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Skeletal diseases

Osteoporosis

Patient 1

A sixty-five years old women presents with a fractured rib after a minor accident. History includes the patient is inactive with a poor diet.

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Causes

Our bones have a natural process called Turn over, it consists in generating itself, Osteoclast are cells in charge of breaking down or removing old bone tissue and Osteoblast cells of renewing the bone the bone tissue using minerals as Calcium and phosphate from the blood.

Hormones such as estrogen in women and testosterone in men are essential for bone growth, maintenance and repair keeping the number and activity of the osteoblast higher than osteoclast producing more bone than removing it.

Women’s ovaries after menopause stops producing the hormone estrogen and that increase bone loss, so they may break or fracture easily as they are unable to keep the natural process of bone resorption.

By the age of 30 years old bone have reached their maximum strength and density know as peak bone, after this age osteoclast removes more bone than osteoblast makes, and that process leads to osteoporosis.

Osteoporosis is the most common type of bone disease it increases the risk of bone braking by loosing bone density and becoming fragile.

Symptoms

Osteoporosis can be asymptomatic in the early stage and while developing, in most of the cases the disorder first sing is a fracture after a minor accident, however older people will present symptoms as bending forwards and back pain a result of partial collapse on one or more bones of the spine. The most common parts of the body affected with osteoporosis are hip, wrist and spine, but it can affect in any other bones as arms and legs.

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There are two types of osteoporosis:

Primary osteoporosis is a bone disease or disorder with unknow origins but related to aging and the process of bone loss, in women because the amount of the hormones Estrogen reduces and accelerate with the menopause and men is also related to low levels of Testosterone.

Secondary osteoporosis: is a bone disorder that can affect both children and adults, caused by a certain reason such as: medical conditions (endocrine and metabolic), family history ( genetic disorder)”,treatments with certain medication for long terms(chemicals), lifestyle behaviors (lack of exercise, smoking and excessive alcohol intake, poor diet) and it is also related White and Asia background “,women particularly.

Diagnostic: Secondary Osteoporosis

Treatment

Patient 1 presents a fractured rib and before any treatment there are some steps to follow and define her current health situation.

The treatment should be prescribed after a screening radiograph”,

DEXA stands for a Dual Energy X-ray Absorptiometry and is a Scan used to measure the bone mineral density, the results are expressed in a number called T-Score. NHS 2018

The results of bone mass will be compared to a healthy and young bone known as Peak bone mass, so it can help to determinate the treatment.

Possible prescriptions for Patient 1 may include:

Bisphosphonates: this medicine helps to slow down bone loss, reducing the risk of fracture, stopping the osteoclast from breaking down and reabsorbing the minerals from bones and improves the renewing work of osteoblast making it more effectively. Fosamax Plus D (Pro): alendronate (slows bone mass loss) cholecalciferol (a form Vitamin D) Boniva (Pro): ibandronate (inhibits bone resorption).

Denosumab (Prolia) is another drug (antibody) used to reduce bone breaking by balancing the resorption(osteoclast) and formation(osteoblast). It can be used by men and women with high risk of fracture in other medication conditions such as: men on androgen deprivation therapy for prostate cancer or women on aromatase inhibitor therapy for breast cancer, and postmenopausal women with osteoporosis. Denosumab is administered as an injection under the skin, 60 mg/mL solution, by a trained healthcare professional twice yearly.

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Fresubin® Protein Energy Drink

Nutritionally complete, high caloric (1.5 kcal/ml), high protein (27 % energy) oral nutritional supplement.

Patient 1 is also recommended to exercise, walking for almost 20 minutes daily until her rib recovers.

Rickets

Patient 2

A three-year-old child with a fracture to the femur. Other symptoms may include deformed legs (bowed) and shorter than average for age. History confirms the child was breast fasted with no supplements.

Causes

Rickets is a child bone disorder that can also affects to adults, known as Osteomalacia, caused by a defective bone formation, due to an extreme and prolonged Vitamin D deficiency (nutritional deficiency) and can also be inherited (Hereditary rickets).

Bones cell Osteoblast produce material called Osteoid and the osteoid get mineralized by Calcium and Phosphate to produce the final bone tissue, but the low levels of Vitamin D in the blood results to be insufficient to healthy bone formation, as Vitamin D acts in the intestine, kidney and bone in order to reserved.

Vitamin D deficiency is developed by various reasons such as: malabsorption syndromes in which intestines do not absorb adequately the nutrients from food, poor nutrition(lack of food rich in vitamin D from sources such as: oily fish, eggs, butter, beef liver, cheese, not enough exposure to sunlight, and other medical conditions such as: kidney failure (renal failure), Liver failure and Inflammatory bowel disease, Celiac disease, Cystic fibrosis.

Hypophosphatemia Rickets (FHR) is another form of rachitic disease caused by low levels of serum phosphate resistant to ultraviolet radiation treatment and Vitamin D ingestion.

Symptoms

Children with rickets disease are affected by weakness, softness, fragile, and painful bones as well as teeth deformation and skeletal deformations such as: short stature (stunted growth), large forehead, odd curve to spine or back, odd shaped ribs and breast bone, wide joints at elbow and wrist, large abdomen, odd shaped (bowed) legs, wide bones, wide ankles.

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Patient 2 is a three-year-old child with a fracture to the femur. Fractures can occur in very-low-birth-weight infants in association with developmental nutritional rickets and older infants and toddlers with rickets but are very rare, known as rachitic fractures.

Diagnostic:

Patient 2 history confirms rickets diseases by the present symptoms an x-ray will diagnose the current situation of fractured bone as well as urine and blood test are required to examine the levels of vitamins and minerals, to determinate dosage of additional medication.

Treatment

Vitamin D deficiency rickets, disorder can be diagnosed at early stage as mother’s vitamin D deficiency during pregnancy, and premature birth are sings of high risk of getting rickets. Once the child born with vitamin D deficiency, nutritional supplements including Vitamin D are significantly important for both mother and child while the child is breastfed, the child can be supported by an appropriate formula (fortified milk) to prevent future complication.

The treatment for patient 2 fracture will follow the same surgery procedure for normal fracture plus additional considerations as rachitic bones have a reduce screw- holding characteristics, osteosynthesis should be consider.

Vitamin D plus nutritional food supplement tablet, one tablet per day. Swallow with water or a cold drink. Not to be chewed. Do not exceed the recommended intake.

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