Metabolic Bone Diseases

Question 1

Hyperparathyroidism:
Clinical findings?
Xray findings?

Answer 1

Kidney stones, hyperreflexia

Osteopenia, osteitis fibrosa cystica

Question 2

Familial syndromes:
Clinical findings?
Xray findings?

Answer 2

Endocrine and renal abnormalities

Osteopenia

Question 3

Hypoparathyroidism:
Clinical findings?
Xray findings?

Answer 3

Neuromuscular irritability, cataracts

Calcified basal ganglia

Question 4

PHP/Albright’s syndrome:
Clinical findings?
Xray findings?

Answer 4

Short MC/MT, obesity

Brachydactyly, exostosis

Question 5

Osteodystrophy:
Clinical findings?
Xray findings?

Answer 5

Renal abnormalities

“Rugger jersey” spine

Question 6

Vit D deficiency rickets:
Clinical findings?
Xray findings?

Answer 6

Bone deformities, hypotonia, pathologic fractures (Looser’s zones: pseudofracture on compression side of bone), Milkman’s fracture
“Rachitic rosary”, wide growth plates, fractures, “codfish” vertebrae, coxa vara, retarded bone growth (defect in hypertrophic zone, widened osteoid seams)

Question 7

Vitamin D-dependent (types I and II) rickets:
Clinical findings?
Xray findings?

Answer 7

Total baldness

Poor mineralization

Question 8

Vitamin D-resistant (hypophosphatemic) rickets:
Clinical findings?
Xray findings?

Answer 8

(Most common form of rickets)
Bone deformities, hypotonia
Poor mineralization

Question 9

Hypophosphatasia:
Clinical findings?
Xray findings?

Answer 9

Bone deformities, hypotonia

Poor mineralization

Question 10

Osteoporosis:
Clinical findings?
Xray findings?

Answer 10

Kyphosis, fractures

Compression vertebral fractures, hip fractures

Question 11

Scruvy:
Clinical findings?
Xray findings?

Answer 11

Fatigue, bleeding, effusions

Thin cortices, corner sign

Question 12

Paget’s:
Clinical findings?
Xray findings?

Answer 12

Deformities, pain, CHF, fractures

Coarse trabeculae, “picture frame” vertebrae

Question 13

Osteopetrosis:
Clinical findings?
Xray findings?

Answer 13

HSM, anemia

Bone within bone

Question 14

WHO definition of osteoporosis?

Answer 14

Lumbar (L2-4) density is 2.5 or more SDs less than mean peak bone mass of a healthy 25 year old

Question 15

WHO definition of osteopenia?

Answer 15

Bone density is 1.0 to 2.5 SDs less than the mean peak bone mass of a healthy 25 year old

Question 16

Osteoporosis stats:

1) After initial vertebral fx, risk for a 2nd is?
2) Lifetime risk of fx in white women after 50 years?
3) Risk for hip fracture?

Answer 16

1) 20%
2) 75%
3) 15-20%

Question 17

Types of osteoporosis?

Answer 17

Type I: postmenopausal = affects trabecular bone, vertebral and distal radius fxs common
Type II: age related = affects trabecular AND cortical bone, hip and pelvic fxs common, more related to poor Ca absorption

Question 18

Tx of osteoporosis?

Answer 18

1) Exercise
2) Ca supplements = 1000-1500mg/day (more effective in type II)
3) Vit D supplements = 400-800IU/day
4) Fluoride
5) Bisphosphonates

Question 19

What can you see in 3rd trimester of pregnancy?

Answer 19

Idiopathic transient osteoporosis of hip

Question 20

What’s required for dx of osteomalacia?

Answer 20

Biopsy (transiliac)

Question 21

Histologic finding of scurvy?

Answer 21

Widening of the zone of provisional calcification in the physis