Systemic Bone Diseases

Question 1

CATBITES

Answer 1

Congenital
Arthritis
Trauma
Blood
Infection
Tumor
Endocrine, Nutritional, Metabolic
Soft Tissue

Question 2

Hormones that stimulate bone production

Answer 2

Growth hormone
Thyroid hormone
Calcitonin
Vitamin D
Vitamin C

Question 3

Hormones that inhibit bone production

Answer 3

PTH parathyroid hormone

Cortisol

Question 4

Osteopenia

Answer 4

All encompassing definition for increased radiolucency or decreased density in bone

increased radiolucency in bone occurs when bone resorption exceeds bone formation

Question 5

What is the the most common etiology for osteoporosis

Answer 5

osteomalacia
rickets
scurvy
neoplasm 
hyperparathyroidism

Question 6

what is the term if there is decrease bone density other than osteoporosis

Answer 6

osteopenia

Question 7

osteomalacia has what on the films

Answer 7

looser lines

Question 8

HPT hyperparathyroidism can produce what on films

Answer 8

subperiosteal and subchondral resoption

Question 9

neoplasm produce what

Answer 9

focal lesions

Question 10

how much bone has to be lost in order to see the change on an xray

Answer 10

30-50% of bone mass must be lost before it can be detected on a plain film

Question 11

what is osteoporosis

Answer 11

qualitatively normal but quantitatively deficient bone

Question 12

when does bone mass decrease due to reduced osteoblastic differentiation activity and life span

Answer 12

after 35 years of age

usually begins earlier in women and proceeds rapid from hormonal deprivation and in turn increased osteoclastic activity

Question 13

3 types of primary osteoporosis

Answer 13

senile
postmenopausal
transient or regional

Question 14

generalized ostepenia due to endocrinopathy

Answer 14

acromegaly
hyperparathyroidism 
hyperthyroidism 
cushings 
pregnancy
heparin
alcoholism

Question 15

what does senile osteoporosis refer to

Answer 15

gradual loss of skeletal mass that is seen with advanced aging

Question 16

what does postmenopausal osteoporosis refer to

Answer 16

increased bone mass loss seen in women following menopause

Question 17

what are features of senile/ postmenopausal osteoporosis

Answer 17

pain (due to microfractures)
loss of height/compression fracture
accentuated kyphosis

Question 18

what are risk factors for ostoeporosis

Answer 18

female
>70 years old 
white or asian
early onset menopause
longer postmenopause interval 
inactivity especially lack of weight bearing exercise

Question 19

what are risk factors for osteoporosis that are able to be modified

Answer 19

smoking
alcohol
caffiene
increase protein 
lack of calcium
lack of sunlight

Question 20

what are radiographic features for ostoporosis

Answer 20

osteopenia
cortical thinning pencil thin
resorption of nonstress bearing trabecular
accentuated vertical struts
altered vertebral shape

Question 21

radiographic manifestations of osteoporosis

Answer 21

radioluncency washed out
altered trabecular pattern 
cortical thinning
wedge shaped vertebrae
compressed vertebrae (fish, codfish deformity,)
schmorls nodes
end plate infractions

Question 22

cod fish deformity

Answer 22

decreased bone density
trabecular changes accentuated primary trabecular (psuedo hemangiomoa)
washed out appearance
cortical thinning 
changes in vertebral shape

Question 23

if there is a severe fracture what might it require

Answer 23

MRI/ CT
evaluate canal and neuroforaminal effacement
evaluate of bone marrow for differentiation between osteoporosis and pathology
evaluate for hemmorage with possible canal and nueroforaminal effacement
CT if compression exceeds 30% of the original body height or retropulsion is present or neurologically compromised

Question 24

osteoporsis in an extremity

Answer 24

thinned cortices pencil thin
endosteal scalloping
loss of the secondary trabeculae
risks of fractures

Question 25

trabecular patterns of the hip

Answer 25

primary compressive medial
secondary compressive lateral
primary tensile
AKA wards triangle

Question 26

radiographic features of osteoporosis in hip

Answer 26

alteration of trabecular pattern
thin cortices
at risk for insufficency fracture

Question 27

pathological generalized osteoporosis/ osteopenia

Answer 27

plasma cell  (multiple myeloma)
metastasis
anemia
nutritional deficiencies
diabetes mellitus
immunodeficiency states
chronic liver disease

Question 28

multiple myeloma

Answer 28

diffuse significant osteopenia
compression fracture
pathological fx
multiple lytic calvarial lesions
punched out lesions

Question 29

DEXA scan Dual energy xray absorptiometry

Answer 29

evaluates osteoporosis

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

a bone density measurement will determine the bone mineral density for the area measured and compares that result with the average BMD of young adults normal of similar sex and race at their peak BMD

Question 30

Recommendations

Answer 30

stay active and get plenty of exercise
eat plenty of supplemental calcium protein and vitamin C
dont smoke
dont drink excessively
strongly consider taking estrogen supplements following menopause

Question 31

regional osteoporosis

Answer 31

immobilization and disuse
reflex sympathetic dystrophy syndrome
transient regional osteoporosis

Question 32

disuse osteoporosis

Answer 32

disuse inhibits osteoblastic activity
immobilization paralysis inflammatory joint disease
extreme injury ( diffuse osteopenia seen throughout the disused body part, lucent bands of osteopenia may be seen just proximal to the physeal line, subchondral lucency, unifrom or spotty demineralization)

Question 33

reflex sympathetic dystrophy AKA pseudo atrophy

Answer 33

acute pain, regional osteoporosis following trivial trauma
>50 equal sex, especially hand
reflex hyperactivity of the SNS
clinical: pain, swelling, vasomotor disturbances, trophic skin changes (atrophy, pigmentation)

Question 34

reflex sympathetic dystrophy imaging

Answer 34

too non specific to make the diagnosis in the absence of clinical information
soft tissue swelling
regional osteoporosis(rapid early mottled appearance, later generalized, aggressive and severe, significant juxtaarticular osteoporosis, initially localized but may spread and become a bilateral process, entire extremity, osteoporosis may be patchy, radionucleotide imaging)