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

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

Answer 1

I think Mary Lou is suffering from a severe form of osteoarthritis. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in the hands, knees, hips and spine Also she has a degenerating cartilage and bone density which led to the fracture of the femur. Osteoarthritis is a degeneration of the articular cartilage that covers the bone ends adjacent to each other. Once this degeneration establishes, it can slowly cause more cartilage loss between the bones which leads to "bone-on-bone" and more pain.

Other joint problems are osteoporosis which also includes reduced bone density and degeneration of cartilage usually after menopause. While OA is a degeneration of a joint, osteoporosis is the loss of BONE mass which causes the risk of fractures, even spontaneously. Osteoporosis is PAINLESS whereas osteoarthritis is painful.  Low bone mass, called osteopenia, is the precursor to osteoporosis and can lead to osteoporosis.