6. Nutritional/Metabolic/Endocrine Flashcards
most common metabolic bone
disorder
Osteoporosis
low bone mass
and microarchitectural deterioration of bone tissue, with a
consequent increase in bone fragility and susceptibility to fracture”
Osteoporosis
Reduction of bone
quantity of otherwise normal bone
Osteoporosis
poverty of
bone with increased
radiolucency
Osteopenia
decreased bone
density in majority of skeleton, especially axial and proximal long bones
Generalized Osteoporosis:
Complex Regional Pain Syndrome and Reflex Sympathetic Dystrophy
Syndrome is also called
Sudeck’s atrophy
T1 -MR of hips
shows a diffuse zone of low signal intensity in the femoral
head and neck consistent with
marrow edema
Transient Osteoporosis of Hip (TOH)
Localized Osteoporosis
focal loss of bone density affecting
a small area of bone
bone mass decreases at what age
35 yo
Complications of osteoporosis include
Spinal compression fractures, Increasing thoracic kyphosis and other fractures
effective to restore AS posture
spine osteotomy
Subtrochanteric
femoral fractures are a complication of
Bisphosphonates
According to a 2009 Swedish study by
Aspberger, the incidence of mid femur stress
fracture is 50 times higher for patients on
_________ compared to untreated women
Bisphosphonates
Fosamax
and Actonel are
bisphosphonate drugs
if patient presents
with pain upon coughing, sneezing or straining, suspect
acute compression fracture
Progressive angular kyphotic deformity within 1 year of spinal compression fracture may result in
spinal
stenosis
are neurological abnormalities common with spinal compression fracture?
NO
Cement injected into vertebral body which usually provides
immediate/substantial
results in pain and function
Vertebroplasty
procedure consists of an image-guided injection of polymethylmethacrylate (PMMA), which is an acrylic bone cement meant to stabilize and strengthen a collapsing vertebral body
Percutaneous Vertebroplasty
uses balloon dilatation of vertebral body,
with subsequent instillation of polymethylmethacrylate.
Kyphoplasty
In Weightbearing Bones (vertebrae) there is preferential resorption of non-essential supporting
trabeculae and relative sparing of the major, ______
oriented stress trabeculae
vertical
why is Single Photon Absorptiometry unreliable?
High false negative rates
DEXA stands for
Dual Energy X-ray Absorptiometry
Dual Photon Absorptiometry is applied to the
spine and prox femur
DEXA scores are reported as
“T-scores” and “Z-scores.”
comparison of a person’s bone density with that of a healthy 30-year-old of the same sex.
T-score
comparison of a person’s bone density with that of an average person of the same age and sex
Z-score
T-score of -1 and above
normal bone density
T-score of -1 to -2.5
osteopenia
T-score of -2.5 and below
osteoporosis.
may suggest that something other than aging is causing abnormal bone
loss.
Z-score of -2 or less
Most commonly used to assess the strength of vertebrae in assessment of fracture risk
Quantitative CT
200-250 mRad
Quantitative CT
Dual photon beam is passed through a vertebral body
Quantitative CT
Advantages of quantitiative CT over DEXA for Dx osteopororsis
- Ability to separate cortical and trabecular bone
- Provides true volumetric density in units of mg/cc
- No errors due to spinal degenerative changes or
aortic calcification - Information on bone morphometry
Roentgen Signs of Osteoporosis
Cortical Thinning and Altered Trabecular Patterns
Pencil thin cortices and
Endosteal scalloping
Cortical Thinning seen in Osteoporosis
Trabecular resorption with accentuation of remaining trabeculae especially in weight bearing regions of bone and Washed-out appearance of bone in severe stages
Altered Trabecular Patterns seen in Osteoporosis
During resorption of trabeculae, typically the transverse vertebral body
trabeculae are resorbed first which gives a
Pseudohemangioma appearance
compression of anterior and posterior portions of
vertebral body
Vertebra Plana (Pancake Vertebra)
Loss of anterior vertebral body height most common in mid T and TL regions
Wedge Vertebra
Magnetic resonance imaging of the thoracic cord shows a wedgeshaped
deformity with increased
signal intensity of T7 indicating
an acute
severe compression
fracture
Due to pressure of nucleus pulposus
upon weakened endplates (Hourglas/Fish vertebrae)
Biconcave Deformities:
present with marked
sacral tenderness on physical examination
Sacral Insufficiency Fractures
present with pain in the low back, groin, or hip
rami fractures
characteristic “H pattern” or Honda sign may be seen with a
sacral insufficiency fracture
stress fractures on nuclear bone scans show ares of increased or decreased tracer uptake?
increased
Acute onset of painful regional osteoporosis
usually following trivial trauma
Reflex Sympathetic Dystrophy Syndrome (RSDS)
Progressive pain, stiffness, swelling, atrophy, contracture
usually in hand and shoulder region
50 + yo
Reflex Sympathetic Dystrophy Syndrome (RSDS)
Aka Complex Regional Pain Syndrome (CRPS)
Hyperemia of bone augments osteoclastic
resorption resulting in rapid osteoporosis
with slow recovery and may never recover fully
Reflex Sympathetic Dystrophy Syndrome (RSDS)
Aka Complex Regional Pain Syndrome (CRPS)
Rapid progressive osteoporosis with normal Joint spaces and margins
Reflex Sympathetic Dystrophy Syndrome (RSDS)
Severe osteoporosis especially of femoral head with sudden pain, antalgia and limp
Transient Osteoporosis of Hip
Full recovery of Transient Osteoporosis of Hip expected in
3-12 months
Transient Osteoporosis of Hip may be associated with
pregnancy
In Disuse and Immobilization Osteoporosis
X ray changes begin after ___ days and are most pronounced
by ___ months
7-10, 2-3
4 patterns of Disuse Osteoporosis
- Uniform
- Spotty
- Bands
- Cortical
Lack of calcium deposited in osteoid altered quality of bone
Osteomalacia (“soft bones”
Bilateral and symmetrical fractures at right angles to cortex seen in Osteomalacia
Pseudofractures, aka Looser or Milkman Lines
Radiographic Findings of osteomalacia
- Osteopenia
- Pseudofractures
- Bone deformities
unmineralized osteoid along anterior rib cage
Rachitic Rosary
In there will be soft tissue swellings around growth plates due to
hypertrophied
cartilage
With rickets at the physis, cartilage cells grow normally, but fail to
calcify
- Absent zone of provisional calcification
- Widening of growth plates due to accumulation of osteoid
- Irregular, frayed, cupped metaphyseal margins
- “Paint brush” frayed zones of provisional calcification
Rickets
Bowing deformities, fractures, osteopenia, scoliosis,
pseudofractures, abnormal bone length
Rickets
“Paint brush” frayed zones of provisional calcification
Rickets
suppression of osteoblastic activity; decreased production of
collagen and osteoid
scurvy
in scurvy you need at least __ months avitaminosis C before symptoms and skeletal changes occur
4
Clinical Hallmark of scurvy
spontaneous hemorrhages from
capillary fragility
- Generalized osteopenia
- White Line of Frankel
- Wimberger’s Ring
- Corner Sign
- Pelken’s Spurs
- Scorbutic Zone (Trummerfeld Zone)
- Subperiosteal Hemorrhage
scurvy
dense zone of provisional
calcification
White Line of Frankel
dense peripheral ring epiphysis
Wimberger’s Ring
infractions of the epiphyseal—metaphyseal
margins
Corner Sign
spurs at metaphyseal margins extending
perpendicular to cortex
Pelken’s Spurs
poor osteoid
formation located along metaphyseal side of ZOPC which
appears as a radiolucent band
Scorbutic Zone (Trummerfeld Zone)
Osteoclastic resorption with fibrous tissue replacement
Osteitis Fibrosa Cystica
Accumulation of fibrous tissue produces localized cyst like destructive bone lesions that are brown in color
Brown Tumors in Hyperparathyroidism
Pathologic Hallmark of hyperparathyroidism
and occurs along outer cortex at insertional points of ligaments
and tendons
Subperiosteal Bone Resorption
- Radial margins 2nd and 3rd digits of hand
- Lacelike appearance
- SI erosion
Subperiosteal Bone Resorption in Hyperparathyroidism
Salt and Pepper Skull
Hyperparathyroidism
Erosion of Lamina Dura
Hyperparathyroidism
Rugger Jersey Spine and Aortic Calcification
Hyperparathyroidism
Subperiosteal Resorption,
Osteopenia, and Rugger Jersey Spine
Hyperparathyroidism
Calcification within subcutaneous, articular, muscular, vascular and visceral organs is common in
Hyperparathyroidism
disease of medium-sized muscular arteries
Monckeberg medial calcific sclerosis
Calcium deposits in media portion of artery of people over 50
Monckeberg medial calcific sclerosis
- Hepatosplenomegaly
- Yellowing of skin
- Dermatitis
- Pruritis
- Alopecia
Hypervitaminosis A
Solid periosteal reactions on
shafts of long bones:
Hypervitaminosis A
Secretory Eosinophilic Adenoma of anterior pituitary gland produces intramembranous bone tissue growth, and subcutaneous tissue hypertrophy
Acromegaly
- Enlarged sella turcica
- Widened mandibular angle
- Sinus overgrowth
- Prominent ungual tufts
Acromegaly
Spade like appearance of ungual tufts
Acromegaly
Dense metaphyseal bands
Lead Poisoning, or Plumbism (Pb)
In children, lead deposition affects the
distal femur, both ends of the tibia, and distal radii
