Musculoskeletal II (metabolic bone disease) Flashcards
complete:
____ means increased bone density where ____ means decreased bone density
- osteosclerosis
- osteoporosis
definition of Osteoporosis
Osteoporosis is a metabolic bone disease characterized by decreased bone mass and skeletal fragility
Risk factors of Osteoporosis
Sex (females have higher risk)
Age (older adults have higher risk)
Body mass index (lower body mass carries higher risk)
Smoking
Alcohol consumption
Ever long term use of oral glucocorticoids
Rheumatoid arthritis
causes of Osteoporosis
- idiopathic
- juvinile
- senile
- menopausal
- cushing’s syndrome
- steroid therapy
hint = idiopathic, 3 ages, 2 cortisole
radiological finding of Osteoporosis
by plain X-ray [5]
- Thinned cortex
- less trabeculae
- endosteal resorption
- pencilling
- osteoporotic biconcave fracture
the last two in vertebrae only
how to measure the Osteoporosis
- corticomedullary index (CMI) in the metacarbal
- DXA scan (Dual energy X ray Absorptiometry)
- Singh index (grade 6 normal to 1 severe) in the femur
normal CMI 25 - 33 %
The diagnosis of osteoporosis/osteopaenia is made on the basis of:
1. plain x ray
OR
2. CT appearances
Neither X-rays nor CT scans.
if the bones appear to be low in density, then the diagnosis can be suspected.
different between Rickets
and osteomalcia
in young –> Rickets
in adults –> osteomalcia
before or after epiphyseal closure
causes of Rickets
and osteomalcia
Decreased production of endogenous vitamin D
hmmm ..what are the causes of “Decreased production of endogenous vitamin D”
malnutrition
malabsorption
mal-reabsorption
mal-synthesis
*the last two are not scientific, i mean renal faliure and decrease sun exposure *
special sign in Osteomalacia
pseudo fracture (weak zone)
radiological signs of Rickets (in the wrist)
Fraying = Indistinct margins of the metaphysis
Splaying =Widening of metaphyseal ends.
Cupping = Concavity of metaphysis
causes of osteosclerosis
- hyperparathyroidism
- paget disease
- metastasis
signs of osteosclerosis due to hyperparathyroidism
- sub-peri-osteal bone resorption in the radial side (in the hand)
- brown tumor (in the manduble & pelvis)
- Rugger Jersy Spine
whay it’s called Rugger Jersy Spine
https://i0.wp.com/radrounds.com/wp-content/uploads/2020/07/Picture1.jpg?w=710&ssl=1
نوع قمصان لرياضة
rugby 🏉
لو انا سميته لسميته zebra spine 😂 🦓
signs of osteosclerosis due to paget disease
paget tride
1. bone expansion
2. cortical thickning
3. trabeculation bone thickning
The radiologist can’t give the diagnosis by CT and X-ray only but at least can say benign or malignant, isn’t right?
no .. even that they can’t.
for most likely benign say (non agressive lesion)
and for most likely malignant say (agressive lesion)
radiological signs of aggressive / nonaggressive bone lesion [4]
- wide zone of transition
- ballooning lesion
- periosteal reaction (soild, lamillated, spiculated, codman’s/sunburst)
- soft tissue swelling
the most common tumor in the Phalanges
enchondroma
differnt between ABC and GCT
ABC
- young
- upper tibia
- metaphysial
- expansile
GCT
- adult
- lower femur
- epiphysial
ABC = aneurysmal bone cyst, GCT = giant cell tumor
differnt between OO and NOF
OO
- diaphysial
- small, round with sclerotic margin
- painful needs (NSAIDs)
NOF
- metaphysial
- bubbly lytic lesion with sclerotic rim
- asymptomatic and resolve spontaneously
OO = ostioid ostioma, NOF = non ostioid fibroma
differnt between metastasis and TB
metastasis
- destruction of vertebral body and posterior element (pedical destruction)
TB
- abscess & calcification
- destruction of intervertebral disc and vertebral plate
most common type of bone tumors (1ry or 2ry)
2ry (70%)
coms from:
1. mainly from prostate/ breast
2. lung
3. liver
4. kidney
5. thyroid
secondary bone tumor can be …. or …. and can be …. or ….
- sclerotic
- lytic
multiple (mainly) or solitary
most common cause of mutiple lytic bone lesion
especially in skull
multiple myeloma
