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Osteoporosis - Most common metabolic bone disorder. Indicates low bone density. It occurs
when bone resorbtion exceeds rate of bone formation. Means "Porous bones." Bone mass is
lost. Bones become more fragile, increasing risk of fractures. Associated with aging, 80% affected
are women. Height is lost, curvature of the spine occurs, called Dowager's hump.
Biphosphanates are used to treat. Calcium intake should be 1000 mg/day with Vitamin D
between 5-10 units/day. Family history is important but does not necessarily indicate the
disorder.

Paget's Disease - Second most common disease of the bone. Progressive disease characterized
by fragile, mishapen bones. There is potentially a genetic link. Osteoclasts increase in bones and
stimulate osteoblasts to replace the lost bone. The new bone is soft and abnormal, prone to
fractures. The bone becomes enlarged and deformed. Increased blood flow to the area causes
skin to become warm. Patients with Paget's have increased risk of having malignant bone
tumors. Treatment is used to manage symptoms and improve function. Usually limited to one
bone. Biphosphanates and NSAIDS for pain are used.

Osteomalacia - Softening of the bone. Also called "Adult Rickets". Metabolic bone disease that
affects the structure and integrity of the bone. Not associated with aging. Results from
inadequate mineralization of the bone. Calcium and phosphate are the primary minerals in
bone. With insufficient amounts the bones don't harden and can't bear weight. Bones may have
pathological fractures. Commonly caused by lack of Vitamin D. Provide supplements for patient.

Osteomylitis - Infection of the bone. Common cause is staph aureus. Can occur at any age but
typically occurs in children under age 12 and over 50. Pathogens enter bone through an open
wound. Phagocytes attempt to contain infection but the enzyme released destroys bone tissue.
Pus forms, followed by edema and vascular congestion which leads to disruption of blood supply
to the bone. Difficult to treat if antibiotics cannot reach the area. Ischemia and necrosis may
develop. Early diagnosis is important to prevent necrosis. CBC results will show elevated WBC
and culture should be obtained to determine the causitive organism. Antibiotics are given via IV
for 4-6 weeks. Wound debridement may be necessary. Strict sterile technique should be used for
care. Long-term care.

Bone tumors - may be benign or malignant. Benign are more common. Primary tumors occur
more frequently in children while metastatic or secondary tumors are more common in adults.
Primary tumors are classified from the originating tissue. "Osteogenic" signifies it came from
bone. Cartilage is chondrogenic. Collagen is collagenic. Bone marrow is myogenic. These can
cause bone breakdown and fractures. Malignant tumors invade and destroy adjacent tissue. Labs
will show elevated RBCs and increased calcium levels. Surgery, chemotherapy, or radiation may
be used for metastatic bone tumors.

Foot disorders

Bunions - (Hallux valgus). Enlargement and lateral placement of the great toe. Develops due to
chronic pressure against the great toe. Heredity and properly fitted shoes are factors.
Hammertoe or "claw toe" - deformity characterized by flexion or hyperextension of the toe. It
affects the second toe. Treatment consists of corrective shoes, bunionectomy, analgesics, and
corticosteroids.

Osteoarthritis - Disorder characterized by progessive deterioration of the articular cartilage.

Noninflammatory, nonsystemic disease. Changes within the joint lead to pain, immobility,
muscle spasms, and potential inflammation. Difficult to distinguish from rheumatoid arthritis in
the early stages. Manifestations include activity that improves with rest, enlarged joints, and
crepitus. Treatment includes analgesic therapy, NSAIDS, topical products, glucosamine to build
cartilage, and injections. Arthroplasty may be necessary.

Rheumatoid Arthritis - RA. Chronic, systemic inflammatory disorder that primarily affects joints.
More common in women than men, between ages 30-50. Mulitiple joints are affected. Periods
of remission and exacerbation. Autoimmune disorder of unknown cause. An abnormal immune
response is triggered, which produces immunoglobulins, which are seen as a foreign body.
Antibodies are produced against the immunoglobulins. These auto-antibodies are called
rheumatoid factors. They bind with the immunoglobulin to form immuneclot complexes. WBCs
are attracted to the area, which results in enzymes that destroy joint tissue. Area becomes
inflammed, swollen, red, or painful. Symptoms are fatigue, anorexia, weight loss, and
nonspecific aching and stiffness before periods of exacerbations. Symptoms will usually develop
slowly. NSAIDS, corticosteroids, and analgesics are used to treat. Treatment with
immunosuppresants increase risk of infection and cancers. Surgery suc has arthrodesis, which is
a joint fusion, or arthroplasty may be needed. During periods of acute inflammation, total rest
may be needed, as well as splinting the joints. Physical therapy and hot/cold therapy as well.

Lupus - (Systemic lupus erythematosus, SLE). Chronic inflammatory connective tissue disease.
Affects multiple body systems and ranges from episodic conditions to rapid fatality. Women are
typically more affected, with persons of African, Asian, or Hispanic descent at an increased risk.
Auto antibodies are produced that target normal cells, forming immune complexes. Complexes
are deposited in connective tissue of blood vessels or lymphatic vessels, which causes an
inflammatory response that damages the tissue. Kidneys are usually the area these complexes
are deposited in and are damaged by the inflammatory response. Manifestations are similar to
rheumatoid arthritis. Red butterfly rash, anorexia, fatigue, nausea, vomiting, swollen glands and
malaise. Severe cases may have inflammation to the lining of the lungs and heart and damage to
the kidneys, CNS, or brain. Patients with SLE have difficulty carrying pregnancy to term. Prone to
infections, with leading cause of death being pneumonia and septicemia. Analgesics and aspirin
used to prevent thrombosis. Proguanil, an antimalaria drug, may be ordered, although this can
damage the retina. Educate client on the need for eye exams. Corticosteroids or
immunosuppresants may be used. Patients are photosensitive so sun exposure should be
avoided. Sunscreen recommended. Oral contraceptives are avoided because estrogen can trigger
an exacerbation.

Gout - Metabolic disorder that causes urate crystals to accumulate in joints. Men are more
affected. Gout may be primary or secondary. Primary is characterized by elevated serum uric
acid. This is the most common form of gout. In secondary gout the uric acid levels are elevated
due to another disorder. Gout can progress from asymptomatic hyperurecemia (above 8.5) to
acute gouty arhritis. Usually affects one single joint. Usually begins at night. Great toe most
commonly affected. Swelling, heat, and redness occur, which continues into fever, chills, and
malaise. The attacks can last days to weeks and can subside on their own.

Chronic tophaceous gout - occurs when deposits of urate crystals develop on the cartilage,
synovial membranes, tendons and soft tissue. Treatment includes NSAIDS and colchicines, which
inhibit deposition of urate crystals on tissue. Aspirin should be avoided as it may intefere with
urate acid excretion. Colchicines may cause GI upset. Uricosuric drugs promote uric acid
excretion. Elevation, rest, and heat/cold therapy may also be used. Colchicines inhibit the
deposition of urate crystals, whereas uricosuric drugs block reabsorption.

Lime disease - inflammatory disorder caused by borrelia burgodorferi carried by ticks. Most
common tick-born illness. Enters skin through a bite and can incubate for up to 30 days. It then
migrates outward on the skin, spreading by lymph or blood. The flat or slightly raised lesion
expands over several days with central area clearing as it expands. Flu-like symptoms are
experienced. If untreated, mild carditis, meningitis, or encephalitis may develop. Treated with
antibiotics.

Ankylosing spondylitis - Chronic inflammatory arthritis that affects the spine causing pain and
progressive stiffening. Patients may experience limited range of motion to the neck. Affects men
more than women. Onset is slow with reports of lower back pain at night followed by morning
stiffness. Pain radiates up and down the legs. In severe cases, the spine is fused, preventing any
motion. Physical therapy and exercise are essential to maintaining posture and range of motion.

Fibromyalgia - A common rheumatic syndrome of muscloskeletal pain and stiffness. The cause
and pathology is unknown. Onset is chronic, achey pain that can affect neck, shoulders, lower
back, and hips. Fatigue, irritable bowel syndrome, and sleep disturbances occur frequently. This
may resolve spontaneously or become chronic. The patient may benefit from antidepressants
because some say it is a mental health disorder. Anticonvulsants can treat neuropathic pain.
Medication should be taken at bedtime due to sedation.