Systemic Bone Diseases Flashcards
CATBITES
Congenital Arthritis Trauma Blood Infection Tumor Endocrine, Nutritional, Metabolic Soft Tissue
Hormones that stimulate bone production
Growth hormone Thyroid hormone Calcitonin Vitamin D Vitamin C
Hormones that inhibit bone production
PTH parathyroid hormone
Cortisol
Osteopenia
All encompassing definition for increased radiolucency or decreased density in bone
increased radiolucency in bone occurs when bone resorption exceeds bone formation
What is the the most common etiology for osteoporosis
osteomalacia rickets scurvy neoplasm hyperparathyroidism
what is the term if there is decrease bone density other than osteoporosis
osteopenia
osteomalacia has what on the films
looser lines
HPT hyperparathyroidism can produce what on films
subperiosteal and subchondral resoption
neoplasm produce what
focal lesions
how much bone has to be lost in order to see the change on an xray
30-50% of bone mass must be lost before it can be detected on a plain film
what is osteoporosis
qualitatively normal but quantitatively deficient bone
when does bone mass decrease due to reduced osteoblastic differentiation activity and life span
after 35 years of age
usually begins earlier in women and proceeds rapid from hormonal deprivation and in turn increased osteoclastic activity
3 types of primary osteoporosis
senile
postmenopausal
transient or regional
generalized ostepenia due to endocrinopathy
acromegaly hyperparathyroidism hyperthyroidism cushings pregnancy heparin alcoholism
what does senile osteoporosis refer to
gradual loss of skeletal mass that is seen with advanced aging
what does postmenopausal osteoporosis refer to
increased bone mass loss seen in women following menopause
what are features of senile/ postmenopausal osteoporosis
pain (due to microfractures)
loss of height/compression fracture
accentuated kyphosis
what are risk factors for ostoeporosis
female >70 years old white or asian early onset menopause longer postmenopause interval inactivity especially lack of weight bearing exercise
what are risk factors for osteoporosis that are able to be modified
smoking alcohol caffiene increase protein lack of calcium lack of sunlight
what are radiographic features for ostoporosis
osteopenia cortical thinning pencil thin resorption of nonstress bearing trabecular accentuated vertical struts altered vertebral shape
radiographic manifestations of osteoporosis
radioluncency washed out altered trabecular pattern cortical thinning wedge shaped vertebrae compressed vertebrae (fish, codfish deformity,) schmorls nodes end plate infractions
cod fish deformity
decreased bone density trabecular changes accentuated primary trabecular (psuedo hemangiomoa) washed out appearance cortical thinning changes in vertebral shape
if there is a severe fracture what might it require
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
osteoporsis in an extremity
thinned cortices pencil thin
endosteal scalloping
loss of the secondary trabeculae
risks of fractures
trabecular patterns of the hip
primary compressive medial
secondary compressive lateral
primary tensile
AKA wards triangle
radiographic features of osteoporosis in hip
alteration of trabecular pattern
thin cortices
at risk for insufficency fracture
pathological generalized osteoporosis/ osteopenia
plasma cell (multiple myeloma) metastasis anemia nutritional deficiencies diabetes mellitus immunodeficiency states chronic liver disease
multiple myeloma
diffuse significant osteopenia compression fracture pathological fx multiple lytic calvarial lesions punched out lesions
DEXA scan Dual energy xray absorptiometry
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
Recommendations
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
regional osteoporosis
immobilization and disuse
reflex sympathetic dystrophy syndrome
transient regional osteoporosis
disuse osteoporosis
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)
reflex sympathetic dystrophy AKA pseudo atrophy
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)
reflex sympathetic dystrophy imaging
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)
