metabolic bone disease Flashcards
What is osteoporosis?
What is osteomalacia?
Decreased bone QUANTITY
Decreased bone QUALITY with normal quantity
How many cases are secondary osteoporosis vs primary?
5% are secondary (due to an underlying pathology)
How is osteopenia diagnosed?
cortical thinning
usually in the 2nd or 3rd metacarpal, the cortical width should be ~1/3 the bone shaft width
Which is more effective in alleviated post menopausal osteopenia?
Estrogen
No proof that calcium helps
What is the difference between primary osteoporosis and disuse osteoporosis?
How can disuse be differentiated from a permeative bone lesion?
Disuse occurs more rapidly and has a patchy appearance
The cortex will be intact in disuse
What is meant by the term pseudopermeative? What causes it?
Permeative appearance of the cortex due to cortical holes
Malignancy
Hmangioma
Radiation
What is the differential for a permeative marrow if 30?
Pseudopermeative?
Ewings, Infection, EG
Lymphoma, Infection, Myeloma, Mets
Aggressive osteoporosis, hemangioma, radiation changes
What is the most common cause of osteomalacia?
Renal osteodystrophy
What finding is pathognomonic for osteomalacia?
Looser fracture
fracture through large osteoid seams
What are the radiographic signs of rickets?
Pediatric osteomalacia
Flared and irregular epiphyses with long bone bending
What is the most common cause of hyperparathyroidism?
Renal disease causing secondary hyperparathyoidism
What are the radiographic findings in hyperparathyroidism?
Subperiosteal bone resorption - commonly seen in the 2nd and 3rd radial middle phalanges
Clavicular osteoclysis
Osteosclerosis - rugger jersey spine
What are the findings of hypoparathyroidism?
Calvarial thickening and basal ganglia calcification
What is pseudohypoparathyroidism? What are the radiographic findings?
What is pseudopseudohypoparathyroidism?
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
What happens with adenohypophysis tumor/hyperplasia if the growth plates are closed/open?
Closed - acromegaly
Open - gigantism
What are the findings in acromegaly?
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
What is thyroid acropachy?
Occurs after thyroidectomy
Periostitis of the metacarpals and phalanges, prominently the ulnar aspect of the fifth metacarpal
Delated epiphyseal closure (30-40yo) and stippled epiphyseal appearance is seen with what disease?
Hypothyroidism in children
What is the differential for osteosclerosis?
Renal osteodystrophy Sickle cell Myelofibrosis Osteopetrosis Pyknodysostosis Mets Mastocytosis Pagets Athletes Fluorosis
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What are the signs of sickle cell disease?
Fish vertebrae - step off deformities of the vertebral body endplates
Hip AVN
Bone infarcts
When should myelofibrosis be considered with osteosclerosis?
What else to look for?
> 50yo
Look for splenomegaly and extramedullary hematopoiesis
What is osteopetrosis? What are the types
What are the radiographic findings?
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
What is pyknodysostosis?
What are the findings? What is pathognomonic of this condition?
Dense sclerosis of the bones
Short stature, hypoplastic mandibles
Acroosteolysis with sclerosis “Chalk phalanges put into sharpener”
What are the findings in mastocytosis?
Uniform sclerosis
Thickend GI folds with nodules
Urticaria pigmentosa
