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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
Q

radiographic features of osteoporosis in the spine

A

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
Q

compression fracture vs endplate fracture vs pathological fracture

A

compression fracture- anterior body fracture only
endplate fracture- step defect
pathological fracture- anterior and posterior height decreased

27
Q

pathological fractures are due to…

A

multiple myeloma**
lytic metastasis
osteoporosis

28
Q

what are other names for wedged vertebrae or compressed vertebrae?

A

fish vertebrae/codfish deformity
schmorl’s nodes
endplate infractions

29
Q

Dowager’s hump

A

severe senile kyphosis from multiple compression fractures

find out if fractures are new or old from clinical presentation, lab work, history

30
Q

burst fracture

A

posterior body convexity

31
Q

when you have a severe fracture of the spine, when do you get the CT?

A

if it exceeds 30% original body height
retropulsion is present
neurologically compromised

32
Q

when you see a pathological fracture, what must you write?

A

pathologic fracture most likely due to___(MC multiple myeloma)

33
Q

describe mechanical stability of the vertebra

A

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
Q

signs of osteoporosis in the extremity

A

thinned cortices
endosteal scallping
loss of secondary trabeculae
risks of fractures

35
Q

trabecular patterns of the hip

A 
primary compressive (medial)
secondary compressive (lateral)
primary tensile
36
Q

ward’s triangle

A

confluence of the three trabecular goups that forms a triangle
becomes more prominent in osteoporosis

37
Q

how do you manage osteoporosis?

A 
diet/supplements
exercise
hormone therapy
bisphosphonates
hip pins/screws
hip prosthesis
38
Q

pathological generalized osteoporosis/osteopenia

A 
multiple myeloma
metastasis
anemia
nutritional deficiencies
diabetes
immunodeficiency states
chronic liver disease
39
Q

multiple myeloma

A 
diffuse significant osteopenia (especially in a patient too young for osteoporosis
compression fractures
pathological fracture
multiple lytic calvarial lesions
puched out lesions
40
Q

what is a DEXA scan?

A

low energy xrays are passed through the bones to measure the mineral content of the bones

41
Q

what does a bone density measurement determine?

A

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
Q

T score

A

number of standard deviations from young adult normals

predicts fracture risk, for every 1 SD the fracture risk doubles

43
Q

name the T scores and what they mean

A

T1 or higher- normal
T -2.5–1 is osteopenia
T below -2.5 is osteoporosis
T below -2.5is severely osteoporotic

44
Q

What are the recommendations for people with osteoporosis?

A

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
Q

possible adverse side effects associated with osteoporosis medication (bisphosponates)

A 
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
Q

types of regional osteoporosis?

A

immobilization and disuse
reflex sympathetic dystrophy syndrome
transient regional osteoporosis

47
Q

disuse osteoporosis

A

disuse inhibits osteoblastic activity

can be from immobilization, paralysis, inflammatory joint disease or extremity injury

48
Q

describe extremity disuse osteoporosis

A

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
Q

reflex sympathetic dystrophy syndrome

A

acute pain, regional osteoporosis following trivial trauma
occurs in those >50, especially in the hands
reflex hyperactivity of the SNS

50
Q

what are some clinical features of reflex sympathetic dystrophy syndrome

A

pain, swelling, vasomotor disturbances, atrophic skin changes

51
Q

imaging for reflex sympathetic dystrophy syndrome

A

too nonspecific to make the diagnosis in the absence of clinical information
soft tissue swelling
regional osteoporosis

52
Q

regional osteoporosis for reflex sympathetic dystrophy syndrome

A

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
Q

what is the main feature with RSD?

A

severe joint mineralization and the joints are okay

54
Q

etiology and demographic for transient osteoporosis of the hip

A

unknown etiology
young to middle aged adults, especially pregnant women
more common and bilateral in men
left hip in women

55
Q

describe xray and MRI for transient osteoporosis of the hip

A 
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
Q

onset of transient osteoporosis of the hip

A

sudden pain, antalgia and limp

self-limiting over 3-12 months

Diagnostic imaging I test 3 (4 decks)

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