Nutritional, Metabolic, Endocrine

Question 0

What is the most common cause of generalized osteoporosis?

Answer 0

Age/Menopause

Question 1

List three presentations/types of osteoporosis

Answer 1

Generalized: age related, post-menopausal, steroid induced, heparin induced, MM, metastasis, scurvy, rickets, SCAnemia….
Regional: disuse/immobilization, RSD
Localized: infection, inflammation, arthritis, neoplasm

Question 2

What is the standard imaging modality to quantify bone mineral density?

Answer 2

DEXA

Question 3

What causes Rickets and Osteomalacia?

Answer 3

Osteomalacia: lack of osteoid mineralization leading to generalized bone softening
Rickets: Vit D deficiency, Renal Osteodystrophy (Renal Rickets), Renal Tubular Defect (failure to resorb phosphate)

Question 4

What are the classic radiographic features of rickets?

Answer 4

generalized osteopenia, coarse trabecular changes, widened growth plate, Rachitic (costal) rosary, absent zone of provisional calcification, frayed “paintbrush” and cupped metaphyses

Question 5

What causes scurvy and what are the classic radiographic features?

Answer 5

Scurvy (Barlow’s Disease): dt Vitamin C deficiency, causes intercellular substance formation in CT, bone–> capillary fragility
Radiographic features: Abnmlities at growing ends of long bones; osteoporosis, White Line of Frankel (dense zone of provisional calcification), Ring epiphysis (Wimberger’s sign), Pelken’s spurs, Scorbutic zone (Trummerfeld zone), Subperiosteal hemorrhages

Question 6

What are the classic radiographic features of hyperparathyroidism in the spine, skull and hand?

Answer 6

osteopenia, accentuated trabecular patterns, SUBPERIOSTEAL RESORPTION, loss of cortical definition, brown tumors (hemorrhagic giant cell tumors), nephrocalcinosis, renal calculi, chondrocalcinosis
HAND: subperiosteal resorption, radial margins of proximal and middle phalanges of 2nd and 3rd digits w/ acroostolysis
SKULL: “salt and pepper”, resorption of lamina dura
SPINE: “rugger jersey”, widened SI joints, trabecula accentuation, end plate concavities

Question 7

What are the face, skull and foot changes seen with acromegaly?

Answer 7

FOOT: heel pad greater than 20mm (1in)
SKULL: sell turcica enlargement (d/t primary neoplasm), sinus overgrowth, malocclusion, widened mandibular angle (prognathism)
HAND:Widened shafts, bony protuberances, enlarged distal tufts (“spade-like”), widened joint spaces
SPINE: increased size, hyperostoses, widened disc heights, posterior body scalloping

Question 8

What osseous changes might long term corticosteroid use cause?

Answer 8

osteonecrosis: usu in femoral/humeral heads, distal femora and talus
collapse of vertabral body may –> “intravertebral vacuum cleft sign”
Osteoporosis: thin cortices, low BMD, biconcave end plate configurations
“buffalo hump”, “moon face”