Assignment: Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders Case Study 

 Assignment: Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders Case Study

Assignment: Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders Case Study

Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders
Musculoskeletal problems are among the common health concerns that nurses witness in daily in their practice. These problems have multiple etiologies that must be addressed to prevent their recurrence. Nurses and other healthcare providers utilize interventions such as interprofessional collaboration and evidence-based strategies to achieve optimum care outcomes in patients suffering from musculoskeletal-related problems. Therefore, the purpose of this essay is to examine Mandy’s case study. Mandy is a competitive figure skater who suffered a fracture while practicing. She is extremely active and maintains athletic physique by ensuring restricted diet. A DXA performed showed that her bone mass is 2.7 standard deviations below mean. The purpose of this paper is to examine the etiology of Mandy’s premature osteoporosis, influence of estrogen, and macroscopic differences between osteoporosis and osteomalacia.

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Etiology of Mandy’s Premature Osteoporosis
The most probable cause of Mandy’s premature osteoporosis is excessive exercise. Mandy has female athlete triad. The characteristics of the triad include amenorrhea, disordered eating, and osteoporosis. Restricted calorie intake among athletes results in an imbalance between the amount of energy consumed and that needed for the intensive exercises (Kopiczko et al., 2021). The imbalance affects the functioning of the hypothalamic-pituitary-ovarian axis, which manifests as hypoestrogenism such as amenorrhea.
Bone formation peaks mainly during the adolescent stage. Mandy is at the peak stage of bone density formation. However, her engagement in weight-bearing exercises as part of her routine as an athlete affects bone density. The decline in estrogen levels due to Mandy’s involvement in active physical activity and restricted diet also plays a role in the development of premature osteoporosis. Accordingly, estrogen is essential for bone mineralization(Freitas et al., 2022). Its deficiency results in increased bone loss and reduced peak bone mass.
Restricted diet may have also contributed to Mandy’s premature osteoporosis. Dietary supplements such as calcium and vitamin D are essential for bone formation. However, as noted above, the restricted diet may lead to an imbalance between the need and supply of essential calories, nutrients, and vitamins. A decreased intake of calcium and vitamin D increases the risk of bone loss(Wilson, 2019). Engaging in intensive physical activity would accelerate Mandy’s bone loss as compared to formation, hence, the premature osteoporosis.
Mandy also has a lean body mass. Evidence has shown that individuals with lean body mass due to causes such as restricted diets are increasingly predisposed to low bone density. The lean body mass also implies the risk of protein deficiencies, which lowers cortical bone thickness alongside bone mass density(Wilson, 2019). Restricted diet intake may also cause electrolyte imbalances. Accordingly, there is an increased risk of hyponatremia, which is associated with elevated risk of bone fractures.
Deficiency of Estrogen
Estrogen plays crucial roles in bone growth and maturation. Estrogen promotes the closure of the epiphyseal growth plates in early stages of life. Estrogen deficiency because of gonadal dysfunction results in delayed closure and defects in the growth of the appositional periosteal bones. Estrogen is also needed for bone maturation. As a result, estrogen deficiency in any stage of life leads to bone demineralization, as seen in postmenopausal women(Farr et al., 2019). Estrogen also affects bone structure. Its deficiency leads to a rapid loss of the bone mass. The loss of bone mass arises from the activation of bone remodeling units that elevate bone resorption more than formation(Fischer & Haffner-Luntzer, 2022). The loss of bone mass has also been shown in studies to trabeculae perforations, which affect bone architecture and stability.
Estrogen also affects bone cells. Accordingly, estrogen receptors are increasingly found in all types of bone cells such as the osteoclasts, osteocytes, and osteoblasts. However, estrogen deficiency results in an increase in osteoclasts, which facilitate bone resorption rather than formation. The deficiency also increases the maturation of resorbing osteoclasts, which heightens bone loss. The lifespan of the osteoclasts also rises due to defects in the normal pathway for programmed cell death. The existing evidence also show that low estrogen levels stimulate the macrophages to increase osteoclasts cytokines production(Cheng et al., 2022). The changes result in acceleration in the trabecular bone loss.
Estrogen also influences mechanical loading in bones. Mechanical loading refers to the strains that affect hemostasis within the bone. It also determines the overall bone mass, structure, and rate of remodeling for its formation. Low estrogen levels affect the mechanical loading in the bones. This can be seen from the reduction in the cortical and trabecular bone density. These changes also increase the rate of bone resorption, which lead to osteoporosis in women(Föger-Samwald et al., 2020). Cumulatively, any imbalance in the body’s estrogen levels affects the above processes leading to accelerated bone loss, as seen from osteoporosis and increased risk for fractures.
Macroscopic Differences
Osteomalacia and osteoporosis are the two most common conditions of the bones.Osteomalacia is a condition where patients experience bone demineralization. This results in the softening of the bones. There is inadequate calcium and phosphorus, which affect bone formation and health. Osteoporosis is the decline in the mineral density of the bones. The affected patients have a bone density of less than 2.5(Minisola et al., 2021). Patients affected by osteomalacia show symptoms that include muscle weaknesses and bones that are easy to break. Patients affected by osteoporosis have symptoms such as curving of the back and increased risk of fractures because of their weak bones. The primary causes of osteomalacia are the lack of calcium, phosphorus, and vitamin D. On the other hand, osteoporosis develops from several causes, including deficiency of calcium, vitamin D, and phosphorus. The other difference is that patients affected with osteomalacia experience abnormal cardiac rhythms. However, this is not the case in osteoporosis(Uday &Högler, 2020). Patients remain asymptomatic until they experience fractures or collapse of the vertebrae.
Patients with osteoporosis also have increased bone resorption and not formation. The resorption results in the reduction in bone density and structure, increasing the risk of fractures. In terms of prevalence, osteoporosis is more common as compared to osteomalacia in the United States of America. For example, the prevalence of osteoporosis in men aged 50 years and above is 4.2% and 18.8% among women of the same age(CDC, 2022). On the other hand, the exact prevalence rate of osteomalacia is unknown since it often remains undiagnosed in the population. The lack of statistics leads to the minimal focus of the existing interventions to address the issue in the population (Minisola et al., 2021).
There are also differences in the overall bone appearance in the two disorders. Accordingly, patients with osteomalacia have highly flexible and soft bones that cause bowing of the bones of the lower extremities. They also have a high rate of pseudo fractures that those suffering from osteoporosis. Patients with osteomalacia also often report myopathy, which is not seen in osteoporosis. Myopathy is characterized by proximal muscle weaknesses, especially of the knee joints and the thigh. As a result, patients will have a waddling gait since they cannot lift the affected extremities off the ground. In severe osteomalacia, patients may be bedridden and show symptoms that are like seen in paralysis(Minisola et al., 2021). The diagnostic approaches between osteomalacia and osteoporosis also differ. Bone density is the only diagnostic investigation that can accurately detect osteoporosis. Osteomalacia can be diagnosed using several tests such as urine and blood tests, and x-rays to detect for any changes in the structure of the bones(Uday &Högler, 2020).
Conclusion
Mandy developed osteoporosis due to intensive exercises, restricted diet, and low levels of estrogen. Low estrogen levels in women affect bone formation and maturation. The effects can be seen from the reduced bone mass, density, and structure, which increases the risk of fractures among the affected populations. Osteomalacia and osteoporosis are the most common disorders of the bones that patients develop. The disorders have macroscopic differences that guide the diagnosis and treatment. Osteomalacia has features such as demineralization of the bones while osteoporosis is characterized by the decrease in bone density. In both disorders, patients experience increased risk of fractures. Therefore, it is crucial that nurses and other healthcare providers screen patients and populations at risk of these bone disorders to prevent their associated complications.
References
CDC. (2022, November 5). FastStats. https://www.cdc.gov/nchs/fastats/osteoporosis.htm
Cheng, C.-H., Chen, L.-R., & Chen, K.-H. (2022). Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover. International Journal of Molecular Sciences, 23(3), Article 3. https://doi.org/10.3390/ijms23031376
Farr, J. N., Rowsey, J. L., Eckhardt, B. A., Thicke, B. S., Fraser, D. G., Tchkonia, T., Kirkland, J. L., Monroe, D. G., & Khosla, S. (2019). Independent Roles of Estrogen Deficiency and Cellular Senescence in the Pathogenesis of Osteoporosis: Evidence in Young Adult Mice and Older Humans. Journal of Bone and Mineral Research, 34(8), 1407–1418. https://doi.org/10.1002/jbmr.3729
Fischer, V., & Haffner-Luntzer, M. (2022). Interaction between bone and immune cells: Implications for postmenopausal osteoporosis. Seminars in Cell & Developmental Biology, 123, 14–21. https://doi.org/10.1016/j.semcdb.2021.05.014
Föger-Samwald, U., Dovjak, P., Azizi-Semrad, U., Kerschan-Schindl, K., & Pietschmann, P. (2020). Osteoporosis: Pathophysiology and therapeutic options. EXCLI Journal, 19, 1017–1037. https://doi.org/10.17179/excli2020-2591
Freitas, L., Bezerra, A., Amorim, T., Fernandes, R. J., Duarte, J., & Fonseca, H. (2022). Is competitive swimming training a risk factor for osteoporosis? A systematic review of the literature and quality of evidence. German Journal of Exercise and Sport Research. https://doi.org/10.1007/s12662-022-00849-4
Kopiczko, A., Adamczyk, J. G., Gryko, K., &Popowczak, M. (2021). Bone mineral density in elite masters athletes: The effect of body composition and long-term exercise. European Review of Aging and Physical Activity, 18(1), 7. https://doi.org/10.1186/s11556-021-00262-0
Minisola, S., Colangelo, L., Pepe, J., Diacinti, D., Cipriani, C., & Rao, S. D. (2021). Osteomalacia and Vitamin D Status: A Clinical Update 2020. JBMR Plus, 5(1), e10447. https://doi.org/10.1002/jbm4.10447
Uday, S., &Högler, W. (2020). Nutritional rickets & osteomalacia: A practical approach to management. The Indian Journal of Medical Research, 152(4), 356–367. https://doi.org/10.4103/ijmr.IJMR_1961_19
Wilson, D. J. (2019). Osteoporosis and sport. European Journal of Radiology, 110, 169–174. https://doi.org/10.1016/j.ejrad.2018.11.010

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Mandy Case Study

Mandy is a 16-year-old competitive figure skater who practices several hours a day with her coach at the skating arena. Because of her extremely active lifestyle and restricted diet to maintain her athletic physique, she experiences ongoing amenorrhea. One day during practice, she landed a jump and fell to the ice in pain. Her left foot swelled up almost immediately, making it difficult for her coach to remove the skate. At the hospital, radiographs revealed a fracture of the fifth metatarsal bone and general radiolucency of all the bones in her foot. A follow-up DXA revealed a bone mass of 2.7 standard deviations below mean.

What is the etiology of Mandy’s premature osteoporosis, and how is her condition thought to contribute to a decrease in bone density?

Knowing what you do about bone mineralization, why does a deficiency of estrogen in women lead to osteoporotic change?

Osteoporosis and osteomalacia both involve abnormal bone mineralization. What are the general macroscopic differences of these two conditions?

Value: 20 points

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