BONE DISORDERS

SPINAL DEFORMITIES
The spine is a complex component of the human body and there are a large variety of conditions
that may affect the spine. For the purpose of this module we will discuss 2 deformities that affect the
curvature of the spine.
1. SCOLIOSIS
Definition: Abnormal curvature of the spine from side to side, causing an ‘S’
shaped spine
Cause: The actual cause for scoliosis is unknown, in some cases children with
cerebral palsy or muscular dystrophy may be predisposed to scoliosis, however,
the vast majority of the cases arise purely from a developmental problem.
Pathogenesis:
Neuromuscular condition or developmental problem

Vertebrae do not form in a straight line instead they curve to one side

‘S’ shaped spine

 SPINAL DEFORMITIES
1. SCOLIOSIS

Signs and Symptoms:

• Shoulders that don’t line up -uneven shoulder height
• Uneven hip height (one higher than the other)
• Waistline that is slanted to one side
• One shoulder blade that protrudes more than the other
• In extremely severe cases there may be breathing difficulties as the
curvature of the spine may decrease the capacity of the thoracic cavity.
Treatment:
• In minor cases treatment is to alleviate any pain caused by the abnormal
curvature – physio, chiropractic, muscle strengthening and stretching.
• Bracing may be done to encourage growth in a more normal curvature
• In severe cases surgery may be done
1. SCOLIOSIS
 SPINAL DEFORMITIES
2. KYPHOSIS
Definition: Abnormal forward curvature of the spine, resulting in a ‘hunchback’ appearance
Cause:
• Age related degeneration of the vertebrae causing the normally rectangular vertebral bodies to
become wedge shaped
• Trauma or injury to the vertebrae
• Abnormal development of the vertebrae
Pathogenesis:
Injury, degeneration or lack of development of the vertebrae

Wedging of the bones in the spine

Exaggerated forward curvature of the spine (hunchback)

Pain and decreased function

2. KYPHOSIS
SPINAL DEFORMITIES
Signs and Symptoms:
• Forward/bent over posture
• Pain in the mid and lower back
• Difficulty moving with ease
Treatment:
• Treat the pain – Physio, chiropractic, exercise
• Pain medication and anti-inflammatories
• In very severe cases and depending on the cause – surgery
2. KYPHOSIS
 OSTEOPOROSIS
Definition: A condition where bone becomes extremely weak and brittle, due to
the resorption of old bone occurring at a faster rate than the laying down of
new bone.
Cause: Caused by bone being broken down faster than it can be replaced. Risk
Factors for osteoporosis include:
• Age – more common in older patients
• Gender – Females are much more likely to develop osteoporosis
• Hormonal imbalances – menopausal women have an increased risk due to a
decrease in oestrogen
• Family history of osteoporosis
• Diet – decreased calcium and vitamin D in the diet can increase the risk for
osteoporosis
• Lack of exercise
• Medication such as steroids can increase the risk
 OSTEOPOROSIS
Pathogenesis:
Hormonal imbalance

Increased stimulation of osteoclasts (cells that break down bone) and decreased
stimulation of osteoblasts (cells that form new bone)

Bone becomes weaker and more porous

Pain, fractures and decreased functionality

 OSTEOPOROSIS
Signs and Symptoms:
• Back pain
• Fractures from minor injury
• Decreased height – compression of vertebrae causes patient to appear shorter over
time
• Stooped posture
Treatment:
• Medication to regulate hormones (help to slow down bone breakdown)
• Diet changes – increased calcium and Vitamin D
• Exercise and strengthening to increase support
• Pain and anti-inflammatory medication
OSTEOPOROSIS
 VITAMIN D DEFICIENCIES
RICKETS
Definition: Vitamin D deficiency in children, resulting in softening of the bones.
Cause:
• Insufficient Vitamin D in the diet
• Malabsorption of the Vitamin D being introduced into the body e.g. Celiac disease
• Insufficient exposure to the sun (the skin produces Vitamin naturally when exposed to
the sun)
Signs and Symptoms:
• Pain and weakness especially in the lower limbs
• Bowed legs or knock knees
• Delayed growth patterns
• Skeletal and spinal deformities due to abnormal growth
• Fractures from minor trauma
• Abnormal teeth development
RICKETS
VITAMIN D DEFICIENCIES
Pathogenesis:
Insufficient Vitamin D or Malabsorption of Vitamin D

Decreases the absorption of calcium and phosphorus (which are necessary for healthy bones)

Imbalance of calcium and phosphorus in the bone

Bones become weak and softer

Treatment:
• Supplementing Vitamin D – dietary, medication and increased sun exposure
• For bone growth and deformities – braces and physical therapy may be needed
• In extreme cases surgery is done to correct the deformities
• In cases where the deficiency is secondary to another disease, the primary disease needs to be
treated and managed appropriately
RICKETS
OSTEOMALACIA
VITAMIN D DEFICIENCIES
Definition: Vitamin D deficiency in adults causing weakening and softening of bones.
Cause:
• Insufficient Vitamin D in the diet
• Malabsorption of the Vitamin D being introduced into the body e.g. Celiac disease
• Insufficient exposure to the sun (the skin produces Vitamin naturally when exposed to the sun)
• Certain drugs create Vitamin D deficiency as a side effect
Pathogenesis:
Insufficient Vitamin D or Malabsorption of Vitamin D

Decreases the absorption of calcium and phosphorus (which are necessary for healthy bones)

Imbalance of calcium and phosphorus in the bone

Bones become weak and softer

 VITAMIN D DEFICIENCIES
OSTEOMALACIA

Signs and Symptoms:

• Pain that tends to be worse in the lower limbs
• Muscle cramping and aching
• Fractures from minor trauma
• Gait changes (patient walks in a waddling fashion)
Treatment:
• Supplementing Vitamin D – dietary, medication and increased sun
exposure
• Braces and surgery for fractures
• In cases where the deficiency is secondary to another disease, the
primary disease needs to be treated and managed appropriately
OSTEOMALACIA
 BONE INFECTIONS (OSTEOMYELITIS)
Definition: Infection of the bone by bacteria.
Cause:
• Direct implantation of bacteria during a traumatic injury – the bacteria is introduced directly into
the bone during an injury e.g. a fracture
• Spread of bacteria to the bone from the skin or muscle that lies over the bone
• Spread of bacteria from a different site of the body via the blood stream
Pathogenesis:
Bone is exposed to bacteria

Bacteria attacks the cells that made up the body

Cell and tissue death occur

Immune response to infection

Redness, swelling, fever

 BONE INFECTIONS (OSTEOMYELITIS)
Signs and Symptoms:
• Severe pain in the infected region
• Fever
• General feeling of being unwell
• Swelling and redness in the area
• Increased skin temperature in the area
• nausea
Treatment:
• Surgery to remove the parts of the bone that have been destroyed by infection
• Treated in hospital
• Antibiotic therapy for a few weeks
• Pain medication
BONE INFECTIONS (OSTEOMYELITIS)