COMMON BONE

DISEASES

METABOLIC DISORDERS
AFFECTING THE BONE
DR. SAMUEL INBARAJA SUNDAR
 TOPICS
● OSTEOPOROSIS
● HYPERPARATHYROIDISM
● HYPOTHYROIDISM
● RICKETS AND OSTEOMALACIA
 OSTEOPOROSIS
●
MOST COMMON METABOLIC BONE DISEASE
●
1 IN 2 W OMEN ARE AFFECTED AND 1 IN 5 MEN OVER THE AGE OF 50
ARE AFFECTED
●
QUANITATIVE ABNORMALITY – REDUCED BONE MASS AND ALTERED
TRABECULAR STRUCTURE
●
IT RESULTS IN INSUFFICIENCY FRACTURES
●
MEASUREMENT OF BONE MINERAL DENSITY AT HIP AND SPINE BY
DUAL X-RAY ABSORPTIOMETRY AS DEFINED BY W HO
●
NORMAL – BMD ABOVE -1 STANDARD DEVIATION OF THE YOUNG
ADULT REFERENCE MEAN
●
OSTEOPENIA – BMD BETW EEN –1 AND -2.5 SD BELOW THE YOUNG
ADULT REFERENCE MEAN
●
OSTEOPOROSIS – BMD > - 2.5 SD BELOW THE YOUNG ADULT
REFERENCE MEAN
●
SEVERE OSTEOPOROSIS – BMD IN THE RANGE OF OSTEOPOROSIS
W ITH ONE OR MORE LOW TRAUMA FRACTURES .
 RADIOLOGICAL FEATURES
●
GENERAL – REDUCED RADIODENSITY OF BONE – OSTEOPENIA
●
PROMINENT IN AREAS RICH IN TRABECULAR BONE PARTICULARLY
AXIAL SKELETON
●
APPENDICULAR SKELETON INVOLVED LATER
● TRABECULAR BONE BECOMES THIN AND MAY DISAPPEAR
COMPLETELY
●
CORTEX – REDUCED IN WIDTH DUE TO ENDOSTEAL BONE
RESORPTION ; INTRACORTICAL TUNNELING AND POROSITY IN
CASES OF INCREASED BON TURNOVER
●
LOW TRAUMA FRACTURES / INSUFFICIENCY FRACTURES OCCUR
BUT MORE COMMON IN VERTEBRAE, DISTAL FOREARM AND
PROXIMAL FEMUR WHERE THE TRABECULAR SKELETON IS MORE
●
FEMORAL NECK FRACTURES OCCUR IN 20% AND CAUSES
SIGNIFICANT MORBIDITY
RADIOLOGICAL FEATURES -
SPINE
● VERTICAL STRIATED
APPEARANCE OF VERTEBRAL
BODIES ON LATERAL SPINE
RADIOGRAPHS
● THIS IS SEEN IN SEVERAL OR ALL
VERTEBRAE TO DISTINGUISH IT
FROM HEMAGIOMA IN WHICH IT IS
SEEN ONLY IN ONE VERTEBRAE.
● FRATURES MOST COMMON OF
ALL OSTEOPOROTIC
FRACTURES
● WEDGE OR END PLATE
FRACTURE OR LESS COMMONLY
CRUSH FRACTURE
● THE HIGHER THE GRADE THE
GREATER THE RISK OF FRACTURES
● POWERFUL PREDICTORS OF FUTURE
FRACTURES
● OCCUR MORE COMMONLY IN THE
THORACO LUMBAR REGION
● UNCOMMON ABOVE T7, IF ABOVE T7
SUSPECT METASTASES
● WEDGE # IN TL SPINE LEADS TO
KYPHOSIS, WHICH IF SEVERE CAN
CAUSE RESPIRATORY COMPROMISE.
RADIOLOGICAL FEATURES – NON SPINAL
●
HANDS – TRABECULAE AT
THE ENDS OF BONE APPEAR
REDUCED AND THOSE THAT
REMAIN APPEAR PROMINENT
●
NORMALLY CORTICAL BONE
APPEARS AS SOLID W HITE
LINE ON A RADIOGRAPH
W ITH SMOOTH INNER AND
OUTER SURFACE
●
IN OSTEOPOROSIS –
THINNED AND IRREGULAR
CORTICAL BONE BECAUSE
OF ENDOSTEAL RESORPTION
●
LONGITUDINAL
RADIOLUCENT STRIATIONS
RESULT BECAUSE OF
ENLARGEMENT OF
HAVERSIAN AND
VOLKMANN'S CANAL
● FEMORAL NECK – THE TRABECULAR
PATTERN IN FEMORAL NECK IS THE
INDEX OF OSTEOPOROSIS – SINGH'S
INDEX
● INSUFFICIENCY FRACTURES OCCUR
IN SYMPHYSIS PUBIS , SACRUM ,
PUBIC RAMI AND CALCANEUS,
STERNUM AND SUPRA ACETABULAR
AREA.DETECTED EARLIER WITH MRI
AND SCINTIGRAPHY
● RADIONUCLIDE SCANS – INCREASED
UPTAKE IN THE AREA OF
INSUFFICIENCY FRACTURESWITH
SACRUM INVILVEMENT , THE
CHARACTERISTIC , “ H” SHAPED
HONDA SIGN CAN BE SEEN.
● CT HELPS DETECT INSUFFICIENCY
FRACTURES OF SACRUM
● MRI HELPS DIFFERENTIATE
FRACTURES FROM OTHER CAUSES
 HYPERPARATHYROIDISM
●
RADIOLOGICAL FEATURES
●
PARTHYROID IMAGING: T99 SESTMIBI SCAN , MRI , USG USED FOR
TUMOR DETECTION
● MUSCULOSKELETAL SYSTEM:
●
HAND – SUB-PERIOSTEAL RESORPTION -SPECIFIC -
PATHOGNOMONIC
●
IF ABSENT – OTHER SITES – NO FINDINGS
●
SKULL – PEPPERPOT SKULL DUE TO EROSION
●
OSTEOPOROSIS : DUAL ENERGY XRAY ABSORBTIOMETRY – NON
SPECIFIC FINDING
●
TUNNELLING OF CORTICAL BONE AND TRABECULAR PATTERN IN
CORTEX ARE SEEN
●
SPINE – COD FISH VERTEBRAE DUE TO DEFORMATION OF MALACIC
BONE BY DISC
●
SUB -
PERIOSTEAL
REACTION
 HYPOPARATHYROIDISM
● RADIOLOGICAL FEATURES

● OSTEOSCLEROSIS: SKULL – VAULT IS

THICKENED
● METASTATIC CALCIFICATION IN THE BASAL
GANGLIA AND SUBCUTANEOUS TISSUE
AROUND PELVIS AND SHOULDER
● RARELY ENTHESOPTHY – MOSTLY IN
PARASPINAL DISTRIBUTION
● BASAL GANGLIA
CALCIFICATION
 RICKETS
●
SEEN IN IMMATURE SKELETON OF CHILDREN
●
WIDENING OF EPIPHSEAL PLATE
●
CUPPING OF METPHYSIS
●
SPALYING OF METAPHYSIS
● SWELLING AROUND THE ENDS OF LONG BONES
●
RACHITIC ROSARY: THE SWELLING AT THE ANTERIOR END OF
RIBS
●
KNEE: GENU VALGUM , GENU VARUM
●
HIP :COXA VARA , COXA VALGA
●
HARRISON'S GROWTH ARREST LINES ARE PRESENT AFTER
TREATMENT AND REMAIN FOREVER
●
POST TREATMENT : NON-MINERALIZED OSTEOID IS PRESENT AT
THE METAPHYSES AND RESEMBLES FRACTURE LINE
●
DIFFERENTIATED FROM FRACTURE BY THE PRESENCE OF
REDUCED BONE DENSITY AND POORLY DIFFERENTIATED
EPIPHYSES IN RICKETS
● BOWING OF LONG
BONES DUE TO
SOFTENING OF
BONE
● CUPPING
AND
FRAYING
OF
METAPHYS
ES
 OSTEOMALACIA
● LOOSER'S ZONE : PATHOGNOMONIC OF OSTEOMALACIA
● COMMON : MEDIAL ASPECT OF FEMORAL NECK, LATERAL ASPECT OF
SCAPULA ,PUBIC RAMI AND RIBS
● TRANSLUCENT AREAS IN THE BONE IN WHICH OSSIFICATION HAS CEASED
● B/L
● SYMMETRICAL
● MADE OF UNMINERALIZED OSTEOID
● APPEARS AS TRANSLUCENT LINES IN RADIOGRAPH
● APPEARS PERPENDICULAR TO BONE CORTEX ACROSS ENTIRE SHAFT OF THE
BONE
● SCINTIGRAPHY MORE SENSITIVE THAN X-RAY IN DETECTING OCCULT LOOSER'S
ZONE
● D/D : INSUFFICIENCY FRACTURES: HAS CALLUS FORMATION AND OSTEOPOROTIC
BONE PICTURE
● PROTRUSIO ACETABULI – LOSS OF TEAR DROP MARGIN , COXA VARA,COX
VALGUM , GENU VARA , GENU VALGUM , TRIRADIATE DEFORMITY OF PELVIS ARE
ALL SEEN BECAUSE OF SOFTENING OF BONE AND BENDING
● SECONDARY HYERPARATHYROIDISM FEATURES PRESENT
● LOOSER'S ZONE