Unit 4 - Skeletal System

Hammer Toe

* Deformity can be painful and often causes abrasion and inflammation where the flexed toe rubs against footwear * Congenital tendencies and shoes that are too short or have high heels are contributing factors * Switching to shoes that fit properly and allow enough space for the second toe can reverse the process

Paget Disease

Affected areas of bone produce new bone tissue faster than can be broken down haphazardly. Occurs in two stages When symptoms do occur, they usually include local bone pain Patients who have no symptoms require no treatment With symptoms, analgesics, antiinflammatory drugs, cytotoxic agents, or injections of a hormone called calcitonin are used

hormonal

All of these changes result in a decrease of bone mass. While the causes of these changes are not well understood, it is thought that __________ imbalances and changes in activity level may be factors. Bone loss causes deformity, loss of height, pain, stiffness , stooped posture and loss of teeth

mineralization

Bones make good fossils. While the soft tissue of a once living organism will decay and fall away over time, bone tissue will, under the right conditions, undergo a process of ___________ , effectively turning the bone to stone.

Osteogenic

Bone Tumors from bone Symptoms Pain, a limp, soft tissue swelling, fever, fatigue Tumor weakens the bone and makes it susceptible to pathogenic fracture Malignant tumors may be primary or secondary in origin

Chondrogenic

Bone Tumors from cartilage Symptoms uPain, a limp, soft tissue swelling, fever, fatigue uTumor weakens the bone and makes it susceptible to pathogenic fracture uMalignant tumors may be primary or secondary in origin

Fibrogenic

Bone Tumors from fibrous tissue Symptoms: - Pain, a limp, soft tissue swelling, fever, fatigue - Tumor weakens the bone and makes it susceptible to pathogenic fracture Malignant tumors may be primary or secondary in origin

adipose

Bone also serves as a site for fat storage and blood cell production. The softer connective tissue that fills the interior of most bone is referred to as bone marrow. There are two types of bone marrow: yellow marrow and red marrow. Yellow marrow contains ________ tissue; the triglycerides stored in the adipocytes of the tissue can serve as a source of energy. Red marrow is where hematopoiesis—the production of blood cells—takes place. Red blood cells, white blood cells, and platelets are all produced in the red marrow.

pagets

Bone disorders include osteoporosis and _________ disease Abnormal spinal curvatures include scoliosis, kyphosis, and lordosis. Joint inflammations include osteoarthritis, rheumatoid arthritis and gouty arthritis Bone infection include Osteomyelitis, Lyme disease Bone injury include fractures

osseous tissue

Bone, or____________ _______, is a hard, dense connective tissue that forms most of the adult skeleton, the support structure of the body.

D

Calcium is a chemical element that cannot be produced by any biological processes. The only way it can enter the body is through the diet. The bones act as a storage site for calcium: The body deposits calcium in the bones when blood levels get too high, and it releases calcium when blood levels drop too low. This process is regulated by PTH, vitamin ___, and calcitonin.

10

Calcium is not only the most abundant mineral in bone, it is also the most abundant mineral in the human body. Calcium ions are needed not only for bone mineralization but for tooth health, regulation of the heart rate and strength of contraction, blood coagulation, contraction of smooth and skeletal muscle cells, and regulation of nerve impulse conduction. The normal level of calcium in the blood is about ___ mg/dL. When the body cannot maintain this level, a person will experience hypo- or hypercalcemia.

Osteosarcoma

Cancer of Bone

parathyroid

Cells of the _______________gland have plasma membrane receptors for calcium. When calcium is not binding to these receptors, the cells release PTH, which stimulates osteoclast proliferation and resorption of bone by osteoclasts. This demineralization process releases calcium into the blood. PTH promotes reabsorption of calcium from the urine by the kidneys, so that the calcium returns to the blood. Finally, PTH stimulates the synthesis of vitamin D, which in turn, stimulates calcium absorption from any digested food in the small intestine. When all these processes return blood calcium levels to normal, there is enough calcium to bind with the receptors on the surface of the cells of the _______________ glands, and this cycle of events is turned off

osteoblastic

During puberty, the sex hormones (estrogen in girls, testosterone in boys) also come into play. They too promote __________ activity and production of bone matrix, and in addition, are responsible for the growth spurt that often occurs during adolescence. They also promote the conversion of the epiphyseal plate to the epiphyseal line (i.e., cartilage to its bony remnant), thus bringing an end to the longitudinal growth of bones.

sunlight

Except for fatty fish like salmon and tuna, or fortified milk or cereal, vitamin D is not found naturally in many foods. The action of _____ on the skin triggers the body to produce its own vitamin D but many people, especially those of darker complexion and those living in northern latitudes where the sun's rays are not as strong, are deficient in vitamin D. In cases of deficiency, a doctor can prescribe a vitamin D supplement.

resistance

Exercise and Bone Tissue Numerous, controlled studies have demonstrated that people who exercise regularly have greater bone density than those who are more sedentary. Any type of exercise will stimulate the deposition of more bone tissue, but ___________ training has a greater effect than cardiovascular activities. ___________ training is especially important to slow down the eventual bone loss due to aging and for preventing osteoporosis.

reabsorption

Finally bone ____________ continues without the continued formation of new bone. This results in larger centrally located medullary cavities of the long bones and thinner walls of compact bone.

hip

For many elderly people, a ____ fracture can be life threatening. The fracture itself may not be serious, but the immobility that comes during the healing process can lead to the formation of blood clots that can lodge in the capillaries of the lungs, resulting in respiratory failure; pneumonia due to the lack of poor air exchange that accompanies immobility; pressure sores (bed sores) that allow pathogens to enter the body and cause infections; and urinary tract infections from catheterization.

Bunion

Hallux Valgus (_________) uSymptoms: Progressive enlargement of the first MTP joint and local inflammation and pain uOften the result of a foot disorder known as hallux valgus; there's also a familial tendency uTreatment uWearing shoes with a bigger toe box uUsing padding between the toes/around bunion uApplication of ice uAnalgesic medications

Rigidus

Hallux ___________: * Causes pain and loss of motion in the joint * The MTP joint becomes painful, stiff, and swollen * Degeneration of the MTP joint can occur as a result of injury or underlying arthritis *Radiographic studies confirm the degenerative process * Conservative treatment includes drug therapy with antiinflammatory medications

Kyphosis

Hunchback (_________) usually refers to an abnormally curved spine. is an abnormally excessive convex curvature of the spine as it occurs in the thoracic section of vertebrae. It's most common in older women and often related to osteoporosis. Some people with _________have back pain and stiffness. Others have no symptoms other than an exaggerated forward rounding of the back. Severe _________can cause pain and be disfiguring. Treatment may include medications for pain, physical therapy, and sometimes surgery.

protein

In addition to the lose of calcium as one ages _______ synthesis also slows. As a result there is little to no new formation of collagen fibers. These fibers are what give the bones strength and flexibility. Without them bones become brittle resulting in a higher rate of fracture.

cartilage

In the areas of the skeleton where bones move (for example, the ribcage and joints), ____________ , a semi-rigid form of connective tissue, provides flexibility and smooth surfaces for movement.

Osteomyelitis

Inflammation, swelling, localized heat, redness, pain, and local tenderness over and around the affected bone are characteristic signs Other symptoms of osteomyelitis include chills, fever, sweating, and malaise Subperiosteal abscess may develop, causing eventual fracturing of small pieces of bone Staphylococcus aureus is the bacterial organism responsible for 90% of infections Treatment 1. Long-term antibiotic treatment 2. Increased intake of proteins and vitamins A, B, and C 3. Bed rest 4. Control of chronic conditions 5. Immobilization of affected part 6. Surgical drainage to remove purulent material and sequestrum 7. Hyperbaric oxygen treatments

calcium

Milk and other dairy foods are not the only sources of ___________. This important nutrient is also found in green leafy vegetables, broccoli, and intact salmon and canned sardines with their soft bones. Nuts, beans, seeds, and shellfish provide __________ in smaller quantities.

Vitamin D

Needed for calcium absorption

Calcium

Needed to make calcium phosphate and calcium carbonate, which form the hydroxyapatite crystals that give bone its hardness

Lyme Disease

No one is immune Patients have a characteristic red, itchy rash with a red circle center Symptoms such as headache, fever, fatigue, joint pain, and general malaise occur Caused by a spirochete bacterium that is transmitted to humans by a bite from a small tick Treatment 1. Removal of tick 2. Oral antibiotics 3. Intravenous antibiotics 4. Bed rest and physical therapy Prevention 1.Avoid tick bites by wearing long clothing 2.Inspect clothes and body for ticks

kidneys

Obviously, calcium homeostasis is critical. The skeletal, endocrine, and digestive systems play a role in this, but the ________ do, too. These body systems work together to maintain a normal calcium level in the blood

3

Omega-___ fatty acids have long been known to reduce inflammation in various parts of the body. Inflammation can interfere with the function of osteoblasts, so consuming omega-___fatty acids, in the diet or in supplements, may also help enhance production of new osseous tissue

nerve

On a metabolic level, bone tissue performs several critical functions. For one, the bone matrix acts as a reservoir for a number of minerals important to the functioning of the body, especially calcium, and potassium. These minerals, incorporated into bone tissue, can be released back into the bloodstream to maintain levels needed to support physiological processes. Calcium ions, for example, are essential for muscle contractions and controlling the flow of other ions involved in the transmission of _________ impulses.

Articular

One of the main roles of the skeletal system is the smooth functioning of the various movable joints of the body. ________ cartilage covers the ends of bone involved in a joint. As the joint moves ________ cartilage rubs against ________cartilage, as opposed to bone on bone contact. This cartilage reduces friction and produces smooth movements in the joints. As you age this cartilage becomes thinner and deteriorates. The resulting bone on bone contact makes movement of the joint painful.

Paget

Only a small number of conditions are commonly responsible for pathological fractures, including osteoporosis, _________ disease, osteitis, bone tumors.

osteoclast

PTH stimulates ___________ proliferation and activity. As a result, calcium is released from the bones into the circulation, thus increasing the calcium ion concentration in the blood. PTH also promotes the reabsorption of calcium by the kidney tubules, which can affect calcium homeostasis

Omega-3 fatty acids

Reduces inflammation that may interfere with osteoblast function

epiphyseal

Sex Hormones: They also promote the conversion of the ____________ plate to the epiphyseal line (i.e., cartilage to its bony remnant), thus bringing an end to the longitudinal growth of bones.

Magnesium

Structural component of bone other than Fluoride

Fluoride

Structural component of bone. other than Magnesium

Vitamin K

Supports bone mineralization; may have synergistic effect with vitamin D

skeletal

The ____ system is the body system composed of bones and cartilage and performs the following critical functions for the human body: supports the body facilitates movement protects internal organs produces blood cells stores and releases minerals and fat

pituitary

The __________ gland secretes growth hormone (GH), which, as its name implies, controls bone growth in several ways. It triggers chondrocyte proliferation in epiphyseal plates, resulting in the increasing length of long bones. GH also increases calcium retention, which enhances mineralization, and stimulates osteoblastic activity, which improves bone density.

endocrine

The _____________ system produces and secretes hormones, many of which interact with the skeletal system. These hormones are involved in controlling bone growth, maintaining bone once it is formed, and remodeling it. Several hormones are necessary for controlling bone growth and maintaining the bone matrix.

homeostasis

The body regulates calcium ________ with two pathways; one is signaled to turn on when blood calcium levels drop below normal and one is the pathway that is signaled to turn on when blood calcium levels are elevated

Fluoride

The minerals magnesium and ____________ may also play a role in supporting bone health. While magnesium is only found in trace amounts in the human body, more than 60 percent of it is in the skeleton, suggesting it plays a role in the structure of bone. ____________ can displace the hydroxyl group in bone's hydroxyapatite crystals and form fluorapatite. Similar to its effect on dental enamel, fluorapatite helps stabilize and strengthen bone mineral. ____________ can also enter spaces within hydroxyapatite crystals, thus increasing their density.

deposition

The ratio of __________ to reabsorption changes as we age. Deposition > Reabsorption from Birth to age 25 Increasing bone mass and density Deposition = Reabsorption from Ages 25 to 45 Maintaining bone mass and density Deposition < Reabsorption at Age 45 and over Decreasing bone mass and density

Calcitonin

The small intestine is also affected by PTH, albeit indirectly. Because another function of PTH is to stimulate the synthesis of vitamin D, and because vitamin D promotes intestinal absorption of calcium, PTH indirectly increases calcium uptake by the small intestine. ____________ , a hormone secreted by the thyroid gland, has some effects that counteract those of PTH. ____________ inhibits osteoclast activity and stimulates calcium uptake by the bones, thus reducing the concentration of calcium ions in the blood. As evidenced by their opposing functions in maintaining calcium homeostasis, PTH and ____________ are generally not secreted at the same time .

D

The vitamins and minerals contained in all of the food we consume are important for all of our organ systems. However, there are certain nutrients that affect bone health. Calcium and Vitamin ___.

206

There are _____ bones in the human body

Osteoporosis

There is wasting or deterioration of bone mass and density Unless it occurs in the vertebrae or weight-bearing bones, ______________ usually does not produce symptoms Caused by the imbalance between the breakdown of old bone tissue and the manufacture of new bone uNotice how this is different from Paget's disease. In Paget's disease, new bone is formed in an attempt to keep up with the resorption by the overactive osteoclasts, but that new bone is produced haphazardly. In fact, when a physician is evaluating a patient with thinning bone, he or she will test for osteoporosis and Paget's disease (as well as other diseases). ______________ does not have the elevated blood levels of alkaline phosphatase found in Paget's disease.

amputation

Treatment and Prognosis of Tumors * Surgical excision and bone grafting * Tumor location may necessitate __________ * Administration of chemotherapy and/or radiation therapy * Prognosis depends largely on tumor type, extent of disease at presentation, and anatomic location

Gouty

Treatment: Bed rest to reduce pressure on affected joints Application of cold packs to inflamed joints NSAIDs and corticosteroids Low-purine diet and adequate fluid intake Antihyperuricemic medications Gradual weight reduction Limiting alcohol intake, avoiding dehydration, and eating a proper diet are keys to prevention

K

Vitamin ____ also supports bone mineralization and may have a synergistic role with vitamin D in the regulation of bone growth. Green leafy vegetables are a good source of vitamin ____ .

Calcitriol

_________ the active form of vitamin D, is produced by the kidneys and stimulates the absorption of calcium and phosphate from the digestive tract.

thyroid

When blood levels of calcium get too high, the ________ gland is stimulated to release calcitonin which inhibits osteoclast activity and stimulates calcium uptake by the bones, but also decreases reabsorption of calcium by the kidneys. All of these actions lower blood levels of calcium. When blood calcium levels return to normal, the ________ gland stops secreting calcitonin.

femur

While osteoporosis can involve any bone, it most commonly affects the proximal ends of the _____ , vertebrae, and wrist. As a result of the loss of bone density, the osseous tissue may not provide adequate support for everyday functions, and something as simple as a sneeze can cause a vertebral fracture. When an elderly person falls and breaks a hip (really, the femur), it is very likely the femur that broke first, which resulted in the fall. Histologically, osteoporosis is characterized by a reduction in the thickness of compact bone and the number and size of trabeculae in cancellous bone.

remodeling

You already know that calcium is a critical component of bone, especially in the form of calcium phosphate and calcium carbonate. Since the body cannot make calcium, it must be obtained from the diet. However, calcium cannot be absorbed from the small intestine without vitamin D. Therefore, intake of vitamin D is also critical to bone health. In addition to vitamin D's role in calcium absorption, it also plays a role, though not as clearly understood, in bone _____________.

bones

____ are used for: Mineral Storage, Energy Storage, and Hematopoiesis

Gouty

________ Arthritis is an inherited condition most commonly affecting men beginning between the ages of 40 and 55. ________ arthritis is caused by excessive levels if uric acid in the blood. The uric acid then crystalized in joints of the body. The crystals often begin in the great toe but may also affect other joints. As the crystals accumulate in the synovial joint they cause pain and swelling. Attacks often subside after a few days but often chronically reappear every few weeks or months. This chronic condition may eventually erode the cartilage and bone of the affected joint. Individuals suffering from this condition are advised to reduce consumption of proteins and increase the consumption of carbohydrates.

Costal

________ cartilage has the specific function of connecting the ribs to the sternum. This cartilage make it possible for the rib cage to expand and contract with respiration. As one ages the cartilage calcifies resulting in a loss of flexibility. This restricts breathing.

Decrease

__________ in estrogen and testosterone levels are responsible for the change. Vertebrae thin out, and the spinal column becomes more curved and compressed The elderly are more prone to falls, resulting in fractures Joints stiffen and become less flexible Minerals may deposit in joints

fracture

__________ is a broken bone. It will heal whether or not a physician resets it in its anatomical position. If the bone is not reset correctly, the healing process will keep the bone in its deformed position.

Arthritis

__________ is one of the most common conditions affecting older people. It is a general term referring to various types of inflammation or degenerative changes that occur in joints.

Joints

___________ hold bones firmly together yet allow movement Classified by the type of material found between the bones Fibrous, cartilaginous, and synovial Also classified according to the degree of movement Immovable, slightly movable, freely movable Range of motion (ROM) is degree of movement

Rheumatoid

____________ Arthritis is an auto immune disorder that is not strictly a disease of old people. It can begin at any age, but ____________ arthritis is progressive and becomes more debilitating with age. ____________ arthritis begins with the inflammation of the synovial membrane causing pain. Prolonged inflammation causes scare tissue to form which destroys the articular cartilage of the joint and bone beneath it. ____________ arthritis can become so severe that surgery may be necessary to repair the affected joints, and in some cases the diseased bone of the joint is removed and replaced with a prosthetic device.

Parathryoid

_____________ and Calcitonin Hormones Bone modeling and remodeling require osteoclasts to resorb unneeded, damaged, or old bone, and osteoblasts to lay down new bone. Two hormones that affect the osteoclasts are ______________ hormone (PTH) and calcitonin.

pathologic

_____________ fracture is a broken bone that's caused by a disease, rather than an injury. Some conditions weaken your bones, which makes them more likely to break. Everyday things, such as coughing, stepping out of a car, or bending over can fracture a bone that's been weakened by an illness

Fibrocartilage

_____________ makes up the intervertebral discs which specifically provides cushioning between the vertebrae which make up the spinal column. After the age of about 40 years of age, the cartilage experiences a gradual loss of cells and water. This results in a decreased level of cushioning provided by these discs.

hypercalcemia

a condition characterized by abnormally high levels of calcium, the nervous system is underactive, which results in lethargy, sluggish reflexes, constipation and loss of appetite, confusion, and in severe cases, coma.

Hypocalcemia

a condition characterized by abnormally low levels of calcium, can have an adverse effect on a number of different body systems including circulation, muscles, nerves, and bone. Without adequate calcium, blood has difficulty coagulating, the heart may skip beats or stop beating altogether, muscles may have difficulty contracting, nerves may have difficulty functioning, and bones may become brittle. The causes of ______________can range from hormonal imbalances to an improper diet. Treatments vary according to the cause, but prognoses are generally good.

Osteoarthritis

is the most common form of arthritis, but the specific causes of osteoarthritis are not well understood. is a chronic inflammation that causes the articular cartilages covering the ends of the bones in the affected joint to degenerate gradually. is characterized by pain in the joints. Occurs mainly in the large weight-bearing joints, especially the knees and hips This is due to bone spurs which form on the exposed ends of the bone after the articular cartilage degrades. Treatment: Physical and drug therapy, nutritional management, and supportive care

osteoporosis

uCurrent treatments for managing osteoporosis include bisphosphonates (the same medications often used in Paget's disease), calcitonin, and estrogen (for women only). Minimizing the risk of falls, for example, by removing tripping hazards, is also an important step in managing the potential outcomes from the disease.

calcium

uThe major age related change in the skeletal system is the loss of calcium in the bone. As previously discussed calcium homeostasis is critical to maintaining bone structure. As one ages this homeostasis is disrupted, which results in a weakening of the bones. While the exact causes of the disruption are not fully understood it has been observed that bone loss is more severe in women that men. In women bones begin to lose calcium around the age of 30. By the age of 70 women may have lose 30% or more of their bone calcium. Most men don't begin to the lose calcium until they reach the age of 60.

50

women lose bone mass more quickly than men starting at about ___ years of age. This occurs because ___ is the approximate age at which women go through menopause. Not only do their menstrual periods lessen and eventually cease, but their ovaries reduce in size and then cease the production of estrogen, a hormone that promotes osteoblastic activity and production of bone matrix. Thus, osteoporosis is more common in women than in men, but men can develop it, too. Anyone with a family history of osteoporosis has a greater risk of developing the disease, so the best treatment is prevention, which should start with a childhood diet that includes adequate intake of calcium and vitamin D and a lifestyle that includes weight-bearing exercise. These actions, as discussed above, are important in building bone mass. Promoting proper nutrition and weight-bearing exercise early in life can maximize bone mass before the age of 30, thus reducing the risk of osteoporosis.