injury to the ligaments in a joint usually caused by a sudden and unusual movement during exercise Grade I: no tear in ligament; slight swelling and pain Treat with ‘RICE’ Rest Ice for 48 hours Compression with elastic wrap Elevation above heart Grade II: ligament is partially torn; swelling, bruising, difficultly moving joint, non-severe pain; RICE may work but additional treatment may be necessary Grade III: complete tear of ligament; severe pain and bruising; may require cast and PT

Joint Disorders Degenerative Disorders: Osteoarthritis: low-grade inflammation resulting in pain in the joints, caused by abnormal wearing of the articular cartilage and destruction or decrease of synovial fluid that lubricates those joints

Joint Disorders Infections: Septic Arthritis: Gonococcal Arthritis arthritis caused by an infection of any microorganism (bacterial, viral, or fungal) that has settled in the joints Examples: Gonococcal Arthritis symptom of a gonorrhea infection (bacterial) Rheumatic Fever inflammatory disease which may develop after a streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain

Joint Disorders Inflammation: Tendonitis Bursitis For Both: inflammation of the tendons or the tendon-muscle attachment Bursitis inflammation of one or more bursae, or small sacs of synovial fluid, in the body For Both: commonly caused by repetition of movement or excessive pressure elbows and knees are the most commonly affected joints because they get the most repetitive use Treatment includes rest of affected joint, analgesics, pressure cuffs to relieve strain on joint, and/or corticosteroid injection to reduce inflammation.

Joint Disorders Secondary Disorders: Rheumatoid Arthritis: inflammatory autoimmune disorder that causes the immune system to attack the joints onset is uncommon under the age of 15 and from then on the incidence rises with age until the age of 80 the prevalence rate is 1%, with women affected three to five times as often as men it is 4 times more common in smokers than non-smokers

Joint Disorders Secondary Disorders: Gout: a disease created by a buildup of uric acid which deposits on the articular cartilage of joints, tendons and surrounding tissues this provokes an inflammatory reaction attacks the big toe (approximately 75 percent of first attacks) usually due to poor diet Extremely painful