Question

Mary-Lou’s family was happy with the management plan established by the doctor as Mary-Lou was progressing quite well. She was using notepads to jot down reminders, a pillbox to keep her medication organized and a calendar to record appointments. Her family members were helping her with routine tasks such as cooking and paying bills. She was feeling much happier and did not have to rely on alcohol to go to sleep. On one particular day she was feeling so good she decided to walk to her GP appointment alone. On her way there she stumbled over a branch and fell. She felt excruciating pain in her hip. A passer-by called an ambulance and she was taken to the emergency department at the Royal Melbourne hospital. An X-ray revealed that she had broken the neck of her femur and had to have surgery to repair it. Mary-Lou wondered whether this was linked to the crepitus she had been experiencing in her joints. Her joints did feel quite stiff and painful lately. The specialist explained to Mary-Lou that the crepitus was likely due to degeneration of her cartilage and said that the fracture might have been due to weakened bones. He told her he would like her to have a bone mineral density test to measure her bone density. The DEXA scan gave a T-score of -3.0. Mary-Lou is now given bisphosphonates and told to increase her daily intake of calcium.

Question 5 Discuss the pathophysiology of the condition causing the crepitus Mary-Lou is experiencing in her joints. In your answer, list at least two more signs and symptoms associated with the disease.

Question 6 Discuss how the aetiology of Mary Lou’s joint disease differs from the other joint disease we covered in BIOL122.

Question 7 Discuss why Mary-Lou’s fracture may take longer to heal than it would for someone who was half her age. In your answer, you are expected to name and discuss three physiological factors that are needed for healing to take place and explain how each of the factors you identified is affected by ageing. Finally, name two complications of hip fracture that are prevalent in the elderly. .

Question 8 Considering Mary-Lou’s T-score, identify the condition she suffers from, briefly describe the pathogenesis of this disease, and explain why bisphosphonate administration is helpful in this condition

Answer 1

5) Osteoarthritis is a degenerative joint disease,

chronic condition causing breakdown of cartilage.

#. Major Signs & Symptoms :-

pain in joint

Joint stiffness

crepitus: cracking when bones rub together

#. Pathophysiology:-

sometimes for no reason BUT

stress on joints

fissures & erosion--cartilage damage--bumpy joint surfaces

enzymes released--more damage

subchondral bone exposed

cysts & osteophytes (bone growths)

osteophytes separate from bone--fill joint cavity--irritation & inflammation--joint space shrinks

difficulty moving--stress--secondary inflammation

6) The etiology of Mary's disease is different from other disease as she had Osteoarthritis because of deficiency of calcium which lead to easy breakage.

7) The stem cell number in the bone marrow significantly declines with increasing age, and that fractures take longer to heal as the stem cell number drops.

Factors that influence fracture healing are both local and systemic; the former include particularly the degree of local trauma and bone loss, the type of bone affected, the degree of immobilization and local pathologic conditions; the latter include age, hormones, local stress and electric currents

Factors that affect Mary's healing are :-

Age ( elderly age will delay healing)

Degree of bone trauma

Bone loss

Type of bone affected

Hormone changes ( deficiency of estrogen causes bone loss )

Complications of hip fracture :-

- bedsore

- UTI , pneumonia

- avascular necrosis

- DVT

8. Condition - Osteoarthritis

Pathophysiology :-

sometimes for no reason BUT

stress on joints

fissures & erosion--cartilage damage--bumpy joint surfaces

enzymes released--more damage

subchondral bone exposed

cysts & osteophytes (bone growths)

osteophytes separate from bone--fill joint cavity--irritation & inflammation--joint space shrinks

difficulty moving--stress--secondary inflammation

Bisphosphonates are drugs that help prevent or slow down bone thinning (osteoporosis). They can help to treat some types of cancer that cause bone damage. You might hear bisphosphonates called bone hardening or bone strengthening treatment. They are also a treatment for high levels of calcium in your blood.