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Toledo PT Bone Physiology/Pathophysiology
Toledo PT Bone physiology/pathophysiology
82
Physiology
Professional
11/04/2009

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Term
Hematopoioesis
Definition
refers to the formation and development of the cells of the blood
Term
What minerals do the bones store?
Definition
calcium phosphate salts (hydroxyapatite)
Term
What kind of collagen is in bone?
Definition
collagen type 1
Term
What kinds of
Definition
Term
What is the weight distribution of the bones between collagen and minerals?
Definition
40% collagen, 60% minerals (calcium phosphate salts)
Term
What are the 3 types of bones
Definition
Cortical/Compact bone, Trabecular or cancellous or spongy bone, Woven bone
Term
What is the purpose for hard and soft parts of bones?
Definition
strength to resist heavy weight, and cushion to accomodate heavy weight.
Term
Where is cortical bone found in the body?
Definition
foudn in the shaft of long bones. forms outer shell around spongy bone at the end of joints and vertebrae
Term
What percent of the skeleton is formed by cortical bone?
Definition
80 %
Term
What makes up the haversian system or oteon in the cortical bone and what does it contain?
Definition
Lamella forming concenteric rings forming the haversian canal which contains capillaries and nerve fibers.
Term
Lacunae
Definition
hollows within matrix where osteoblasts are encased
Term
Canaliculi
Definition
tiny canals that interconnect lacunae
Term
Volkmann's canals
Definition
penetrates bones perpendicularly & communicates with vessels in the Haversian canals
Term
Trabecular Bone
Definition
Less dense and more porosity. Found in the end of long bones, vertebrae and flat bones like pelvis. 20% of skeleton. Lamellae present but do not form haversian system. trabeculae laid down in proportion to amount of mechanical stress pere Wolff's law.
Term
T/F. Osteocytes, lacunae, and canaliculi in trabecular bone DO NOT resemble those in compact bone.
Definition
False. They do resemble compact bone.
Term
When is woven bone mostly present?
Definition
Forms embryonic skeleton, largely absent from normal bone after age 4 yrs. can be seen in fracture callus in both children and adults.
Term
T/F. Woven bone does not contain lamellae, but rathere has a relatively disorganized array of collagen with irregular mineralization pattern.
Definition
True
Term
Diaphysis
Definition
shaft of a long bone.
Term
Epiphysis
Definition
proximal and distal
Term
Metaphysis
Definition
portion of a long bone bbetween the epiphyses and the diaphysis
Term
Periosteum
Definition
Is fibrous connective tissue that is wrapped around the bone in all places exept at joints. Nociceptive nerves. Provides nourishment. Osteogenic cells & osteoblasts, vital role in healing. insertion point for tendons and ligaments.
Term
Endosteum
Definition
Covers the trabeculae of spongy bone.
Term
Endosteum
Definition
covers the trabeculae of spongy bone, lines medullary cavity, contains osteogenic cells & osteoblasts.
Term
Bone Marrow
Definition
found mainly in the flat bones such as hip bone, skull, ribs, vertebrae, and sholder blades, cancellous bone at proximal ends of long bones femur and humerus.
Term
In what kind of marrow are red blood cells, platelets and most white blodd cells produced?
Definition
Red marrow.
Term
Yellow Marrow
Definition
foudn in the hollow interior of the middle portion of long bones. has high fat cells, which cause the marrow to appear in yellow.
Term
Stem cells in bone marrows
Definition
Hematopoietic stem cells, and mesnchymal cells are located in the bone marrow.
Term
What kind of bone marrow is used for bone marrow transplants?
Definition
Hematopoietic Stem Cells
Term
What kind of stem cells have the capability to differentiate into osteoblasts, chondrocytes, myocytes, and many other types of cells.
Definition
Mesenchymal Cells
Term
How do osteoclasts originate?
Definition
Formed by the fusion of mononuclear cells derived from hematopoietic stem cells in marrow.
Term
Where are osteoclasts typically located in the bones and what is it's function?
Definition
Large motile, multinucleated cell in resorption bay. Responsible for bone resorptio. Adhere to bone surface via integrins.
Term
How are Osteoblasts formed
Definition
They are derived from mesenchymal precursor cells in the bone marrow.
Term
What are the primary functions of osteoblasts?
Definition
produce new bone "osteoid". Forming matrix-> type 1 collagen. making cell lines after finishing filling cavity during remodeling process. control Ca2+ and mineral deposition.
Term
Osteocytes
Definition
Resides in lacunae. have thin processes, which exteend from lacunae into small channels in bone, called the canaliculi. sense pressure and cracks. direct osteoclasts.
Term
Osteogenic Cells
Definition
Derived from embryonic mesenchyme; capable of differentiating into osteoblasts. dound in eendosteum and periosteum. contribute bone growth, remodeling and repair of bone.
Term
What regulatory factors are secreted by osteoblasts?
Definition
Macrophage-Stimulating factor (M-CSF), and Osteoclast differentiating factor (ODF).
Term
What function does M-CSF do?
Definition
permissive role for ODF/RANK complex which results in differentiation of Osteoclast precursor cells into full grown osteoclasts.
Term
What factor regulates inhibits ODF from inducing differentiation and activation in osteoclasts?
Definition
Osteoprotegerin (OPG), which competes with ODF to bind to RANK. As OPG binds to RANk, it creates and inactive complex.
Term
What are factors that stimulate production of RANK and what are the ramifications of this?
Definition
glucocorticoids, PTH, TNFa, IL's. Result in increased bone resorption
Term
Factors that inhibit production of RANK
Definition
estrogen. Result is that it stimulates bone formation.
Term
Factors that stimulate OPG production
Definition
Estrogen, leptin, mechanical stress. Result: blocks RANK and favors bone formation.
Term
Factors that inhibit OPG production
Definition
glucocorticoids, cyclosporin A.(an immunosuppressive agent) Resultant increased activity of RANK and bone resoprtion.
Term
What are the 4 ways that blood is supplied to the bones?
Definition
Nutrient Artery, Periosteal system, Metaphyseal system, Epiphyseal system
Term
Nutrient Artery
Definition
supplies the inner cortex from within endosteal linings. high pressure system, divides after reaching the medullary cavity, sending arteriole branches in proximal & distal directions to join w/ metaphyseal arteries.
Term
Periosteal System
Definition
forms extensive network of vesels covers entire length of bone shaft. Supplies outer cortex (1/3). very important in children for circumferential bone growth.
Term
Metaphyseal system
Definition
Supplies the zone of provisional calcification in the physis. anastomoses w/ nutrient artery system.
Term
Epiphyseal System
Definition
supplies layers of physis by diffusion. Arterial supply of the cortex is centrifugal and venous flow is centripetal.
Term
T/F. Arterial suupply of the cortex is centrifugal (inside to out) while venous slow is centripetal (outside to in)
Definition
True
Term
Endochondral Ossification
Definition
From a preformed cartilaginous structure. Longitudinal Growth, part of the diaphysis adjacent to the epiphyseal cartilage is the site of advancingn ossification.
Term
Intramembranous Ossification
Definition
De novo at specific sites in the skeleton. Diameter of bone growth (thickening the bone). direct transformation of fibrous matrix into osteoid.
Term
Achondroplasia
Definition
genetic defect of endochondral ossification: dwarfism. people with achondroplasia produce less cartilage, so limbs are shorter.
Term
Key features of Genetic defect in Achondroplasia
Definition
Fibroblast growth factor receptor 3 gene. point mutation: single nucelotide mutation. Mutation results in a sustained activation of FGFR3, that in turn inhibits the normal proliferation of cartilage at the growth plate.
Term
Is achondroplasia inherited as an autosomal dominant or recessive trait?
Definition
autosomal dominant for most variants. autosomal recessive for the rare lethal type II variants.
Term
Osteogenesis Imperfecta
Definition
genetic defects in encoding type I collagen: could be insufficient or poor quality of collagen
Term
What kind of inheritance pattern is seen with osteogenesis imperfecta?
Definition
autosomal dominant for most common variants
Term
What are the phenotypes of osteogenesis imperfecta?
Definition
brittle bone, bone deformity & fractures.
Term
Type I collagen
Definition
consists of 2 proa1 chains and 1 proa2 chain. triple helical section with 338 tandem gly-X-Y. glycine smallest and substitution is disruptive.
Term
Type I osteogenesis imperfecta
Definition
diminished type I collagen production. brittle bone but no bony deformity. infrequent substitution of glycine.
Term
Type II, III, IV
Definition
structural defects in type I collagen. substituion of glycine in the triple helix region. fracture. bony deformities.
Term
Osteopetrosis
Definition
marble bone disease. stone-like and thickened appearance, autosomal or recessive trait. defect in ostoclasts which are unable to resorb collagen. bones thick and brittle. fractures common.
Term
Osteomyelitis definition
Definition
bacterial infection of bones commonly by pyogenic cocci. usually originates in metaphysis.
Term
Osteomyelitis etiology
Definition
originates in metaphysis. PMN leukocytes to site of infection pus formation, enzymes lyse bone. formation of sequestra. iNVOLUCRUM AROUND ZONE OF INFLAMMATION TO PREVENT SPREAD OF INFECTION. Bone deformities predisposing to fractures. Common after bone surgery.
Term
Osteoporosis definition
Definition
absolute reduction of bone mass. most prevalent bone disease.
Term
Multiple factors of osteoporosis
Definition
hormonal changes: estrogen, PTH, corticosteroids; Early Menopause; Diet: Ca2+ and vitamin D; activity level; gentic predisposition; inital bone mass; kidney disease: 1,25 dihydroxy vitamin D.
Term
Osteomalacia definition
Definition
softening bones with inadequate mineralization of bone matrix due to abnormal vitamin D or phosphate metabolism.
Term
What are some causes of Osteomalacia
Definition
vitamin d deficiency, abnormal phosphates, growth retardation, bone deformities: bowlegs, serum Ca2+ and phosphate are low but PTH is high with Vit. D deficiency, phosphate is low but normal Ca 2+ and PTH levels with phosphate deficiency.
Term
Vitamin D deficiency causes
Definition
inadequate intake, inadequate sunlight exposure, abnormal GI malabsorption
Term
Abnromal phosphate causes
Definition
abnormal GI malabsorption. excess loss of phosphate in the presence of hyprparathyroidism.
Term
What are the actions of Vitamin D?
Definition
promotes action of PTH on resorption of Ca2+ and phosphate from bone. stimulates production of 1,25 D3 of kidney. role is not clear.
Term
Paget's Disease definition
Definition
osteitis deformans. characterized by irregular restructuring of bone that leads to thickening and deformities.
Term
Paget's Disease phases
Definition
Destructtive Phase: resorption; Mixed Phase: resorption counterbalanced by formation; Osteosclerotic phase: TBs thickened and CBs replaced by wide, sclerotic, dense bones.
Term
Clinical Features of Paget's Disease
Definition
Affected sites: cranium, long bones of LE, vertebrae; Osteosarcoma develops in some pt.s, mental deterioration, cardiovascular & pulmonary impairments.
Term
Tx of Paget's Disease
Definition
calcitonin and bisphosphate have been used to inhibit bone resorption and manage pain.
Term
Inflammatory Phase
Definition
injured tissues and platelets release vasoactive mediators, growth factors and other cytokines. influence cell migration, proliferation, differentiation and matrix synthesis. fibroblasts, mesenchymal cells & ostoprogenitor cells to the fracture site.
Term
Reparative Phase
Definition
2 days-2 weeks. vasoactive substances cause neovascuularisation & local vasodilation. undifferentiated mesenchymal cells migrate to fracture site and have ability to form fibroblasts and chondroblasts which in turn form cartilage, bone or fibrous tissue.
Term
What are the reparative phase callus?
Definition
External callus: from fracture hematoma, ossifies by endochondral ossificatino to form woven bone; Internal callus: forms more slowly and occurs later; Periosteal Callus: forms directly from the inner periosteal cell layer. Ossifies by intramembranous osification to form woven bone.
Term
Bone remodeling phase
Definition
remodeling of woven bone is dependant on wolff's law. Cortical bone- remodelling occurs by invasion of osteoclast, which is followed by osteoblast. Cancellous bone- remodeling occurs on surface of trabeculae which causes trabeculae to become thicker.
Term
Problems with severe injury
Definition
post-traumatic arthritis, growth abnormalities, delayed union, malunion.
Term
Factors influencing bone healing
Definition
age, type of fracture, location of fracture, type of bone, blood supply, infection, functional activity, hormones, cortisone, TH, GH.
Term
Cortisone effect on factors influencing bone healing
Definition
decreases healing by decreasing callus production.
Term
Thyroid Hormone effect on factors influencing bone healing
Definition
increases healing by increasing bone remodeling
Term
Growth Hormone effect on factors influencing bone healing
Definition
increases healing by increasing callus production.
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