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Diagnostic imaging I test 3 > Osteopenia/osteoporosis > Flashcards

Osteopenia/osteoporosis Flashcards

1
Q

What are the hormones that stimulate bone production?

A 
growth hormone
thyroid hormone
calcitonin
vitamin D
vitamin C
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2
Q

What are the hormones that inhibit bone production?

A

PTH

cortisol

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3
Q

what is the most common etiology of osteopenia?

A

osteoporosis

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4
Q

what are the etiologies of osteopenia?

A 
osteomalacia
hyperparathyroidism
rickets
scurvy
neoplasm
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5
Q

what is the definition of osteopenia?

A

increased radiolucency of bone when bone resorption exceeds bone formation

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6
Q

radiographic clues for osteomalacia

A

looser’s lines

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7
Q

radiographic clues for hyperparathyroidism

A

subperiosteal resorption

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8
Q

radiographic clues for multiple myeloma

A

lytic lesions/rain drop skull

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9
Q

what percent of bone must be lost before it can be dected on plain film?

A

30-50%

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10
Q

osteoporosis

A

qualitatively normal but quantitatively deficient bone

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11
Q

after what age does bone mass begin to decrease?

A

35

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12
Q

reduction in skeletal mass becomes clinically observable in __ decade in women and ___ decade in men

A

5th or 6th decade in women

6th or 7th decade in men

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13
Q

what are some radiographic features of osteoporosis?

A

compression fractures, increasing thoracic kyphosis, fracture of femur, ribs, humerus and radius

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14
Q

symptomatology related to decreased bone mass

A

variable and often absent

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15
Q

types of primary osteoporosis

A

senile
postmenopausal
transient/regional

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16
Q

secondary osteoporosis is also known as..

A

AKA osteopenia

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17
Q

Things that can cause secondary osteoporosis

A 
corticosteroids
malignancy
infection
arthridities
disuse
reflex sympathetic dystrophy
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18
Q

generalized osteopenia

A

age-related (senile and postmenopausal osteoporosis)

endocrinopathy (acromegaly, hyperparathyroidism, cushing’s, pregnancy, heparin, alcoholism)

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19
Q

what are some images that can be used for osteoporosis?

A 
prior films***
MRI
bone scan
clinical lab
bone densitometry
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20
Q

what are the radiographic features that can indicate a new osteoporotic fracture?

A

zone of impaction

step defect

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21
Q

step defect

A

superior endplate goes forward

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22
Q

how can you tell the difference between an old or new fracture on MRI?

A

white- old fracture

black- new fracture

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23
Q

senile/postmenopausal osteoporosis

A

gradual loss of skeletal mass that is seen with advancing age
postmenopausal- increased bone loss in women following menopause

24
Q

risk factors for osteoporosis

A 
female
>70 years
caucasian or asian race
early onset of menopause
longer menopausal interval
inactivity, especially weight bearing
smoking
alcohol abuse
excessive caffeine consumption
excessive dietary protein consumption
lack of dietary calcium
lack of sunlight exposure
25
radiographic features of osteoporosis in the spine
osteopenia cortical thinning (pencil-thin) resorption of nonstress-bearing trabeculae accentuated vertical struts altered vertebral shape subchondral bone is resorbed wedged shaped vertebrae, compressed vertebra
26
compression fracture vs endplate fracture vs pathological fracture
compression fracture- anterior body fracture only endplate fracture- step defect pathological fracture- anterior and posterior height decreased
27
pathological fractures are due to...
multiple myeloma** lytic metastasis osteoporosis
28
what are other names for wedged vertebrae or compressed vertebrae?
fish vertebrae/codfish deformity schmorl's nodes endplate infractions
29
Dowager's hump
severe senile kyphosis from multiple compression fractures | find out if fractures are new or old from clinical presentation, lab work, history
30
burst fracture
posterior body convexity
31
when you have a severe fracture of the spine, when do you get the CT?
if it exceeds 30% original body height retropulsion is present neurologically compromised
32
when you see a pathological fracture, what must you write?
pathologic fracture most likely due to___(MC multiple myeloma)
33
describe mechanical stability of the vertebra
fracture of column A is stable fracture of column C is stable fracture of column B is unstable fracture of two of any of these is unstable (A-anterior body, B- middle/posterior of body, C- spinous, etc)
34
signs of osteoporosis in the extremity
thinned cortices endosteal scallping loss of secondary trabeculae risks of fractures
35
trabecular patterns of the hip
``` primary compressive (medial) secondary compressive (lateral) primary tensile ```
36
ward's triangle
confluence of the three trabecular goups that forms a triangle becomes more prominent in osteoporosis
37
how do you manage osteoporosis?
``` diet/supplements exercise hormone therapy bisphosphonates hip pins/screws hip prosthesis ```
38
pathological generalized osteoporosis/osteopenia
``` multiple myeloma metastasis anemia nutritional deficiencies diabetes immunodeficiency states chronic liver disease ```
39
multiple myeloma
``` diffuse significant osteopenia (especially in a patient too young for osteoporosis compression fractures pathological fracture multiple lytic calvarial lesions puched out lesions ```
40
what is a DEXA scan?
low energy xrays are passed through the bones to measure the mineral content of the bones
41
what does a bone density measurement determine?
bone mineral density for the area measured and compares that result with the average of young adult normals of similar sex and race at their peak BMD
42
T score
number of standard deviations from young adult normals | predicts fracture risk, for every 1 SD the fracture risk doubles
43
name the T scores and what they mean
T1 or higher- normal T -2.5--1 is osteopenia T below -2.5 is osteoporosis T below -2.5is severely osteoporotic
44
What are the recommendations for people with osteoporosis?
stay active and get plenty of exercise eat plenty of supplemental dietary calcium, protein and vitamin C don't smoke don't drink excessively strongly consider taking estrogen supplementas following menopause
45
possible adverse side effects associated with osteoporosis medication (bisphosponates)
``` ulcers of the esophagus upper GI irritation irregular heartbeat fractures of the femur low calcium in the blood skin rash joint, bone and muscle pain jaw bone decay (rare) increased parathyroid hormone ```
46
types of regional osteoporosis?
immobilization and disuse reflex sympathetic dystrophy syndrome transient regional osteoporosis
47
disuse osteoporosis
disuse inhibits osteoblastic activity | can be from immobilization, paralysis, inflammatory joint disease or extremity injury
48
describe extremity disuse osteoporosis
diffuse osteopenia seen throughout the disused body part lucent bands of osteopenia may be seen just proximal to the physeal line subchondral lucency uniform or spotty demineralization
49
reflex sympathetic dystrophy syndrome
acute pain, regional osteoporosis following trivial trauma occurs in those >50, especially in the hands reflex hyperactivity of the SNS
50
what are some clinical features of reflex sympathetic dystrophy syndrome
pain, swelling, vasomotor disturbances, atrophic skin changes
51
imaging for reflex sympathetic dystrophy syndrome
too nonspecific to make the diagnosis in the absence of clinical information soft tissue swelling regional osteoporosis
52
regional osteoporosis for reflex sympathetic dystrophy syndrome
rapid, early mottled appearance, later generalized aggressive and severe significant juxtaarticular osteoporosis initially localized but may spread and become a bilateral rpocess entire extremity osteoporosis may be patchy
53
what is the main feature with RSD?
severe joint mineralization and the joints are okay
54
etiology and demographic for transient osteoporosis of the hip
unknown etiology young to middle aged adults, especially pregnant women more common and bilateral in men left hip in women
55
describe xray and MRI for transient osteoporosis of the hip
``` periarticular osteoporosis joint space remains normal fracture may occur increased uptake on radionuclide imaging diffuse bone marrow edema on MRI decreased T1, increased T2 ```
56
onset of transient osteoporosis of the hip
sudden pain, antalgia and limp | self-limiting over 3-12 months

Diagnostic imaging I test 3 (4 decks)

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