Metabolic Bone Disease – Radiology Flashcards

1
Q

What are the two main radiographic signs?

A

Osteopenia

Osteosclerosis

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2
Q

What is the lucency of the following scans proportional to:

a. X rays
b. Densitmetry
c. CT scans
d. MRI scans
e. Radionucline bone scans

A

a. X rays
Density

b. Densitometry
Density and attenuation

c. CT scans
Density and attenuation

d. MRI scans
Chemical and water content

e. Radionuclide bone scans
Bone turnover

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3
Q

What is the main difference between osteoporosis and osteomalacia?

A

Osteoporosis – decreased bone mass

Osteomalacia – decreased bone mineralisation

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4
Q

Describe the microstructure in osteoporosis.

A

Normal

Though there is an overall decreased quantity of bone

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5
Q

What are the features of osteomalacia?

A

Too little mineral – osteopenic and soft bone bends and deforms

Too much osteoid – Looser’s zones

If calcium remains low –> secondary hyperparathyroidism

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6
Q

What are Looser’s zones? Where are they found?

A

Narrow lucency, perpendicular to the bone cortex

Found in the pubic rami, proximal femur, scapular and lower ribs

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7
Q

What is a distinctive feature of osteomalacia that can be seen in an X-ray of the vertebrae?

A

Codfish vertebrae – biconcave loss of height

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8
Q

What radiographic feature is common to both osteomalacia and osteoporosis?

A

Osteopenia

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9
Q

What is the key difference between osteomalacia and rickets?

A

Rickets occurs before the growth plates have fused

As the metaphysis grows most rapidly, it shows the most obvious changes- Widened growth plate

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10
Q

What are the radiographic features of rickets that are linked to the metaphysis?

A

Indistinct frayed metaphyseal margin

Widened growth plate (no calcification taking place)

Bowing of weight bearing bones

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11
Q

What is Rickety Rosary?

A

Enlargement of the anterior ribs

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12
Q

Describe how PTH, calcium and phosphate change in:

a. Primary HPT
b. Secondary HPT
c. Tertiary HPT

A

a. Primary HPT
PTH – high
Calcium – high
Phosphate – low

b. Secondary HPT
PTH – high
Calcium – low
Phosphate – normal or low

c. Tertiary HPT
PTH – high
Calcium –high
Phosphate – low

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13
Q

What are the main consequences of secondary HPT to bone?

A

Resorption and increased density

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14
Q

List 4 types of bone resorption.

A

Subperiosteal

Subchondral

Intracortical

Brown tumours

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15
Q

What are the differences between slow and fast bone loss?

A

Slow – Involutional Osteoporosis
 Bone has time to remodel
 Bone loss occurs according to mechanical needs

Fast – hyperparathyroidism/disuse osteoporosis
 Bone loss is too rapid
 Loss does not cater to mechanical needs

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16
Q

Describe the radiological features of renal osteodystrophy.

A

 Subperiosteal bone erosions

 Brown tumours- secondary HPT

 Sclerosis – axial skeleton/vertebral end plates (rugby jersey spine)

 Soft tissue calcification (arteries/cartilage)