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Y2 LCRS 2 - Musculoskeletal > 2. Metabolic Bone Disease – Radiology > Flashcards

2. Metabolic Bone Disease – Radiology Flashcards

1
Q

What are the two main radiographic signs?

A

Osteopenia

Osteosclerosis

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2
Q

What is the lucency of the following scans proportional to:

a. X rays
b. Densitmetry
c. CT scans
d. MRI scans
e. Radionucline bone scans

A 
a. X rays  
Density 
b. Densitometry 
Density and attenuation
c. CT scans  
Density and attenuation 
d. MRI scans  
Chemical and water content
e. Radionuclide bone scans  
Bone turnover
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3
Q

What is the main difference between osteoporosis and osteomalacia?

A

Osteoporosis – decreased bone mass

Osteomalacia – decreased bone mineralisation

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4
Q

Describe the microstructure in osteoporosis.

A

Normal

Though there is an overall decreased quantity of bone

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5
Q

What are the features of osteomalacia?

A

Too little mineral – osteopenic and soft bone bends and deforms
Too much osteoid – Looser’s zones
If calcium remains low –> secondary hyperparathyroidism

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6
Q

What are Looser’s zones? Where are they found?

A

Narrow lucency, perpendicular to the bone cortex

Found in the pubic rami, proximal femur, scapular and lower ribs

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7
Q

What is a distinctive feature of osteomalacia that can be seen in an X-ray of the vertebrae?

A

Codfish vertebrae – biconcave loss of height
Osteopaenia (increased lucency)
Pencilled in margin

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8
Q

What radiographic feature is common to both osteomalacia andosteoporosis?

A

Osteopenia

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9
Q

What is the key difference between osteomalacia and rickets?

A

Rickets occurs before the growth plates have fused

As the metaphysis grows most rapidly, it shows the most obvious changes

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10
Q

What are the radiographic features of rickets that are linked to the metaphysis?

A
  • Indistinct frayed metaphyseal margin
  • Widened growth plate (no calcification taking place)
  • Bowing of weight bearing bones
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11
Q

What is Rickety Rosary?

A

Enlargement of the anterior ribs

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12
Q

Describe how PTH, calcium and phosphate change in:

a. Primary HPT
b. Secondary HPT
c. Tertiary HPT

A 
a. Primary HPT 
PTH – high  
Calcium – high  
Phosphate – low 
b. Secondary HPT 
PTH – high  
Calcium – low  
Phosphate – normal or low  
c. Tertiary HPT 
PTH – high  
Calcium –high  
Phosphate – low
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13
Q

What are the main consequences of secondary HPT to bone?

A

Resorption and increased density

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14
Q

List 4 types of bone resorption.

A
  • Subperiosteal
  • Subchondral
  • Intracortical
  • Brown tumours
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15
Q

What are the differences between slow and fast bone loss?

A

Slow – Involutional Osteoporosis
 Bone has time to remodel
 Bone loss occurs according to mechanical needs
Fast – hyperparathyroidism/disuse osteoporosis
 Bone loss is too rapid
 Loss does not cater to mechanical needs

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16
Q

Describe the radiological features of renal osteodystrophy.

A

 Subperiosteal bone erosions
 Brown tumours
 Sclerosis – axial skeleton/vertebral end plates (rugby jersey spine)
 Soft tissue calcification (arteries/cartilage)

17
Q

What are the 4 factors that make bones strong?

A

4Ms

  • Mass
  • Matrix and Material Properties
  • Microarchitecture
  • Macroarchitecture
18
Q

What constitutes material properties of a bone?

A

Collagen, cross-linking, advanced glycation end products
Woven vs lamellar bone
Mineralization
Microcracks

19
Q

What constitutes microarchitecture of bone?

A

Trabecular thickness
Trabecular connectivity
Cortical porosity

20
Q

What constitutes macroarchitecture of bone?

A

Hip axis length

Diameter of bone

21
Q

What are the compounds measured in serum biochemical investigations in bone disease?

A 
Calcium
Corrected calcium (albumin)
Phosphate
Alkaline phosphatase
Creatinine
PTH
25(OH)D3
22
Q

What are the compounds measured in urine biochemical investigations in bone disease?

A

Calcium
Phosphate
NTX

23
Q

In osteoporosis radiology, what are the main observations?

A
  • Loss of cortical bone/ thinning of cortex
  • Loss of trabeculae
  • Insufficiency fractures
24
Q

Where are Looser’s Zones commonly found?

A

Insufficiency fractures at high tensile stress areas

  • Medial proximal femur
  • Lateral scapula
  • Pubic rami
  • Posterior proximal ulna
  • Ribs

Y2 LCRS 2 - Musculoskeletal (10 decks)

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