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PATHOLOGY & PATHOPHYSIOLOGY

DISORDERS OF THE SKELETAL SYSTEM

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MAINTAINING BONE DENSITY

Calcium, magnesium,

phosphorus, vitamin D,

parathyroid hormone,

calcitonin, growth

hormone, oestrogen,

progesterone and

testosterone

Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135


OSTEOPOROSIS

Definition: Progressive decrease in the density of bones

Bones are weaker and more prone to fractures

Signs and symptoms:

None at first

Sudden back pain may occur

There may be loss of normal curve of the spine (kyphosis)

Loss of height

Easy fractures

Fractures take long to heal



OSTEOPOROSIS

Risk factors:

Advanced age

Family history

Petite/low body weight

Eating disorders

Female athletes

Late menarche

Early menopause

Never had children

Sedentary lifestyle

High protein diet

More than 2 cups of coffee per day

On: Thyroid medicine, corticosteroids, anticonvulsants



OSTEOPOROSIS

Aetiology:

Nutrient deficiencies: Calcium, magnesium, potassium,

vitamin D and K

Acidic diet

Smoking

Salt

Caffeine and alcohol

Lack of exercise

Ageing

Cushing’s disease

Hyperthyroidism

Certain medications: Corticosteroids, hypothyroidism

medications, anticonvulsants



OSTEOPOROSIS

Prevention:

Avoid risk factors

Weight bearing exercise

Diet: Good sources of calcium, e.g. diary (especially yoghurt),

almonds, “beans and greens”

Calcium & magnesium supplement with a 2:1 ratio

Get some sunshine

Reduce intake: Salt, animal proteins, alcohol, cigarettes and

coffee



OSTEOPOROSIS

Conventional treatment:

Calcium supplement

Oestrogen/testosterone therapy

Biphosphanates

Calcitonin


Complementary treatment:

Change the diet

Progesterone cream

Calcium & magnesium supplement

Tissue salts


OSTEOPOROSIS

For calcium to be absorbed:

The stomach must be acidic (Antacids make calcium

absorption difficult. Older people may also have a lack of

stomach acid)

Calcium competes with other substances for absorption,

especially with phosphorus. Fizzy drinks make calcium

absorption difficult!

You need vitamin D for calcium absorption



OSTEOPOROSIS

Calcium loss:

Diets rich in meat increases calcium excretion in the urine

Calcium use in the body:

If blood calcium levels become low, your body will draw from

the calcium “bank” which is your bones

If the blood is acidic, your body will increase the blood

calcium levels to neutralise the acidity



HORMONE REPLACEMENT THERAPY (HRT)

Oestrogen can help to prevent further bone loss, but as soon as

the oestrogen is stopped, the bone loss continues

HRT has risks: Uterine cancer, breast cancer, thrombosis

Oestrogen prevents the breakdown of old bone - it does not build

new bone

Natural progesterone builds new bone



OSTEOARTHRITIS

The most prevalent form of arthritis

Degeneration of the articular cartilage (“wear and tear”)

Signs and symptoms:

Aching pain in one/more joints

Pain worse for activity and better for rest

In later stages of the disease, pain may also be felt at rest or

during sleep

The joint(s) may make a grinding sound when used

Limitations of joint motion

Nodes next to the joints



OSTEOARTHRITIS

Joints that are usually affected: Hips, knees, lumbar vertebrae,

cervical vertebrae, PIP joints of the hands, DIP joints of the

hand, 1st carpometacarpal joint, 1st metarsophalangeal joint



OSTEOARTHRITIS



OSTEOARTHRITIS

Treatment:

Weight loss

Physical rehabilitation

Medication

Surgery

Supplements: Omega 3, Glucosamine, Magnesium

Herbs: Boswelia serrata, Turmeric, Ginger



RHEUMATOID ARTHRITIS

Onset of the disease is usually between the ages of 30 and 50

An autoimmune disorder in which the synovial membrane of

joints become inflamed and damaged

70 to 80% of people with rheumatoid arthritis have a substance

called rheumatic factor (RF) in their blood

Rheumatoid factor is an antibody that plays a role in this disease




Signs and symptoms:

Insidious onset marked by systemic manifestations, e.g.

fatigue, weight loss, general aching and stiffness

Inflammation of the joints

Exacerbations and remissions




Signs and symptoms:

Usually affects joints in a symmetrical pattern

Affects the following joints first: fingers, wrists, feet and

knees

Affected joints are swollen, painful, feel spongy and warm

Affected joints may become immobile

Deformities of the hands are common





Hands and feet:




Rheumatoid nodules:


GOUT

Definition: Deposition of uric acid crystals in synovial joint

cavities

Pathogenesis: Increased serum uric acid

Aetiology:

Idiopathic

Kidney disease

Treatment for cancer

Some diuretics interfere with uric acid excretion



GOUT

Signs and symptoms:

The excess uric acid forms crystals in joints (synovial fluid is a

poorer solvent for uric acid than plasma)

The crystals create inflammation in the joint

Frequent attacks of gout cause damage to the affected joints

Acute attacks in which a joint becomes inflamed. The joint is

red, swollen and very painful. An acute attack may last for

days.

Acute attacks usually start during sleep at night



GOUT



GOUT

Treatment:

Loose weight if overweight

Decrease alcohol consumption

Avoid/decrease purine rich foods: Liver, kidney, sardines,

anchovies, mackerel, shellfish, asparagus, herring, meat

gravies, mushrooms, mussels, mincemeat, baker’s yeast,

brewer’s yeast, peanuts etc.

Avoid meat as much as possible



SLIPPED DISC

Ruptured disc/herniated disc

If the IV disc degenerates due to injury or ageing – the soft inner

core can bulge out

This hernia can compress, irritate or damage a nerve root



SLIPPED DISC

Signs and symptoms: Pain in the back, sciatica, weakness of a

leg, numbness or tingling in a leg

Treatment:

Activities that put stress on the spine should be avoided

Specific back exercises (Pilates)

Posture, posture, posture!

Pick up heavy things by bending the legs, not the back!



SCIATICA

Definition: Pain down the back of the leg in the area supplied by

the sciatic nerve.


Aetiology: Pressure on the

sciatic nerve root. This may

be due to a slipped disc,

osteoporosis or injury to the

vertebra.


CARPAL TUNNEL SYNDROME

Definition: A set of signs and symptoms due to the entrapment

of the median nerve between the carpal bones and the

transverse carpal ligament.

Aetiology: Repetitive strain injury, pregnancy, menopause,

obesity

Pathogenesis: Oedema, subluxation or fibrotic build up

Signs and symptoms: Tingling, pins and needles, numbness and

weakness in a specific area of the hands



CARPAL TUNNEL SYNDROME



BURSITIS

Aetiology: Repetitive

movements, e.g.

“housemaid’s knee”,

“student’s elbow” or

“weaver’s bottom”


Definition: Inflammation of bursa

Bursae pad the sharpest corners in the body


ADVICE FOR BONE AND JOINT HEALTH


Keep fit and supple

Eat healthy

Consult an osteopath/chiropractor

Supplements:

Omega 3

Turmeric

Boswelia serrata

Glucosamine hydrochloride

Magnesium


QUESTIONS

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