Systemic and Nutritional Diseases Flashcards
What hormones and nutrients can STIMULATE bone production?
Vitamins D and C, growth hormone, thyroid hormone (T3, T4), and calcitonin
Which hormones can INHIBIT bone production?
Parathyroid hormone (PTH) and cortisol
What is the definition of increased radiolucency or decreased density of bone?
Osteopenia
What condition is the most common cause of osteopenia?
Osteoporosis
Does the finding of osteopenia (radiolucent bone) automatically indicate osteoporosis?
No; other conditions can also cause osteopenia
What percentage of bone mass loss is needed before it can be detected on a plain film?
30-50%
Is bone involved with osteoporosis deficiently quantitatively or qualitatively?
Quantitatively (density)
At what age does bone mass begin to decrease due to reduced osteoblastic differentiation, activity, and overall life span?
35
Why is osteoporosis uncommon in children?
Both osteoblasts and osteoclasts function at equal rates in kids
Why does osteoporosis start sooner in females?
Hormonal deprivation (then increased osteoclastic activity)
When does reduction in skeletal mass become clinical observable in both males and females?
Males: 50s-60s (6th or 7th decade)
Females: 40s-50s (5th or 6th decade)
What is the most visible sign that someone could be developing osteoporosis?
Fractures (vertebral, proximal femur, ribs, humerus, radius)
What is the rate of hip fractures seen among women as they age over 60 years?
Chance doubles every 5 years after 60
What is the most common fracture seen among the elderly?
Spinal compression fracture
What percentage of the population has osteoporosis after the age of 50?
55%
Is the “step defect” seen in the acute or chronic stage of a spinal compression fracture?
Acute
What kind of change to the thoracic stature is seen in individuals with senile or postmenopausal osteoporosis?
Accentuated kyphosis
What is the race bias for osteoporosis?
Asians or Caucasians
What is the gender bias for osteoporosis?
Females
What is the age risk factor for osteoporosis?
Being over 70
What are the risk factors for osteoporosis?
Female, Caucasian/Asian, >70 years old, early onset of menopause, longer postmenopausal interval, inactivity (lack of weight bearing exercise)
What are some modifiable risk factors for osteoporosis?
Smoking, alcohol abuse, excessive caffeine, excessive dietary protein, lack of calcium, lack of sunlight to get vitamin D
What radiographic sign and change is seen on the endplates of the vertebrae with osteoporosis?
Cortical thinning **
What is the term for the biconcave***, washed-out appearance of the vertebral bodies seen with osteoporosis?
Codfish deformity
What is the term for the accentuated primary trabeculae seen with osteoporosis?
Pseudo-hemangioma appearance
When must a CT be done following a spinal compression fracture?
If compression exceeds 30% of original body height or if neurological compromise is present from retropulsion
A spinal compression fracture can be stable when the damage occurs at what part of the vertebral body?
Anterior body margin
What is the name of the confluence of the 3 trabecular patterns at the hip that becomes more prominent in osteoporosis?
Ward’s triangle
In what order do we see changes in the trabecular patterns of the hip?
1 primary compressive (medial) 2 secondary compressive (lateral) 3 primary tensile
An increase in which lab value is associated with osteoporosis?
Hydroxyproline
What radiographic signs are seen with multiple myeloma?
Punched out lesions, multiple lytic calvarial lesions, compression fractures, raindrop skull
In a case of diffuse significant osteopenia in a patient too young for osteoporosis, what would be a condition to consider?
Multiple myeloma
What type of machine directly evaluates osteoporosis?
Dual Energy X-ray Absorptiometry (DEXA scan)
How does the WHO define osteoporosis in terms of T-scores from a DEXA scan?
-1 or higher = normal, -2.5 to -1 = osteopenia, below -2.5 = osteoporosis, below -2.5 plus fragility fracture = severe osteoporosis
At what T-level is a patient considered osteoporotic?
Below -2.5
What are good recommendations for our patients who may be at risk for osteoporosis?
Stay active, get calcium, protein, and vitamin C in the diet, don’t smoke or drink excessively, maybe take estrogen supplements
What is the most common cause of regional osteoporosis?
Disuse (example = cast following injury)
Why does disuse lead to osteoporosis of that area?
Inhibition of osteoblasts
What is another name for reflex sympathetic dystrophy?
Sudeck’s atrophy
If a patient came in complaining of pain in the hands or feet accompanied by regional osteoporosis following a trivial trauma like hitting his/her funny bone, what would the suspected condition be?
Reflex sympathetic dystrophy (Sudeck’s atrophy)
What is the most common location for Sudeck’s atrophy?
Hands or feet
What other visible signs can be seen on the hands and feet of someone with Sudeck’s atrophy?
Skin color changes, skin atrophy
Is the location of osteoporosis seen distal or proximal to the site of minor trauma with reflex sympathetic dystrophy (RSD)?
Distal to (example = trauma on knee results in issues with foot)
What is the age and gender bias for transient osteoporosis of the hip?
Males aged 30-50 (usually bilateral)
In what population of females do we see transient osteoporosis of the hip more commonly and uniquely on which hip, most likely?
Pregnant females in 3rd trimester - usually left hip
How is transient osteoporosis of the hip diagnosed?
MRI (diffuse bone marrow edema, decreased T1 and increased T2)
How is transient osteoporosis of the hip treated?
Usually self-resolving over 3-12 months
Which affects the QUALITY of bone: osteoporosis or osteomalacia?
Osteomalacia
Which condition is caused by the lack of calcium salts deposited in bone resulting in inadequate mineralized bone matrix with an abnormally high ratio of osteoid to mineralized bone?
Osteomalacia
What are the 2 main causes of osteomalacia?
1 vitamin D metabolism 2 renal tubular phosphate loss
What condition is equivalent to osteomalacia but in children?
Rickets
In which organ is vitamin D converted into its physiologically active form?
Kidneys
What other organ besides the kidneys participates in vitamin D metabolism?
Liver
What other mineral is lost besides calcium due to decreased vitamin D intake?
Phosphate
Looser lines are associated with what condition?
Osteomalacia
What are looser lines?
Pseudo fractures seen as horizontal osteoid seams
What is the best diagnostic procedure for osteomalacia?
Bone biopsy
What is the condition meaning the presence of multiple pseudofracture lines that are commonly seen with osteomalacia (Looser lines)?
Milkman’s syndrome
How does osteomalacia affect trabeculation?
Makes it more coarse
In what direction do Looser lines lie?
Perpendicular to long axis of bone
What is the term for the deformity of the femurs commonly seen in children with Rickets?
Shepherd’s Crook deformity
What is the term for the deformity of the tibia seen in children with Rickets (and also other conditions)?
Saber shin
What elevated lab value is present with rickets?
Alkaline phosphatase
What are the causes of rickets?
Inadequate intake of vitamin D or lack of exposure to UV radiation, malabsorption, chronic acidosis, renal tubular defects, anticonvulsants
How is rickets treated?
Sunlight and vitamins D supplementation (resolvable)
What are the areas of most rapid growth in order?
1 costochondral junctions of middle ribs 2 distal femur 3 both ends of tibia
What is the second most rapidly growing area?
Proximal tibia
What is the third more rapidly growing area?
Distal radius/ulna
What is the term for the appearance at the ribs of a children with rickets where the chest has cartilage overgrowth and metaphysical splaying at the costochondral junction of the ribs?
Rachitic rosary
What is the term for the frayed appearance seen at the epiphyseal plate junction of the bones with those who have rickets?
Paintbrush metaphysis
What is the term for the central radiolucency seen near the bone fraying in those with rickets?
Cupping (splaying)
Tibial bending is naturally occurring up to what age?
Up to 6 months
What is another name for scurvy?
Barlow’s disease
Scurvy is the long term deficiency of what vitamin?
C (low serum ascorbic acid levels)
Scurvy primarily involves with population?
Infants 8-14 months fed pasteurized or boiled milk
Why does a lack of vitamin C lead to the symptoms of scurvy?
Vitamin C is important for the formation of collagen, osteoid, and endothelial linings
Why does spontaneous hemorrhage occur with scurvy?
Capillary fragility due to lack of vitamin C
Scurvy is also mistaken for what?
Child abuse
Those with scurvy tend to lie in what position?
Frog-leg: supine and motionless with thighs abducted
What is the ring-shaped radiodense sclerosis around of the epiphysis called that is seen with scurvy?
Wimberger’s sign
What is the dense (sclerotic) zone (WHITE) of provisional calcification seen with scurvy that is due to delayed conversion to bone?
White line of Frankel
What is the term for the radiolucent (DARK) band that is sometimes visible directly beneath the zone of provision calcification (white line of Frankel) seen with scurvy?
Trummerfeld’s zone
What is the term for the beak-like metaphyseal outgrowths that extend at right angles to the shaft with scurvy patients?
Pelken’s spurs
What change to the periosteum is most commonly seen in kids with scurvy?
Subperiostial hemorrhage
