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Musculoskeletal Y2 > Metabolic Bone Disease: Histopathology > Flashcards

Metabolic Bone Disease: Histopathology Flashcards

1
Q

4 functions of bone?

A

STRUCTURE: Gives the body structure and shape
MECHANICAL: it provides attachments for muscle sites.
PROTECTIVE: It is protective, protects vital organs and bone marrow.
METABOLIC: Metabolically it acts as a reserve of calcium (the largest reserve in the body) and other minerals.

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2
Q

What % of bone is inorganic vs organisation?

A

INORGANIC - 65%

ORGANIC - 35%

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3
Q

What is the organic part of bone? (2)

A

bone cells and protein matrix

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4
Q

What is stored in the inorganic part of bone? (4)

A

calcium hydroxyapatite (Ca10(PO4)6(OH)2)
is storehouse for 99% of Calcium in the body
85% of the Phosphorus, 65% Sodium, Magnesium

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5
Q

condyles are …

A

the knuckle shaped regions on the articular cartilage surface.

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6
Q

the end region of the bone is called?

A

Epiphysis

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7
Q

All the main shaft is separated from the epiphysis by the….

A

epiphyseal line/metaphysis

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8
Q

What is the main shaft of the bone known as

A

Diaphysis

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9
Q

small depression or dip in the surface in the bone is known as the…

A

Fovea

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10
Q

. The main portion of the bone is the ….

A

diaphysis

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11
Q

main marrow cavity is known as the …

A

medulla

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12
Q

outside surface of the bone in the diaphysis is the….

A

periosteum

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13
Q

the cartilage structure known as the growth plate during growth is found at the ….

A

metaphysis

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14
Q

the region in long bones that contains the bulk of the trabecular or cancellous bone is the ….

A

metaphysis

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15
Q

Ends of a long bone are known as …

A

epiphysis

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16
Q

medulla which is filled with bone marrow is surrounded by X which is surrounded by Y

A

Cortical bone

Periosteum

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17
Q

Bone has to be X% mineralised to be seen on X-ray

A

50%

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18
Q

5 types of bone

A 
Flat bones 
Long bones 
short/cuboid bones 
Irregular bones 
Sesamoid bones
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19
Q

Example of flat bones? Function of these bones?

A

cranial bones, or the ribs, generally protect internal organs

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20
Q

Example of Irregular bones? Function of these bones?

A

complex shape like the vertebrae or the pelvis. That allows them to protect a specific organ or set of organs.

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21
Q

Example of short/cuboid bones? Function of these bones?

A

like the carpals and tarsals, stabalise and facilitate movement

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22
Q

Example of Long bones? Function of these bones?

A

femur and tibia

support weight and facilitate movement

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23
Q

Example of Sesamoid bones? Function of these bones?

A

patella, protective

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24
Q

2 bone formations at the microscopic level?

A

immature woven bone or mature lamellar bone.

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25
Q

Structure of immature woven bone? (4)

When do you see this type of bone?

A

lamellae are absent. Collagen fibres are laid down in a disorganized fashion: such as states of high bone turnover(Pagets disease of bone, certain stages of fluoride treatment, tumours) not so tightly packed, random bundles

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26
Q

Structure of mature woven bone? (collagen laid down how?)

A

Cortical and cancellous bone are lamellar and this is particularly evident when viewed under polarised light
Collagen fibres are arranged in alternating orientations allowing for the highest density of collagen per unit of tissue

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27
Q

Macroscopic formation of bone? (2)

A

trabecular/cancellous/spongy

cortical/compact

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28
Q

What bones are cortical?

A

Long bones

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29
Q

What bones are cancellous?

A

vertebrae & pelvis

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30
Q

Majority of bones are cancellous or cortical?

A

Cortical

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31
Q

Cortical bones are [appendicular/axial]?

A

appendicular

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32
Q

Cancellous bones are [appendicular/axial]?

A

axial

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33
Q

% calcification of cancellous bones ?

A

15-25%

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34
Q

% calcification of cortical bones?

A

80-90%

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35
Q

Main function of cortical bone?

A

mainly structural, mechanical, and protective

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36
Q

Main function of cortical bone?

A

mainly metabolic

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37
Q

Which has higher surface area, cancellous or cortical bone?

A

Cancellous

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38
Q

4 types of lamellae of bone?

A

circumferential
interstitial
trabecular
Concentric

39
Q

Where is circumferential lamellae

A

layered around the bone

40
Q

Describe location of interstitial lamellae

A

Between osteons

41
Q

Describe location of trabecular lamellae

A

do not surround a central channel but are organized into layers

42
Q

what are the dendritic structures inside lamellae?

A

Osteocytes

43
Q

Osteocytes are…

A

the dendritic structures inside lamellae

44
Q

The circular regions in bone are known as?

A

Osteons

45
Q

Osteons are centred around…

A

haversion canal

46
Q

hversion canals are found…

A

in the centre of an osteon

47
Q

How are the mechosensory functions of osteocytes possible?

A

eocytes are all connected through small channels

48
Q

Why can you mature bone under polarised light but not immature

A

You can see mature lamellar bone by imaging it under polarised light but not immature woven bone as it is much more disorganised and the collagen is disorganised and therefore it is a lot weaker.

49
Q

Purpose of the osteocytes?

A

determine where bone needs to be repaired and replaced and do it

50
Q

Inside a aversion canal is?

A

Blood vessels

51
Q

Woven bone can be found under what conditions? (3)

A

Woven bone is most often found in the developing skeleton as the cartilage scaffold is first converted to bone, but can also be found in states of rapid grow, or high bone turnover.

52
Q

3 types of specialised bone cells?

A

Osteoclasts
Osteoblasts
Osteocytes

53
Q

What do osteoclasts do?

A

multinuclear cells formed from haematopoietic stem cell lineage that remove and resorb bone.

54
Q

What do osteoblasts do?

A

produce osteoids, which is mineralised to form new bone.

55
Q

What do osteocytes do?

A

mechanosensory network embedded in mature bone to find where bone needs to be repaired and replaced.

56
Q

Majority of bone cells are of which type?

A

Osteocytes

57
Q

What signals an osteoclast to resorb bone and how

A

Osteocyte apoptosis as it releases RANKL

58
Q

What molecule activates an osteoclast

A

RANKL and M-CSF

59
Q

Describe bone remodelling (signalling to activate, resorption, and then new bone)

A

Osteocyte apoptosis signals the osteoclast to come over and resorb as it releases RANKL(igand) stimulating the osteoclast to come over and resorb the old and damaged bone. They then die and are replaced by reversal cells. Osteoblasts are signalled to come in by the reversal cells and they form new bone to the same level osteoclasts resorbed.

60
Q

What do osteoblasts produce?

A

RANKL and M-CSF

61
Q

Osteoblasts produce … (3)

A

RANKL M-CSF and OPG

62
Q

what is OPG

A

decoy receptor for RANKL

63
Q

Differentiate between osteocyte and osteoblast/osteoclast? in histology

A

Osteoblasts/clasts are more purply is histology

64
Q

Differentiate between osteoblast/osteoclast?

A

Osteoclast are have many segments of nucleus

65
Q

Osteoblasts once they’ve formed new bone can become ….

A

embedded in the bone and go on to become osteoclasts.

66
Q

Why perform bone biopsies? (6)

A

Confirm the diagnosis of a bone disorder
Find the cause of or evaluate ongoing bone pain or tenderness
Investigate an abnormality seen on X-ray
For bone tumour diagnosis (benign vs malignant)
To determine the cause of an unexplained infection
To evaluate therapy performance

67
Q

2 types of bone biopsy?

A

Open - needle is inserted into bone, and pulled out with the core still in it allowing for histological examination (Jamshidi).

closed - less common, in cases of really hard osteosclerotic bone or inaccessible region or you just need a large sample of bone for some reason. This is under general anaesthesia and surgical.

68
Q

Most location for a bone biopsy?

A

transiliac bone biopsy

69
Q

Usual stain for bones?

A

H&E

70
Q

Stain for mineralised and non-mineralised bone?

A

Masson Goldner trichrome stain

71
Q

Stain for for bone turnover?

A

Tetracycline/calcein labelling - inject once, then wait, then inject again, biopsy, see distance between two layers of stain which is incorporated into the bone to see the turnover

72
Q

Common metabolic bone diseases? (5)

A 
Osteoporosis
Osteomalacia/Rickets
Primary hyperparathyroidism
Renal osteodystrophy
Paget’s disease
73
Q

Causes of primary osteoporosis?

A

age, post-menopause

74
Q

Causes of secondary osteoporosis?

A

drugs, systemic diseases

75
Q

What is high turnover osteoporosis

A

high resorption and formation but resorption is higher

76
Q

What is low turnover osteoporosis

A

low level of both but resorption is lower, or same level formation but resorption is lower

77
Q

unmineralized osteoid suggests ….

A

high turnover

78
Q

2 causes of osteomalacia

A

Deficiency of vitamin D

Deficiency of PO4

79
Q

Osteomalacia is caused by?

A

Defective mineralisation of normally synthesised bone matrix, no sufficient available calcium (or in some cases Phosphate) to form the hydroxyapatite crystals necessary to mineralise bone

80
Q

Looser’s zone fractures are common in X disease and Y area and due to….

A

Osteomalacia/in the hip

due to lack of mineralisation

81
Q

What mineral is in bone mainly

A

Calcium hydroapatite

82
Q

Osteomalacia symptoms?

A

bone pain/tenderness
fracture
proximal weakness
bone deformity

83
Q

pathogenesis of hyperparathyroidism? (7 stages)

A

Excess PTH. Results in increased Ca absorption and phosphate excretion. Leads to hypercalcaemia and hypophosphataemia which leads to skeletal changes of osteitis fibrosa cystica – replacement of bone with fibrous cystlike tissues.

84
Q

2 types of hyperparathyroidism? and examples of each?

A

Primary hyperparathyroidism: parathyroid adenoma (85-90%), or chief cell hyperplasia.
Secondary: chronic renal deficiency (kidney disease), or vitamin D production deficiency (due to kidney probs).

85
Q

Symptoms for hyperparathyroidism and the pneumonic?

A

STONES (Ca oxalate renal stones)
BONES (osteitis fibrosa cystica, bone resorption)
ABDOMINAL GROANS (acute pancreatitis)
PSYCHIC MOANS (psychosis and depression)

86
Q

4 organs in/directly affected by PTH?

A

Parathyroid glands
Bones
Kidneys
Proximal small intestine

87
Q

In the late stages of hyperparathyroidism, extensive resorption causes XXX with reparative tissue called YYYY

A

lytic bone lesions

giant cell reparative granuloma

88
Q

Brown tumours are found in what disease?

A

Hyperparathyroidism

89
Q

Renal osteodystrophy comprises of…. (5)

A

all the skeletal changes resulting from chronic renal disease:

Increased bone resorption (osteitis fibrosa cystica)
Osteomalacia
Osteosclerosis
Growth retardation 
Osteoporosis
90
Q

3 stages of Paget’s disease:

A
  1. Osteolytic
  2. Osteolytic-osteosclerotic
  3. Quiescent osteosclerotic
91
Q

Paget’s disease:

Age and ethnicity and gender - who is it more common in?

A

Onset > 40y (affects 3-8% Caucasians > 55y)
M>F
Rare in Asians and Africans

92
Q

Cause of Paget’s?

A

Unknown, genetic link, previous bone injuries and some virus particles have been seen

93
Q

Symptoms of Paget’s? (11)

A

pain
microfractures
nerve compression (incl. Spinal N and cord)
skull changes may put medulla at risk
deafness
+/- haemodynamic changes, cardiac failure
hypercalcaemia
Development of sarcoma in area of involvement

Musculoskeletal Y2 (11 decks)

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