Bone Disorders

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
• 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.

– 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 menopause
 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
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
• 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. • Pallor
• Spongy gums, often leading to tooth loss. • Bleeding gums
• Bleeding from all mucous membranes. • Sunken eyes
• Opening of healed scars and separation of knitted bone fractures. • 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
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
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:
• 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
• 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