Osteoporosis

Question 1

Generalized osteoporosis is most prominent in the

Answer 1

axial skeleton (VT column, pelvis, ribs, sternum)

Question 2

Major causes of generalized osteoporosis are

Answer 2

Age
Medication 
    (steroids and heparin)
Endocrine 
     (HPT, hyperthyroidism, cushing's,            acromegaly, pregnancy, diabetes, hypogonadism)
Deficient states 
     (scurvy, malnutrition, calcium deficiency)
Alcoholism
Chronic liver disease
Anemic States
Osteogenesis Perfecta

Question 3

What is the etiology of generalized osteoporosis?

Answer 3

Idiopathic

Question 4

Is osteoporosis a bone softening disease? why or why not?

Answer 4

No it is NOT a bone softening disease
Osteoporosis deals with the decrease in quantity of the bone - but not the quality of the bone. The quality of the bone is normal

Question 5

Hyperemia stimulates

Answer 5

osteoclasts

Question 6

Regional Osteoporosis is caused by

Answer 6

immobilization and dis use - fracture healing

Question 7

Explain Complex regional pain syndrome - CRPS - which can be related to regional osteoporosis

Answer 7

sympathetically mediated pain syndrome e- happens subsequent to trauma - could be suicidal pain

Question 8

Transient regional osteoporosis means

Answer 8

It is self limiting and will usually cure its self after some time

Question 9

A common example of transient regional osteoporosis is

Answer 9

Transient osteoporosis of the hip (TOH)

Regional Migratory osteoporosis

Question 10

TOH most commonly occurs in

Answer 10

middle aged healthy males

rarely seen in women - if so it is during the 3rd trimester or immediate postpartum

Question 11

Patients with TOH will present with

Answer 11

acute disabling pain
functional disability
NO trauma

Question 12

TOH is

Answer 12

paraarticular bone loss around the hip - self limiting - will go away

Question 13

What differentiates TOH from regional migratory osteoporosis (RMO)

Answer 13

RMO jumps from joint to joint

Question 14

What percentage do we see people with RMO?

Answer 14

5- 41%

Question 15

It is very similar to TOH for example there is no trauma it is idiopathic. T/F

Answer 15

True

Question 16

Is RMO exclusive to one joint?

Answer 16

Not exclusive to one joint but the next join too go will be the one closets to the disease

Question 17

Describe osteoporosis

Answer 17

general slowing down of osteoblastic activity

Question 18

When does osteoporosis begin for men and women?

Answer 18

Men = 5th - 6th decade aka 40's - 50's 
Women = 4th decade AKA 30's

Question 19

How much bone do men loose after 50 a year?

Answer 19

.4%

Question 20

How much bone do women loose after 35 a year?

Answer 20

.75%

Question 21

What % increase do women loose more bone post metapause?

Answer 21

2 - 3%

Question 22

Symptoms of osteoporosis include

Answer 22

spinal pain due to compression fracture, biconcave “fish vertebrae”, hip, wrist, spine

Question 23

List and describe the different Vertebral Body Configurations

Answer 23

A. Normal - the horizontal trabecular bone helps with support of the bone
B. Normal with Pencil thin cortices - starting to loose trabecular bone, horizontally
C. Wedge shape owing to anterior loss of height - common in axial load traumas on normal bone
D. Both anterior and posterior bodies collapse - Verebra Planna: bone has been destroyed internally. ( internal destruction - uniform collapse
E. Biconcave: fish vertebrae, owing to gradual endplate depression, the disc pushes the endplate down
F. Angular Endplate depression from acute fracture

Question 24

What bone deformity is classic in osteoporosis

Answer 24

Fish vertebrae

Question 25

Explain what a pseudo-hemangiomatour appearance is

Answer 25

Over multiple segnemtn levels there is accentuated vertical trabecular patterns of multiple segments - this is a sign of an early manifestation of osteoporosis

Question 26

What is the difference between an pseudo-hemangiomatour and lateral thoracolumbar spine hemangioma

Answer 26

Lateral thoracolumbar spine hemangioma has similar appearances but is only on one bone - this is the most common benign tumor of the spine

Question 27

Acute compression fractures of the spine are corrected by what type of surgery

Answer 27

percutaneous vertebroplasty - inject bone cement (methyl methacremate) to prevent further fracture

Question 28

Major cause of fracture is osteoporosis - usually a stress fracture that are micor-tramatic - and its findings tends to be bilateral - what are the two types of fractures and explain them.

Answer 28

1) fatigue fracture: consistant micro trauma 2) insufficiency fractures: occurs when the elastic strength of the bone is not sufficient o withstand normal physiological stress - type of stress fracture - bone is abnormal it does not have the strength

Question 29

The most common area for insufficiency fracture is

Answer 29

The sacrum | "Honda sign"

Question 30

What are osteoporosis risk factors?

Answer 30

``` ACESS Alcohol Corticosteroids Calcium low Estrogen low Smoking Sedentary lifestyle ```

Question 31

Osteoporosis is an __________ deficiency not a ______ deficiency

Answer 31

Osteoporosis is an osteoblastic deficiency not a ca++ deficiency

Question 32

What is used as the MOST sensitive measure of bone mineral density?

Answer 32

DEXA/DXA Scan

Question 33

AKA for Scurvy

Answer 33

Barlow Disease

Question 34

Explain scurvy and its association with osteoporosis

Answer 34

Subcategory of osteoporosis - it slows down osteoblastic activity because of a LONG TERM deficiency of Vitamin C

Question 35

Scurvy is predominantly seen in

Answer 35

infants

Question 36

Vitamin C is essentail in formation in _____, ______, and _______/

Answer 36

collagen, osteoid and endothelial linings

Question 37

What are signs of scurvy? What is a hallmark sign of Scurvy?

Answer 37

``` bleeding gums cutaneous petechiae hematuria (kidney bleeding) Fragile capillaires -hallmark is spontaneous hemorrhage due to capillary fragility - sub periosteal = bone pain because it lifts up the periosteum decreased osteoblastic function ```

Question 38

Hypovitaminosis C/Scurvy in Pediatrics SIGNS

Answer 38

White line of Frankel = dense zone of provionsal mineralization - appears brighter Limburger's ring = dense cortical margin of epiphysis with radiolucent center (brighter) Corner (angle) sign = irregular metaphysical margin Pelken's sign = bony protuberance at margin of zone of provisional mineralization Trummerfeld/scorbutic zone = radiolucent band directly beneath zone of provionsal mineralization

Question 39

Reflex Sympathetic Dystrophy Syndrome (RSDS)

Answer 39

aka for CRPS