Fatimah's Soft Bones

Fatimah's Soft Bones

1. Anatomy

   • bones
     • Hip bone
       • surfaces
         • gluteal
         • pelvic
       • parts
         • ilium
         • pubis
         • ischium
       • articulation surfaces
         • symphesseal
         • sacral
         • acetabulum
     • femur
       • anteriorly
         • lesser trochanter
         • greater trochanter
       • posteriorly
         • linea aspera
           • gluteal tuborosity
           • pectinate line
   • Joints
     • Hip joint
       • Type
         • Synovial
       • variety
         • Ball and socket
       • Articulations
         • between
       • movements
         • Abduction
         • Adduction
         • extension
         • Flexion
         • rotation
   • muscles
     • femoral triangle
       • Psoas major
       • Iliacus
       • Pectinues
     • Gluteal region
       • 3 Gluteus muscles
         • Maximus
         • Medius
         • Minimus
       • 2 Gemellus M.
       • Obturator internus M.
       • Piriformis M.
       • quadratus femoris M.
   • Neurovasculature
     • Nerves
       • Obturator N.
       • Femoral N.
     • blood supply
       • Femoral A.
     • Venous drainage
       • Femoral vein
   • femoral triangle
     • boundaries
       • base
         • inguinal Lig
       • apex
         • Adductor canal
       • lateral margin
         • sartorius m.
       • medial border
         • adductor longus M.
       • roof
         • fascia lata

2. Osteoporosis

   • Pathophysiology
     • Bone loses mass
       • Resorption by osteoclasts
         • Bones become weaker and more fragile
           • fractures
             • mostly in
               • spine
               • femur
               • wrist
             • falling
               • increased possibility
                 • Cognitive impairment
                 • tobacco use
                 • steroids use
   • risk factors
     • sedentary lifestyle
     • low estrogen
     • Alcohol use
     • Low calcium
     • smocking
   • Diagnosis
     • asymptomatic
     • Blood levels of minerals are normal
     • DEXA
       • measure bone mineral density
         • T score
           • measures bone density in comparison to his age group
         • Z score
           • measures bone density in comparison to Younger people
   • clinical features
     • Asymptomatic
       • fractures
         • pain
         • immobility
   • Treatment
     • Osteoblastic action
       • Teriparatide
         • recombinant form of PTH
     • osteoclasts supression
       • Denosumab
         • Target receptor activator of RANKL
       • raloxifene
         • Estrogen receptor modulator
       • calcitonin
         • Adverse effects
           • rhinitis
           • potential malignancy
       • biphosphonates
         • used for
           • postmenopausal osteoporosis
           • paget's disease
           • hypercalcemia
         • side effects
           • esophagitis
           • gastric ulcers
           • jaw osteonecrosis
   • Reduction in bone mass
   • types
     • localized
       • disuse
     • generalized
       • primary
         • senile
         • postmenopausal
       • secondary
         • neoplastic
         • GI
         • Endocrine related
   • morphology
     • widened
       • cortex
       • trabeculae
     • thinned
       • haversian systems
   • regulators
     • RANK/RANKL
       • Regulates osteoclast formation
         • increased
     • OBG
       • Protect from excessive resorption
         • decreased

3. Lab Investigations

   • Pagets disease
     • High
   • Osteocalcin
     • should not be used to diagnose osteoporosis
     • Higher in osteoporosis
   • Osteoporosis
     • Normal
       • Ca
   • Alkaline phosphatase ALP
     • removes phosphate group
     • Found in
       • Bones, Kidney, Liver, placenta
     • produced by
       • osteoblast
   • Osteomalacia
     • High
       • PTH
     • Low
       • Ca
       • Vitamin D

4. Femur Fractures

   • subcapital neck fracture
     • 4 types
       • Type I
         • incomplete, stable and impacted
       • Type 2
         • complete, stable and undisplaced
       • Type 3
         • complete, unstable and partially displaced
       • Type 4
         • complete, unstable and fully displaced
     • most common type of intracapsular neck fracture
   • transcervical neck fracture
     • the top part of the femur is broken
   • femoral head fracture
   • intertrochanteric fracture
     • between the greater and lesser trochanter

5. Ca regulation

   • 3 hormones
     • Vit D
       • deficiency
         • rickets
           • children
         • osteomalacia
           • adults
       • function
         • maintain plasma levels of Ca
           • by
     • PTH
       • secreted
         • parathyroid gland
     • Calcitonin
       • decrease serum levels of Ca
         • by
           • inhibiting bone resorption
           • Increasing Ca excretion
       • secreted
         • thyroid gland
     • act on
       • Kidneys
       • intestines
       • bones

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