Editing Bone (section)

==Clinical significance==
{{See also|Bone disease}}
A number of diseases can affect bone, including arthritis, fractures, infections, osteoporosis and tumors. Conditions relating to bone can be managed by a variety of doctors, including [[Rheumatology|rheumatologists]] for joints, and [[orthopedic]] surgeons, who may conduct surgery to fix broken bones. Other doctors, such as [[rehabilitation medicine|rehabilitation specialists]] may be involved in recovery, [[radiology|radiologists]] in interpreting the findings on imaging, and [[pathologist]]s in investigating the cause of the disease, and [[family doctor]]s may play a role in preventing complications of bone disease such as osteoporosis.

When a doctor sees a patient, a history and exam will be taken. Bones are then often imaged, called [[radiography]]. This might include [[ultrasound]] [[X-ray]], [[CT scan]], [[MRI scan]] and other imaging such as a [[Bone scan]], which may be used to investigate cancer.{{sfn|Davidson|2010|pp=1059–1062}} Other tests such as a blood test for autoimmune markers may be taken, or a [[synovial fluid]] aspirate may be taken.{{sfn|Davidson|2010|pp=1059–1062}}

===Fractures===
[[File:Xraymachine.JPG|thumb|[[Radiography]] used to identify possible [[bone fracture]]s after a knee injury]]
{{main|Bone fracture}}
In normal bone, [[Bone fracture|fractures]] occur when there is significant force applied or repetitive trauma over a long time. Fractures can also occur when a bone is weakened, such as with osteoporosis, or when there is a structural problem, such as when the bone remodels excessively (such as [[Paget's disease of bone|Paget's disease]]) or is the site of the growth of cancer.{{sfn|Davidson|2010|p=1068}} Common fractures include [[wrist fracture]]s and [[hip fracture]]s, associated with [[osteoporosis]], [[vertebral fracture]]s associated with high-energy trauma and cancer, and fractures of long-bones. Not all fractures are painful.{{sfn|Davidson|2010|p=1068}} When serious, depending on the fractures type and location, complications may include [[flail chest]], [[compartment syndrome]]s or [[fat embolism]].
[[Compound fracture]]s involve the bone's penetration through the skin. Some complex fractures can be treated by the use of [[bone grafting]] procedures that replace missing bone portions.

Fractures and their underlying causes can be investigated by [[X-ray]]s, [[CT scans]] and [[MRI]]s.{{sfn|Davidson|2010|p=1068}} Fractures are described by their location and shape, and several classification systems exist, depending on the location of the fracture. A common long bone fracture in children is a [[Salter–Harris fracture]].<ref>{{cite journal |vauthors=Salter RB, Harris WR |year=1963 |title=Injuries Involving the Epiphyseal Plate |journal=J Bone Joint Surg Am |volume=45 |issue=3 |pages=587–622 |url=http://jbjs.org/content/45/3/587 |doi=10.2106/00004623-196345030-00019 |s2cid=73292249 |access-date=2 December 2016 |archive-url=https://web.archive.org/web/20161202172951/http://jbjs.org/content/45/3/587 |archive-date=2 December 2016 }}</ref> When fractures are managed, pain relief is often given, and the fractured area is often immobilised. This is to promote [[bone healing]]. In addition, surgical measures such as [[internal fixation]] may be used. Because of the immobilisation, people with fractures are often advised to undergo [[Physical medicine and rehabilitation|rehabilitation]].{{sfn|Davidson|2010|p=1068}}

===Tumors===
{{main|Bone tumor}}

Tumor that can affect bone in several ways. Examples of benign [[bone tumor]]s include [[osteoma]], [[osteoid osteoma]], [[osteochondroma]], [[osteoblastoma]], [[enchondroma]], [[giant-cell tumor of bone]], and [[aneurysmal bone cyst]].<ref>{{Cite web|url=http://my.clevelandclinic.org/health/articles/benign-bone-tumors|title=Benign Bone Tumours|date=2017|website=Cleveland Clinic|access-date=29 March 2017}}</ref>

===Cancer===
{{main|Bone metastases}}
[[Cancer]] can arise in bone tissue, and bones are also a common site for other cancers to spread ([[metastasise]]) to.{{sfn|Davidson|2010|p=1125}} Cancers that arise in bone are called "primary" cancers, although such cancers are rare.{{sfn|Davidson|2010|p=1125}} Metastases within bone are "secondary" cancers, with the most common being [[breast cancer]], [[lung cancer]], [[prostate cancer]], [[thyroid cancer]], and [[kidney cancer]].{{sfn|Davidson|2010|p=1125}} Secondary cancers that affect bone can either destroy bone (called a "[[lytic cycle|lytic]]" cancer) or create bone (a "[[sclerosis (medicine)|sclerotic]]" cancer). Cancers of the bone marrow inside the bone can also affect bone tissue, examples including [[leukemia]] and [[multiple myeloma]]. Bone may also be affected by cancers in other parts of the body. Cancers in other parts of the body may release [[parathyroid hormone]] or [[parathyroid hormone-related peptide]]. This increases bone reabsorption, and can lead to bone fractures.

Bone tissue that is destroyed or altered as a result of cancers is distorted, weakened, and more prone to fracture. This may lead to compression of the [[spinal cord]], destruction of the marrow resulting in [[bruising]], [[bleeding]] and [[immunosuppression]], and is one cause of bone pain. If the cancer is metastatic, then there might be other symptoms depending on the site of the original cancer. Some bone cancers can also be felt.

Cancers of the bone are managed according to their type, their [[cancer staging|stage]], prognosis, and what symptoms they cause. Many primary cancers of bone are treated with [[radiotherapy]]. Cancers of bone marrow may be treated with [[chemotherapy]], and other forms of targeted therapy such as [[immunotherapy]] may be used.{{sfn|Davidson|2010|p=1032}} [[Palliative care]], which focuses on maximising a person's [[quality of life]], may play a role in management, particularly if the likelihood of [[5-year survival|survival within five years]] is poor.

===Diabetes===

[[Type 1 diabetes]] is an autoimmune disease in which the body attacks the insulin-producing pancreas cells causing the body to not make enough insulin.<ref name="Ndisang_2017">{{cite journal | vauthors = Ndisang JF, Vannacci A, Rastogi S | title = Insulin Resistance, Type 1 and Type 2 Diabetes, and Related Complications 2017 | journal = Journal of Diabetes Research | volume = 2017 | issue = | page = 1478294 | date = 2017 | pmid = 29279853 | doi = 10.1155/2017/1478294 | doi-access = free | pmc = 5723935 }}</ref> In contrast [[type 2 diabetes]] in which the body creates enough Insulin, but becomes resistant to it over time.<ref name="Ndisang_2017" />

Children makeup approximately 85% of Type 1 Diabetes cases and in America there was an average 22% rise in cases<ref>{{cite journal | vauthors = Kamrath C, Holl RW, Rosenbauer J | title = Elucidating the Underlying Mechanisms of the Marked Increase in Childhood Type 1 Diabetes During the COVID-19 Pandemic-The Diabetes Pandemic | journal = JAMA Network Open | volume = 6 | issue = 6 | pages = e2321231 | date = June 2023 | pmid = 37389881 | doi = 10.1001/jamanetworkopen.2023.21231 | doi-access = free }}</ref> over the first 24 months of the COVID-19 Pandemic. With the increase of developing some form of diabetes across all ranges continually growing the health impacts on bone development and bone health in these populations are still being researched. Most evidence suggests that diabetes, either Type 1 and Type 2, inhibits osteoblastic activity<ref>{{cite journal | vauthors = Loxton P, Narayan K, Munns CF, Craig ME | title = Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis | journal = Diabetes Care | volume = 44 | issue = 8 | pages = 1898–1905 | date = August 2021 | pmid = 34285100 | doi = 10.2337/dc20-3128 | pmc = 8385468 }}</ref> and causes both lower BMD and BMC in both adults and children. The weakening of these developmental aspects is thought to lead to an increased risk of developing many diseases such as osteoarthritis, osteoporosis, osteopenia and fractures.<ref>{{cite journal | vauthors = de Araújo IM, Moreira ML, de Paula FJ | title = Diabetes and bone | journal = Archives of Endocrinology and Metabolism | volume = 66 | issue = 5 | pages = 633–641 | date = November 2022 | pmid = 36382752 | doi = 10.20945/2359-3997000000552 | pmc = 10118819 }}</ref> Development of any of these diseases is thought to be correlated with a decrease in ability to perform in athletic environments and activities of daily living.

Focusing on therapies that target molecules like osteocalcin or AGEs could provide new ways to improve bone health and help manage the complications of diabetes more effectively.<ref>{{cite journal | vauthors = Booth SL, Centi A, Smith SR, Gundberg C | title = The role of osteocalcin in human glucose metabolism: marker or mediator? | journal = Nature Reviews. Endocrinology | volume = 9 | issue = 1 | pages = 43–55 | date = January 2013 | pmid = 23147574 | doi = 10.1038/nrendo.2012.201 | pmc = 4441272 }}</ref>

===Other painful conditions===
* [[Osteomyelitis]] is inflammation of the bone or bone marrow due to bacterial infection.<ref>{{cite web |url= https://www.lecturio.com/concepts/osteomyelitis/| title= Osteomyelitis|website=The Lecturio Medical Concept Library |access-date= 26 August 2021}}</ref>
* [[Osteomalacia]] is a painful softening of adult bone caused by severe vitamin D deficiency.<ref>{{cite web |url= https://www.lecturio.com/concepts/osteomalacia-and-rickets/| title= Osteomalacia and Rickets|website=The Lecturio Medical Concept Library |access-date= 26 August 2021}}</ref>
* [[Osteogenesis imperfecta]]<ref>{{cite web |url= https://www.lecturio.com/concepts/osteogenesis-imperfecta/| title= Osteogenesis Imperfecta
|website=The Lecturio Medical Concept Library |access-date= 26 August 2021}}</ref>
* [[Osteochondritis dissecans]]<ref>{{cite web |url=
https://www.lecturio.com/concepts/osteochondritis-dissecans/| title= Osteochondritis Dissecans
|website=The Lecturio Medical Concept Library |access-date= 26 August 2021}}</ref>
* [[Ankylosing spondylitis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/ankylosing-spondylitis/| title= Ankylosing Spondylitis
|website=The Lecturio Medical Concept Library |access-date= 26 August 2021}}</ref>
* [[Skeletal fluorosis]] is a bone disease caused by an excessive accumulation of [[fluoride]] in the bones. In advanced cases, skeletal fluorosis damages bones and joints and is painful.<ref>{{cite journal | vauthors = Whitford GM | title = Intake and metabolism of fluoride | journal = Advances in Dental Research | volume = 8 | issue = 1 | pages = 5–14 | date = June 1994 | pmid = 7993560 | doi = 10.1177/08959374940080011001 | s2cid = 21763028 }}</ref>

===Osteoporosis===
{{Main|Osteoporosis}}
[[File:Osteoporosis in Bones.jpg|thumb|Reduced bone mineral density in Osteoporosis (R), increasing the likelihood of fractures]]
Osteoporosis is a disease of bone where there is reduced [[bone mineral density]], increasing the likelihood of [[bone fracture|fractures]].{{sfn|Davidson|2010|pp=1116–1121}} Osteoporosis is defined in women by the [[World Health Organization]] as a bone mineral density of 2.5 [[standard deviation]]s below peak bone mass, relative to the age and sex-matched average. This density is measured using [[dual energy X-ray absorptiometry]] (DEXA), with the term "established osteoporosis" including the presence of a [[fragility fracture]].<ref name=WHO1994>{{cite journal | vauthors = WHO | title = Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group | journal = World Health Organization Technical Report Series | volume = 843 | pages = 1–129 | year = 1994 | pmid = 7941614 }}</ref> Osteoporosis is most common in women after [[menopause]], when it is called "postmenopausal osteoporosis", but may develop in men and premenopausal women in the presence of particular hormonal disorders and other [[Chronic (medicine)|chronic]] diseases or as a result of [[tobacco smoking|smoking]] and [[medications]], specifically [[glucocorticoid]]s.{{sfn|Davidson|2010|pp=1116–1121}} Osteoporosis usually has no symptoms until a fracture occurs.{{sfn|Davidson|2010|pp=1116–1121}} For this reason, DEXA scans are often done in people with one or more risk factors, who have developed osteoporosis and are at risk of fracture.{{sfn|Davidson|2010|pp=1116–1121}}

One of the most important risk factors for [[osteoporosis]] is [[ageing|advanced age]]. Accumulation of oxidative [[DNA damage (naturally occurring)|DNA damage]] in [[osteocyte|osteoblastic]] and [[osteoclast]]ic cells appears to be a key factor in age-related osteoporosis.<ref>Chen Q, Liu K, Robinson AR, et al. DNA damage drives accelerated bone aging via an NF-κB-dependent mechanism. J Bone Miner Res. 2013;28(5):1214-1228. {{doi|10.1002/jbmr.1851}}</ref>

Osteoporosis treatment includes advice to stop smoking, decrease alcohol consumption, exercise regularly, and have a healthy diet. [[Calcium]] and [[trace mineral]] supplements may also be advised, as may [[Vitamin D]]. When medication is used, it may include [[bisphosphonate]]s, [[Strontium ranelate]], and [[hormone replacement therapy]].<ref name=DAVIDSONS2010>{{harvnb|Davidson|2010|pages=1116–1121}}</ref>

===Osteopathic medicine===
{{Main|Osteopathic medicine in the United States}}
[[Osteopathic medicine]] is a school of medical thought that links the musculoskeletal system to overall health. {{As of|2012}}, over 77,000 physicians [[Osteopathic medicine in the United States|in the United States]] are trained in osteopathic medical schools.<ref>{{cite web|title=2012 Osteopathic Medical Profession Report|url=http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2012-OMP-report.pdf|website=Osteopathic.org|publisher=American Osteopathic Organisation|access-date=26 November 2014|archive-url=https://web.archive.org/web/20130616054507/http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2012-OMP-report.pdf|archive-date=16 June 2013|df=dmy-all}}</ref>