systemic bone diseases Flashcards
What does CATBITES stand for?
Congenital Arthritis Trauma Blood Infection Tumor Endocrine, nutritional, metabolic Soft tissue
what are the 2 hormones that inhibit bone production?
PTH
cortisol
what hormones and nutrients stimulate bone production?
GH T3, T4 Calcitonin D C
what is an all encompassing definition for increased radiolucency or decreased bone density?
osteopenia
what is the MC osteopenia?
osteoporosis
what are some other causes of osteopenia?
osteomalacia hyperparathyroidism rickets/osteomalacia scurvy neoplasm
which osteopenia has linear radiolucencies/ looser lines on imaging?
osteomalacia
which osteopenia produces subchondral and subperiosteal resorption?
HPT
which osteopenia produces focal lesions?
neoplasms- plasma cell myeloma
what percent of bone mass loss is needed to be seen on film?
30-50%
which condition has qualitatively normal but quantitatively deficient bone?
osteoporosis
which type of fracture in women doubles every 5 years after 60?
hip fracture
vertebral fractures are also high at 64%
senile, postmenopausal and transient or regional are all what classification of osteoporosis?
primary
what are some causes of secondary osteoporosis?
corticosteroids malignancy infection arthritides disuse RSD
osteoporosis radiographic features seen in the spine
cortical thinning- pencil thin
resorption of non-stress bearing trabeculae
accentuated vertical struts
altered vertebral shape- wedge shaped, compressed, fish vertebra, codfish deformity
schmorl’s nodes
end plate infarctions
with severe fractures, if the compression exceeds 30% of original body height or retropulsion is present or if neurologically compromised, what additional imaging is needed?
CT- evaluation of canal, bone marrow and hemorrhage in canal
what are some radiographic signs for osteoporosis in an extremity?
pencil thin cortices
endosteal scalloping
loss of secondary trabeculae
fracture risk
what are the trabecular patterns of the hip?
1 primary compressive- medial
2 secondary compressive- lateral
3 primary tensile
confluence of the 3 trabecular groups forms a triangle of radiolucency known as?
Ward’s triangle
in osteoporosis, which trabecular pattern is last to be involved?
primary compressive
radiolucency of ward’s triangle is more prominent in?
osteoporosis
with increasing severity, tensile group compression regresses ___ to _______ opening Ward’s triangle laterally
medial to lateral
with significant osteopenia how do you differentiate osteoporosis from MM?
with MM patient is too young for osteoporosis and will have multiple punched out lesions
what are T-scores used to measure?
fracture risk associated with osteoporosis
What are the WHO t-scores?
T-1 or higher= normal
T -2.5 to -1= osteopenia
T below -2.5= osteoporosis
T below -2.5 + fragility fracture= severe osteoporosis
disuse inhibits ______ activity
osteoblastic
what is a regional osteoporosis following a trivial trauma with acute pain in those under 50 and especially affects the hands?
reflex sympathetic dystrophy
what are some clinical signs of RSD?
reflex hyperactivity of SNS
pain, swelling, vasomotor disturbances, trophic skin changes (skin atrophy, pigmentation abnormal)
who is most affected by transient osteoporosis of the hip?
30-50 year olds
3:1 males
3rd tri pregnancy females- usually left hip
bilateral in men
onset of sudden pain, antalgia and limp, self limiting over 3-12 months
which condition has an abnormally high osteoid to mineralized bone ratio- inadequately mineralized bone matrix?
osteomalacia
what are the 2 main causes of osteomalacia?
Vit D metabolism
renal tubular phosphate loss
what is fanconi’s syndrome?
renal tubular phosphate loss, associated with osteomalacia
what are linear regions of unmineralized osteoid usually bilateral and symmetrical at right angles to the bone?
looser lines
what condition do you see looser lines/ pseudofractures?
osteomalacia
what condition presents with muscle tetany, irritability, weakness, delayed development, small stature, bone deformities and pain
rickets- also soft tissue swelling around growth plates due to hypertrophied cartilage
what is elevated in rickets?
alkaline phosphatase
where are the most prominent radiographic features of rickets usually seen?
costochondral jx of middle ribs
distal femur, proximal humerus
both ends of tibia
distal ulna and radius
what is fraying and what condition do you see it in?
widened, bulky growth plates and irregularity- rickets
splaying, fraying, bowing deformities and rachitic rosary of the chest are all seen in?
rickets
what is the term for expansion of the anterior rib ends at the costochondral junctions?
rachitic rosary
splaying of weakened bone at jx of metaphysis and physis predisposes to?
slipped epiphysis- epiphysiolysis
paintbrush metaphysis is seen in?
rickets
what is Barlow’s disease?
scurvy
what are some clinical findings of scurvy?
osteopenic bone spontaneous hemorrhage cutaneous petechiae, bleeding gums, hematuria joint swelling irritability frog-leg position malaise and lethargy
what is a dense sclerotic zone of provisional calcification due to delayed conversion of bone?
white line of Frankel
what are beak like metaphyseal outgrowths extended at right angles to shaft?
Pelken’s spurs
what sign shows radiodense sclerosis around epiphysis and radiolucency centrally?
wimberger’s sign
what is corner sign?
irregularity of metaphyseal margins
what is it called when there is a radiolucent band visible directly beneath zone of provisional calcification?
Trummerfeld’s zone/ scorbutic zone
subperiosteal hemorrhage, Trummerfeld’s zone, white line of frankel, wimberger’s ring and pelken’s spurs are all radiographic features seen in?
scurvy
primary HPT is the MC and 90% caused by?
parathyroid gland adenoma
what is the MC cause of hypercalcemia?
primary HPT
what are 3 causes of secondary HPT?
chronic renal disease
hemodialysis
renal osteodystrophy
what type of HPT is seen in dialysis patients, parathyroid gland acts independent of serum calcium?
tertiary HPT
renal stones, peptic ulcers, pancreatitis, confusion, lethargy, weakness, bone pain, polyuria and polydypsia are all signs of?
HPT
what are brown tumors?
cystic accumulations of fibrous tissue
what are some radiographic signs seen in HPT?
osteopenia subperiosteal resorption distal tuft resorption brown tumors soft tissue calcification cortical definition loss
what is the most radiographic definitive sign of HPT?
subperiosteal resorption- esp at radial margins of middle and proximal phalanges of 2-3 digits
widened joint spaces and osteolysis is seen MC where in HPT?
AC and SI joints
what happens to the teeth with HPT?
loss of lamina dura of teeth
rugger jersey sign and salt and pepper skull are classic signs of?
HPT
what are lytic lesions containing osteoclasts and mononuclear cell and fibroblasts with focal hemorrhages?
brown tumors
what produces the brown color in a brown tumor?
hemosiderin from hemorrhage
brown tumor aka
osteoclastoma
what accounts for 10% of all neoplasms within the cranium?
pituitary tumors
headaches, visual disturbances and generalized discomfort in the extremities are all signs of?
pituitary tumor
what is a classic radiographic sign seen in pituitary tumors?
enlarged sella turcica
an oversecretion of GH from pituitary adenoma occuring AFTER open growth plate closure resulting in excessive growth and proliferation of CT?
acromegaly
excessive GH before growth plates close
gigantism
“spade like” distal tufts and hooking osteophytes with widened shaft and increased joint spaces of extremities is seen with?
acromegaly
frontal bossing is seen with?
acromegaly and gigantism
macroglossia and heel pad thickening are seen with?
acromegaly
what is cushings aka
hypercortisolism
what are radiographic features seen in cushings?
generalized osteopenia compression fractures avascular necrosis- high atherosclerotic plaquing healing with excessive callus
