metabolic bone disease

Question 1

What is osteoporosis?

What is osteomalacia?

Answer 1

Decreased bone QUANTITY

Decreased bone QUALITY with normal quantity

Question 2

How many cases are secondary osteoporosis vs primary?

Answer 2

5% are secondary (due to an underlying pathology)

Question 3

How is osteopenia diagnosed?

Answer 3

cortical thinning

usually in the 2nd or 3rd metacarpal, the cortical width should be ~1/3 the bone shaft width

Question 4

Which is more effective in alleviated post menopausal osteopenia?

Answer 4

Estrogen

No proof that calcium helps

Question 5

What is the difference between primary osteoporosis and disuse osteoporosis?

How can disuse be differentiated from a permeative bone lesion?

Answer 5

Disuse occurs more rapidly and has a patchy appearance

The cortex will be intact in disuse

Question 6

What is meant by the term pseudopermeative? What causes it?

Answer 6

Permeative appearance of the cortex due to cortical holes

Malignancy
Hmangioma
Radiation

Question 7

What is the differential for a permeative marrow if 30?

Pseudopermeative?

Answer 7

Ewings, Infection, EG

Lymphoma, Infection, Myeloma, Mets

Aggressive osteoporosis, hemangioma, radiation changes

Question 8

What is the most common cause of osteomalacia?

Answer 8

Renal osteodystrophy

Question 9

What finding is pathognomonic for osteomalacia?

Answer 9

Looser fracture

fracture through large osteoid seams

Question 10

What are the radiographic signs of rickets?

Answer 10

Pediatric osteomalacia

Flared and irregular epiphyses with long bone bending

Question 11

What is the most common cause of hyperparathyroidism?

Answer 11

Renal disease causing secondary hyperparathyoidism

Question 12

What are the radiographic findings in hyperparathyroidism?

Answer 12

Subperiosteal bone resorption - commonly seen in the 2nd and 3rd radial middle phalanges

Clavicular osteoclysis

Osteosclerosis - rugger jersey spine

Question 13

What are the findings of hypoparathyroidism?

Answer 13

Calvarial thickening and basal ganglia calcification

Question 14

What is pseudohypoparathyroidism? What are the radiographic findings?

What is pseudopseudohypoparathyroidism?

Answer 14

End organ failure with normal pituitary and PTH. Brachydactyly within the tubular bones of the hand

Clinical pseudohypoparathyroidism with no end organ or pituitary abnormality

Question 15

What happens with adenohypophysis tumor/hyperplasia if the growth plates are closed/open?

Answer 15

Closed - acromegaly

Open - gigantism

Question 16

What are the findings in acromegaly?

Answer 16

Calvarial thickening, enlarged sinuses, enlarged sella turcica

Prognathia

Hypertrophied “spade” appearance distal phalangeal tuft

Mild joint space widening due to cartilage overgrowth

Soft tissue thickening, such as the fat pad medial to the calcaneus

Question 17

What is thyroid acropachy?

Answer 17

Occurs after thyroidectomy

Periostitis of the metacarpals and phalanges, prominently the ulnar aspect of the fifth metacarpal

Question 18

Delated epiphyseal closure (30-40yo) and stippled epiphyseal appearance is seen with what disease?

Answer 18

Hypothyroidism in children

Question 19

What is the differential for osteosclerosis?

Answer 19

Renal osteodystrophy
Sickle cell
Myelofibrosis
Osteopetrosis
Pyknodysostosis
Mets
Mastocytosis
Pagets
Athletes
Fluorosis

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Question 20

What are the signs of sickle cell disease?

Answer 20

Fish vertebrae - step off deformities of the vertebral body endplates

Hip AVN

Bone infarcts

Question 21

When should myelofibrosis be considered with osteosclerosis?

What else to look for?

Answer 21

> 50yo

Look for splenomegaly and extramedullary hematopoiesis

Question 22

What is osteopetrosis? What are the types

What are the radiographic findings?

Answer 22

Congenital - can be fatal, anemia, jaundice, hepatosplenomegaly, infections

Tarda - milder clinical presentation

Bone in bone appearance of the spine - small replica of vertebral body inside the normal one

Sandwich spine - densely sclerotic endplates similar to rugger jersey spine, though this will be denser than PHPT

Question 23

What is pyknodysostosis?

What are the findings? What is pathognomonic of this condition?

Answer 23

Dense sclerosis of the bones

Short stature, hypoplastic mandibles

Acroosteolysis with sclerosis “Chalk phalanges put into sharpener”

Question 24

What are the findings in mastocytosis?

Answer 24

Uniform sclerosis

Thickend GI folds with nodules
Urticaria pigmentosa

Question 25

What are the findings in Pagets disease?

Where does it classically present? What is a classic sign?

Answer 25

Bony enlargement with three distinct phases
1 - lytic
2 - sclerotic
3- mixed

Pelvis

Iliopectineal line thickening

Always starts at the end of the long bone (except tibia)

Question 26

What are the three phases of Pagets?

Answer 26

Lytic - flame shaped or blade of grass
Sclerotic
Mixed

Question 27

Where does paget affect long bones classically?

Answer 27

Ends extending centrally

If there is a central lesion, pagets can be ruled out

Question 28

What is fluorosis?

What is the classic finding?

Answer 28

Chronic intake of fluoride

Ligamentous calcification

Sacrotuberous ligament calcification

Question 29

What is the teardrop sign with regards to joint effusion?

Answer 29

The distance from the most medial part of the femoral head to the most medial extent of the acetabulum (teardrop).