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Management of Musculoskeletal Disorders

Osteoporosis. Metabolic disease caused by bone demineralization ? ? bone density ? fracturesCommon areas: wrist, hip, vertebraeBone mineral desity (BMD) = T-scoresOstopenia (low bone mass) T-score between -1 and -2.5BMD decreased rapidly as estrogen levels ?Osteoporosis in post-menopausal women

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Management of Musculoskeletal Disorders

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    1. Management of Musculoskeletal Disorders Chapter 68 We will discuss the metabolic bone diseases (osteoporosis, osteomalacia, Paget’s Disease), Osteomyelitis, and Bone Tumors We will discuss the metabolic bone diseases (osteoporosis, osteomalacia, Paget’s Disease), Osteomyelitis, and Bone Tumors

    2. Osteoporosis Metabolic disease caused by bone demineralization ? ? bone density ? fractures Common areas: wrist, hip, vertebrae Bone mineral desity (BMD) = T-scores Ostopenia (low bone mass) T-score between -1 and -2.5 BMD decreased rapidly as estrogen levels ? Osteoporosis in post-menopausal women = T-score = -2.5

    3. Osteoporosis: Classification Primary Not associated with underlying disease Most common in women after menopause and men in later years Type I: postmenopausal: ages 55-65 Type II: senile: over age 65 Secondary Related to an associated medical condition Treatment related to underlying cause

    4. Primary Osteoporosis: Risk Factors Age over 60 years Family history Caucasian or Asian Thin, lean body build Low lifetime calcium intake Estrogen deficiency/androgen deficiency Smoking history/high alcohol intake Lack of physical exercise/prolonged immobility

    5. Primary Osteoporosis: Clinical Manifestations Dowager’s hump, kyphosis, shortened height Sharp, acute back pain Tenderness, restriction of spinal movement Vertebral compression fracture(s) Constipation/abdominal discomfort/reflux esophagitis Most common fractures: Between T8 and L3 Distal end of radius and hip

    6. Primary Osteoporosis: Interventions Drug therapy Estrogen/calcium/vitamin D Biphosphonates (BPs) Selective estrogen receptor modulators (SERMs) Calcitonin/androgens Diet therapy Prevention of falls Exercise Pain management Orthotic devices

    7. Osteomalacia Defect in bone mineralization resulting from lack of vitamin D Often present with muscle weakness and bone pain Diagnosis: Low or normal calcium, high alkaline phosphatase Xrays show radiolucent bands (Looser’s zones) Treatment: increasing vitamin D intake, sun exposure and drug supplements

    8. Paget’s Disease (Osteitis Deformans) Metabolic disorder of bone remodeling or turnover Pathophysiologic phases: Active: massive bone destruction and deformity Mixed Bone: bone is disorganized and chaotic structure Inactive: newly formed bone becomes sclerotic and ivory hard Possible due to latent viral infection Familial autosomal dominant pattern

    9. Paget’s Disease: Clinical Manifestations 80% asymptomatic Aching bone pain, worse with weight bearing Back pain, headache, and arthritis at joint of affected bones Nerve impingement in lumbosacral area Loss of normal spinal curvature Lower extremity malalignment

    10. Paget’s Disease: Clinical Manifestations Bowing of long bones Deformity of elbows and knees Flexion contractures of hips Enlarged, thick skull Pathologic fractures Skin changes: flushed, warm Apathy, lethargy, fatigue Other: Hyperparathyroidism and gout, urinary or renal stones, heart failure

    11. Paget’s Disease: Interventions Nonsurgical Relieve pain Decrease bone resorption Surgical Partial or total joint replacement

    12. Osteomyelitis Infection of the bone Acute Most common in children Infection moves from another part of the body to the bone tissue Penetrating trauma Chronic Results from acute type Common in adult with compromised vascular supply Advance age and concurrent disease

    13. Osteomyelitis: Assessment Fever Swelling and tenderness at affected site Erythema and heat Draining ulcers Bone pain Elevated WBC, ESR 50% have positive blood cultures

    14. Osteomyelitis: Interventions Nonsurgical Drug therapy Infection control Hyperbaric oxygen therapy Surgical Sequestrectomy Bone grafts Bone segment transfers Muscle flaps Amputation

    15. Bone Tumors Major classifications Chonrogenic: arise from cartilage Osteogenic: arise from bone Fibrogenic: arise from fibrous tissue

    16. Benign Bone Tumors Most often asymptomatic Symptoms may include: pain, tenderness and/or swelling at site Diagnostics: xray, CT, bone biopsy Nonsurgical Management: Pain medication Heat and/or cold applications Surgical Management: Curettage Excision with bone/joint restoration

    17. Malignant Bone Tumors May be primary or secondary Clinical manifestations: non-specific c/o (pain, local swelling, and tender, palpable mass) Cause psychosocial issues Lab: ? serum alkaline phosphatase (ALP) Dx: xrays, CT, Bone bx, Bone scan Nonsurgical Drug therapy Radiation Surgical Wide or radical resection Limb salvaging procedures

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