Metabolic And Endocrine Skeletal Disease Flashcards
Differentiate the main causes of osteoporosis.
Primary
Juvenile Idiopathic of young adults Postmenopausal Senile
Secondary
Endocrine
Glucocorticoid excess Oestrogen/testosterone deficiency Hyperthyroidism Hyperparathyroidism Growth hormone deficiency (childhood onset)
Nutritional
Intestinal malabsorption Chronic alcoholism Chronic liver disease Partial gastrectomy Vitamin C deficiency (scurvy)
Hereditary
Osteogenesis imperfecta Homocystinuria Marfan’s syndrome Ehlers–Danlos syndrome
Haematological
Thalassaemia Sickle-cell disease Gaucher’s disease
Other
Rheumatoid arthritis Haemochromatosis
What are the x-ray features of osteoporosis?
Reduced bone density is often more prominent in areas of the skeleton rich in trabecular bone, particularly in the axial skeleton (vertebrae, pelvis, ribs and sternum). Eventually, changes may also be evident in the bones of the appendicular skeleton. Trabeculae become thin and may disappear completely; they may be sparse, but those that remain may become thickened due to stresses to which the skeleton is exposed. The cortex becomes reduced in width through endosteal bone resorption, and in states of increased bone turnover there will be intracortical tunnelling and porosity. Such fractures can occur at any skeletal site, but they are most common in sites of the skeleton rich in trabecular bone, particularly the vertebrae, the distal forearm and the proximal femur
What are the x-ray findings of osteogenesis imperfecta?
Radiographic features vary according to the type of disease and its severity and include osteopenia and fractures, which may heal with florid callus formation, mimicking osteosarcoma. Bones are thin and undertubulated (gracile), normal in length or shortened, thickened and deformed by multiple fractures. Intra-sutural (Wormian) bones can be identified on skull radiographs[70]. In severe forms of osteogenesis imperfecta the diagnosis may be made before birth by detailed ultrasound in the second trimester. Diagnostic features include cranial enlargement, reduced echogenicity of bone and deformity and shortening of limb bones as a result of intrauterine fractures
What are the secondary causes of hyperparathyroidism?
Secondary hyperparathyroidism is induced by any condition, or circumstance, which causes the serum calcium to fall. This occurs in vitamin D deficiency, intestinal malabsorption of calcium, chronic renal failure (through lack of the active metabolite of vitamin D, 1,25(OH)2D), and retention of phosphorus.
What are the x-ray features hyperparathyroidism?
Subperiosteal erosions, intracortical bone resorption, chondrocalcinosis,
Brown tumours, osteosclerosis/porosis, metastatic calcification
What are the secondary causes of hypoparathyroidism?
Hypoparathyroidism can result from reduced or absent parathyroid hormone production or from end organ (kidney, bone or both) resistance. This may be the result of the parathyroid glands failing to develop, the glands being damaged or removed, the function of the glands being reduced by altered regulation, or the action of parathyroid hormone (PTH) being impaired
What are the radiology features of hypoparathyroidism?
There may be localized (23%) or generalized (9%) osteosclerosis in affected patients[115]. This particularly affects the skull where the vault is thickened. At an early age of onset, the dentition is hypoplastic. Metastatic calcification may be present in the basal ganglia or in the subcutaneous tissue, particularly about the hips and shoulders
What are the radiology signs of osteogenesis imperfecta?
Radiographic features vary according to the type of disease and its severity and include osteopenia and fractures, which may heal with florid callus formation, mimicking osteosarcoma. Bones are thin and undertubulated (gracile), normal in length or shortened, thickened and deformed by multiple fractures. Intra-sutural (Wormian) bones can be identified on skull radiographs[70]. In severe forms of osteogenesis imperfecta the diagnosis may be made before birth by detailed ultrasound in the second trimester. Diagnostic features include cranial enlargement, reduced echogenicity of bone and deformity and shortening of limb bones as a result of intrauterine fractures
