1. 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.

2. 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

3. Congenital Bone Disorders
Abnormal Curvature of the Spine
Kyphosis Lordosis Scoliosis

4. 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

5. 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

6. 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.

7. 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

9. 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)

10. 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)

11. Normal
Osteoporosis

12. (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)

13. Osteoporetic vertebrae (marrow removed) Shows a compression fracture
                                                        

14. 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)

15. 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

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

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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.

27. 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

28. 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