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Skeletal Radiology A > Skel A-MEtabolic Bone Disease > Flashcards

Skel A-MEtabolic Bone Disease Flashcards

1
Q

Descriptive term for decreased bone or increased radiolucency of bone that occurs when bone resorption exceeds bone formation regardless of specific pathogenesis.

A

Osteopenia

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2
Q

What results when bone resorption exceeds bone formation regardless of specific pathogenesis?

A

Osteopenia

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3
Q

T/F: Radiographic findings of osteopenia does not alone allow a precise diagnosis

A

True

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4
Q

What are the four major causes of osteopenia?

A

Osteoporosis

Osteomalacia/ Rickets

Hyperparathyroidism

Neoplasm

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5
Q

Bone Cells:

Originates from the marrow stem cells, develop into osteoblasts

A

Osteoprogenitor cells

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6
Q

Bone cells:

Produces osteoid which is soft material main of 90-95% collagen and 5-10% ground substance, the mucopolysaccharide.

It is numerous in growing skeleton and decrease in number and size at maturity

A

OSTEOBLAST

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7
Q

Bone cell:

Arises from osteoblast that become entrapped in their own osteoid.

They maintain bone integrity

Mature bone cells

A

Osteocytes

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8
Q

Bone Cells:

Inactive/dormant osteoblast

A

Bone lining cells

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9
Q

Bone Cell:

Bone resorptive cells, derived from hematopoietic monocyte lineage.

Different lineage from other bone cells

A

Osteoclast

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10
Q

For normal bone density what is required

A

Osteoblastic=Osteoclastic activity

Normal nervous system function

Normal GI, Liver, Renal Function

Dietary intake of calcium and phosphorus

Normal endocrine function

Weight bearing exercises

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11
Q

Non-cellular constituents of bone:

% of wet weight of bone that is accounted for by water

A

20%

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12
Q

Non-cellular constituents of bone:

% of bone weight accounted for by cellular components

A

Tiny fraction

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13
Q

Non-cellular constituents of bone:

% of dry bone weight accounted for by organic matrix/osteoid

A

30%

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14
Q

Non-cellular constituents of bone:

% of dry bone weight accounted for by inorganic material

A

70%

Accounts for 70% of osseous tissue

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15
Q

Non-cellular constituents of bone:

Inorganic material exists as what ?

A

Calcium hydroxyapatite

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16
Q

Calcium homeostasis:

Function of the skeleton in calcium homeostasis

A

99% of calcium stored in skeleton

Serves as a reserve for serum calcium

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17
Q

Calcium homeostasis:

70% of plasma calcium is believed to be maintained how?

A

Continuous exchange of calcium ions between bone and extracellular fluid

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18
Q

Calcium homeostasis:

The remaining 30% of plasma calcium is mediated by what?

A

The function of Parathyroid hormone and Calcitonin

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19
Q

Osteoclast and Osteoblast function:

Osteoclast exist in pits on bone surfaced called?

A

Resorption bays or Howship’s Lacunae

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20
Q

Osteoclast and Osteoblast function:

Osteoclast function

A

Secretion of Collagenase to break down osteoid

Secrete Acid to break down calcium hydroxyapatite

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21
Q

Osteoclast and Osteoblast function:

What are substances that can have direct or indirect influence on osteoclasts increasing their function or numbers or both?

A

Parathyroid hormone

Active Vitamin D

Prostaglandin E2

Thyroid hormone

Heparin

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22
Q

Osteoclast and Osteoblast function:

Substance that inhibits osteoclast

A

Calcitonin

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23
Q

Metabolic bone disease:

Bone quantity not quality disorder

Associated with decreasing osteoblastic function with age

Estimated 30-50% loss before detectable radiographically

A

Osteoporosis

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24
Q

Metabolic bone disease:

Where is the predominant location of osteoporosis ?

A

Axial skeleton

Proximal long bones

*can be generalized of localized

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25
Q

Metabolic bone disease:

Senile Osteoporosis is (men/women)

Post-menopausal osteoporosis is (men/women)

A

Senile-men

PM- women

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26
Q

Metabolic bone disease:

Inadequate mineralization of osteoid

Related to deficiency in calcium, vitamin D or phosphorus which can be

Deficiency caused by renal disease, sunlight deficiency, liver disease, dietary insufficiency and GI Disease

A

Osteomalacia

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27
Q

Metabolic bone disease:

Primary type of HPT characterized by?

A

Increase PTH production usually benign adenoma

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28
Q

Metabolic bone disease:

With Primary HPT you will see (hypercalcemia/hypocalcemia)

A

Hypercalcemia

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29
Q

Metabolic bone disease:

Secondary HPT Characterized by?

A

Abnormal stimulation of glands by sustained hypocalcemia and hyperphosphatemia

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30
Q

Metabolic bone disease:

Potential causes of secondary HPT

A

Renal disease

GI Malabsorption

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31
Q

Metabolic bone disease:

Tertiary HPT characterized by?

A

Long standing secondary HPT to the point parathyroid function is autonomous

Can be related to ectopic tissue, or paraneoplastic syndrome

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32
Q

Metabolic bone disease:

Function of PTH

A

Osteoclastic and osteocytic stimulation

Osteoblastic inhibition

Renal calcium absorption vs inhibition of phosphate resorption

Renal stimulation of 1-Alpha- hydroxylase

Indirection effect on GI absorption of calcium

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33
Q

Metabolic bone disease:

Function of 1-alpha-hydroxylase

A

Increase formation of 1-25-vitamin D

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34
Q

Metabolic bone disease: Hormone?

Secreted by the human parafollicular or C cells of the thyroid gland -

Controlled by the serum calcium levels

Inhibits bone calcium resorption by decreasing osteoclastic function and

May lead to hypocalcemia and hypophosphatemia

Inhibits GI calcium absorption

Stimulates osteoblastic activity

Inhibits renal tubular cell reabsorption of calcium

A

Calcitonin

35
Q

Metabolic bone disease:

MAjor causes of generalized osteoporosis

A

Age related

Medication

Endocrine

Deficiency states

Alcoholism

Chronic liver disease

Anemic state

Osteogenesis imperfecta

Idiopathic condition

36
Q

Metabolic bone disease:

Osteoporosis seen in -

  1. Immobilization an disuse-fx healing
  2. Complex region pain syndrome-sympathically mediation pain, Reflex sympathetic dystrophy syndrome
  3. Transient regional osteoporosis
A

Regional osteoporosis

37
Q

Metabolic bone disease:

Describe CRPS/SMPS

A

Syndrome that typically follow trauma unilaterally

Soft tissue swelling

Very painful

38
Q

Metabolic bone disease:

Transient demineralization of the hip usually in healthy middle aged men, and pregnant women in 3rd trimester

Affects left hip

Acute pain & functional disability w/o previous trauma

Clears up on its own-self limiting

A

Transient osteoporosis of the hip

39
Q

Metabolic bone disease:

Osteoporosis-

  1. Discovered by Duncan et. al
  2. Happens in 5-41%
  3. Unpredictable
  4. Affects joint nearest the disease
A

Regional migratory osteoporosis

40
Q

Metabolic bone disease:

6 vertebral configurations in osteoporosis

A

Normal

Losing horizontal trabeculation

Anterior wedging

Plana: ant/post collapse

Bison cave endplates

Angular endplate depression from fox

41
Q

Metabolic bone disease:

Plana vertebrae in osteoporosis may be caused by ?

A

Malignancies

  1. Mets
  2. Mult. Myeloma
42
Q

Metabolic bone disease:

Biconcave endplates in osteoporosis may be caused by?

A

Mult. Myeloma 5

43
Q

Metabolic bone disease:

Fx- Cause by Osteoporosis

Low extremity bilaterally

Pain major symptom

Occurs when elastic strength < normal phys stress

A

Insufficiency Fox

44
Q

Metabolic bone disease:

Risk factors of osteoporosis

ACCESS

A

Alcohol

Corticosteroids

Calcium low

Estrogen low

Smoking

Sedentary lifestyle

45
Q

Metabolic bone disease:

Scan for bone density

A

Duel Energy X-ray Absorptiometry

DEXA/DXA

46
Q

Metabolic bone disease:

Associated with long term vitamin C deficiency

Predominantly in children

A

Scurvy/Barlow’s disease- hypovitaminosis C

47
Q

Metabolic bone disease:

What is the hallmark Scurvy?

A

Spontaneous bleeding due to capillary fragility

SUBPERIOSTEAL BLEEDING —>BONE PAIN

48
Q

Radiographic finding of Scurvy:

dense zone of provisional mineralization- no secondary spongiosa

A

White line of frankel

49
Q

Radiographic finding of Scurvy:

Dense cortical margin of epiphysis with radiolucent center

A

Wimbergers ring

50
Q

Radiographic finding of Scurvy:

Irregular mataphyseal margin

A

Corner/angle sign

51
Q

Radiographic finding of Scurvy:

Bony protuberance at margin of ZPM

Spurs

A

Pelken sign

52
Q

Radiographic finding of Scurvy:

Radiolucent metaphyseal band directly beneath ZPM, due to defective bone formation

A

Trumerfeld/subortic line

Leukemia lines in leukemia

53
Q

Radiographic finding of Scurvy:

Pathognomonic sign visible with healing

A

SUBPERIOSTEAL hemorrhage

54
Q

Metabolic bone disease:

Clinical findings of hypovitaminosis D

A

Muscle weakness

Bone pain

Deformities of pelvis, femur, tibia and spine

55
Q

Radiographic features of osteomalacia:

What are the radiographic features of osteomalacia ?

A

Osteopenia

Coarse do trabecular pattern

Loss of cortical definition

Pseudo fx

56
Q

Radiographic finding of osteomalacia:

Deformities seen on radiograph

A

Weight bearing bones:

  1. Triradiate pelvis
  2. Acetabular protrusion
  3. Femoral and tibial bowing
  4. Kyphoscoliosis
  5. Endplate concavity
  6. Bell shaped thorax
57
Q

Radiographic finding of osteomalacia:

Common sight of osteomalacia

A

Femur

Ribs

Axillary border of scapula

Pelvic rami

58
Q

Radiographic finding of osteomalacia:

AKA for pseudo fx

A

Umbauzonen/increment fx

Looser’s lines

Milkman syndrome

Osteoid seams

59
Q

Pseudo fx:

Characterized by

A

Seam of unmineralized osteoid

No trauma

Perpendicular to cortex

Ribs, pelvis, femur, no spine involvement

Bone softening disease

60
Q

Metabolic bone disease:

Renal tubular loss of phosphorous, not cured by the administration of vitamin D

A

Resistant/refractory/ renal rickets

61
Q

Metabolic bone disease:

Secondary HPT + renal rickets =

A

Renal osteodystrophy

62
Q

Clinical presentation of rickets

A

Muscle tetany

irritability

weakness

delayed bone development

small stature and bone deformities/bowing

63
Q

T/F: findings of enlarged growth plates (trumpeting) and rib ends (rachitic rosary) are present in rickets

A

True

64
Q

Metabolic bone disease:

Generally an x-linked transmitted

Renal tubular loss of phosphate

Rickets develops

In adults skeleton, develops osteosclerosis and enthesopathic paravertebral ligament

Lumbar stenosis

Type of dwarfism

A

Hypophosphatemia

65
Q

Metabolic bone disease:

Hypophosphatemia is classified under which group of syndromes?

A

Fanconi syndrome

66
Q

Metabolic bone disease:

Rare disease related to low serum alkaline phosphatase produced by osteoblasts

Resembles rickets

Radiolucent metaphyseal defect from physis to metaphysis

A

Hypophosphatasia

67
Q

Metabolic bone disease:

Hypophosphatasia is a mineralization disorder

A

True, however it doesn’t have to due to with mineral deficiency.

It is the linking of the hydroxyapatite to osteoid that is absent

68
Q

Metabolic bone disease:

Histology also changes of HPT

A

Bone resorption with fibrous tissue replacement

69
Q

Metabolic bone disease:

Major bone changes in HPT

A

Osteopenia

Accentuated trabecular pattern

Loss of cortical definition

BROWN TUMORS

Subperiosteal bone resorption

70
Q

Metabolic bone disease:

hallmark HPT finding

A

Superiosteal bone - pathognomonic in the hands

71
Q

Metabolic bone disease:

HPT CLinical findings

A

3:1 Female :male 30-50 yoa

Found accidentally by dentist

Hypercalcemia, weakness, lethargy, poly dips is, polyuria, renal calculi, bone tenderness

72
Q

AKA for renal osteodystrophy

A

Uremic osteodystrophy

73
Q

HPT bone changes:

In many location but in the middle phalanx of the hands on the radial aspect is pathognomonic

2-4 digits

A

Subperiosteal bone resorption

74
Q

HPT bone changes:

Within harversion canals

Linear striations in long bones

A

Intracortical bone resorption

75
Q

HPT bone changes:

Typically hands and with other findings

A

Endosteal bone resorption

76
Q

HPT bone changes:

Common, SI, SC, AC, SP (symphysis pubis), and DV junction, can mimic inflammatory joint disease in SI joint sacroiliitis; DRA (dialysis
related arthropathy), DRSA (dialysis related spondylo-arthropathy)

A

Subchondral bone resorption

77
Q

HPT changes:

Diffuse in skeleton, very prominent in cranium, causes very granular appearance to diploic space “salt and pepper” or “pepper pot skull”

A

Trabecular bone resorption

78
Q

HPT changes:

At entheses; trochanters, ischial and humeral
tuberosities, elbow, calcaneus, inferior distal end of clavicle

A

Subligamentous bone resorption

79
Q

HPT changes:

localized cyst-like bone resorption containing (overcummulation) fibrous tissue & blood, giant cells and
hemorrhages

A

Brown tumor

80
Q

HPT changes:

distal tuft resorption (of fingers), seen with many other conditions
- Look at hands!!!

A

Acro-osteolysis

81
Q

Brown tumor and chondrocalcinosis are common in (primary/secondary) HPT

A

Primary

82
Q

Osteoscelrosis and periostitis more in (primary/secondary) HPT

A

Secondary

83
Q

Serum (-) Rheumatoid types

A 
Rheumatoid arthritis 
System lupus erythematous
Progressive systemic sclerosis 
Dermatomyositis/polymyositis 
Transient: viral infection
84
Q

Serum (+) rheumatoid variants

A

Ankylosing spondylitis
Reiter‘ s syndrome aka Reactive arthritis syndrome
Psoriatic arthritis
Inflammatory bowel disease

Skeletal Radiology A (5 decks)

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