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Muscloskeletal System

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Ahmed Mohammed
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3 views

Muscloskeletal System

Uploaded by

Ahmed Mohammed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Clinical Nutrition

• Chapter 5
• Musculoskeletal System

• Abdurehman Mohamed(BSc, Msc in Nutrition)


Musculoskeletal System
• Cartilage, ligaments, tendons,
bones
• Metabolically active cells and
tissue
• Continual state of change

01/30/25 2
• Cells of Osseous Tissue
– Osteogenic cells –stem cells that
differentiate into osteoblasts
– Osteoblasts -bone-building cells
– Osteocytes –mature osteoblasts,
majority of cells in bone
– Osteoclasts –bone-removing cells that
secrete HCl; bone resorption
• Skeletal growth and
development
– Continual state of change; linear
and circumferential growth, and in
response to changes in forces
applied to them - remodeling
– Osteoclasts remove bone from low-
stress areas, osteoblasts lay down
new bone in high-stress areas
• Cortical bone
– Dense, outer surface of most bones,
shafts of long bones, and caps over end
of long bones
– 75% of skeletal weight
• Trabecular bone
– Loosely organized with a sponge-like
appearance; lattice-like pattern
– “Ends” of long bones, primary bone of
vertebrae, pelvis, sternum, scapula
– 25% of skeletal weight
Osteoporosis

• Decreased bone mineral and


organic matrix which weakens
bones, making them more
susceptible to fracture and
pain
• Bone strength reflects:
– Bone density
– Bone quality
• Diagnosis
• Measures of bone mineral
density (BMD)
– DEXA –dual-energy x-ray
absorptiometry
– “T-score” –comparing patient’s BMD
to healthy young reference
population
– BMD assessed at hip and lumbar
spine
DEXA
• Diagnosis
• Others:
– Quantitative ultrasound of the heel
used in conjunction with risk
assessment –useful for screening
• Osteopenia–bone mineral density is
low but not low enough to be
classified as osteoporosis, although
fracture risk is increased
• BMD increases rapidly during
growth spurt (ages 11-14 y)
• Maximum density reached in
late 20s or 30s
• Females lose BMD at faster rate
than men
• Rate of loss increases during
menopause
Con’t….

• Fractures
– Most common sites: hip, spine,
wrist
– Hip fractures have severe impact
on morbidity and mortality
• 20% die within first year, 20% end
up in nursing homes
• Etiology
– Primary –disease of elderly,
cumulative impact of bone
mineral loss and deterioration of
bone with age; “age-related,”
“postmenopausal”
– Secondary -disease and drug
associated
• 2/3 of cases in men
• Risk factors
– Genetic susceptibility
– Family hx
– Female sex
– Premenopausal amenorrhea
– Physical inactivity
– Low calcium and vitamin D
intakes
• Prevention strategies
– Risk reduction in adolescence and early
adulthood
– Adequate calcium and vitamin D intake
– Weight-bearing exercise
– Fall prevention
– Smoking cessation
– Avoidance of excessive alcohol intake
Etiology:
 Medications
 Cardiac arrest
 Disease or trauma affecting
musculature of respiratory
system & chest wall.
Nutrition
Recommendations
• Calcium
– Maintenance of serum calcium levels
to combat bone resorption
– Achieve peak bone mass and
minimize bone mineral loss
– Lower intakes of sodium, caffeine
– More physical activity
– Sun exposure
• Calcium
– Consume calcium-rich foods
– Calcium-fortified foods
– Calcium supplements
• Calcium carbonate –taken with
meals, not at the same time as iron
• Calcium with vitamin D
• Alcohol
– Decreased BMD, reduced bone
formation, increased risk of fractures
– Increased calcium and magnesium
losses
– Adversely impacts vitamin D and
overall nutritional status
– Increased risk of falls
• Phosphorus – essential for
bone formation
• High protein or sodium -
increase urinary calcium losses
• Potassium, magnesium, fruits,
vegetables associated with
higher BMD
• Medical management
– Risk factor modification
– Dietary treatment
– Drug therapy
• Pharmacologic prevention and
treatment
– Estrogens/ hormone therapy
– Selective estrogen receptor
modulators (SERMs)
– Bisphosphonates
– Drug-nutrient interactions
Rickets
• Inadequate maturation
and mineralization of
bone in children
• Due vitamin D
deficiency or calcium
deficiency
• Symptoms: lethargy,
weakness, growth
stunting, abnormally
shaped thorax, bowing
of legs
• CF: no specific sign and
symptoms,
 Electrolyte abnormalities,
abnormal sensation.
 If there is associated hypokalemia
and decrease in ECF, patient may
experience muscle cramping,
weakness and.
Who is at risk for developing
rickets

• Age(6 months up to 36 month)


• Diet(Vegens)
• Skin color
• Geographic location
Diagnosis

Physical examination
• Tenderness or pain in the bones
Blood test
• To measure the level of calcium
and phosphate in the blood
Bone X-ray
• To check for bone deformation
• Prevention
– Exclusively breast fed infants should
receive supplement of 200 IU vitamin D
– Fortified infant formulas
• If receiving less than 500 mL/day, should
be given multivitamin supplement
– After 1 year – vitamin D-fortified cow’s
milk
• Treatment
– Balanced, age-appropriate diet
– Adequate vitamin D, calcium,
phosphorus
Osteomalacia
• Organic matrix of bones inadequately
mineralized in adults
• Muscular weakness, bone pain,
deformities of ribs, pelvis, legs
• Due to vitamin D deficiency, impaired
Vit D action, calcium deficiency,
hypophosphatemia
• Osteomalcia is a weakining of the
bones
• Treatment
– Address underlying cause
– Multivitamin supplementation
– Calcium supplementation
– Pharmacological doses of vitamin
D
Gout
• Inflammatory disease resulting in
swelling, redness, heat, pain, and
stiffness in affected joint
• Due to elevated serum
concentrations of uric acid,
formation of uric acid crystals
– End product of purine (adenine and
guanine) metabolism
• Hyperuricemia results from
overproduction of uric acid,
inadequate elimination by the
kidneys, or combination

• Risk factors: genetics, male sex, older


age, overweight, excessive alcohol
consumption, eating foods rich in
purines, certain drugs
• Most commonly affects great toe,
ankles, heels, knees, wrists, elbows,
fingers
• Rapid occurrence
• Sudden severe pain; swelling; shiny,
red skin around joint; extreme
tenderness
• Typically resolves 5-10 days, may
reoccur
• Treatment:
– Pain relief medications,
glucocorticoids,
– Treat uricemia
Avoid/reduce foods high in purines
– Lifestyle modifications
Thank you

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