Professional Documents
Culture Documents
Metabolic Bone Disease
Metabolic Bone Disease
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