Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
1
Disorders of Bone Mass
OsteoporosisDefinitionLoss of bone mass associated with deterioration of bone architecture and increasedsusceptibility to fracture
2
Epidemiology
75 million in US, Europe and Japan300,000 new hip fractures/ year750,000 vertebral fractures/ year1 of every 4 postmenopausal women
3
4
Osteoporosis Risks Factors
Genetic• Race • Familial
prevalenceAge/ Sex
Endocrine• Menopause • Ovarian/
testicular dysfunction
Osteoporosis Risks Factors
Nutritional• Low calcium • High alcohol• High caffeine/
sodium• High anim. protein
Lifestyle• Low physical
activity• Cigarette
smoking
5
6
• Postmenopausal• Age-related• Idiopathic
OsteoporosisPrimary
• Endocrine disorders• Gastro-intestinal diseases• Chronic Inflammatory diseases• Malignant neoplasms• Connective tissue disorders• Drug-induced
OsteoporosisSecondary
7
Endocrine• Ovarian/ testicular dysfunction
early menopause• Cushing syndrome• Hyperthyroidism• Hyperparathyroidism (severe)
OsteoporosisRisk Factors
Fracture sites• Spine• Hips• Distal radius (Colle’s fracture)• Proximal humerus
OsteoporosisClinical
8
Unsuitable for early detectionIndicate advanced disease
RadiologyRoutine Xrays
• “Fish-mouth” deformity• Thin cortices• Diffuse osteopenia• Old or current fractures
RadiologyRoutine Xrays
9
10
11
Diseases of Mineralization
RicketsOsteomalacia
12
13
RicketsPathogenesis
Defective mineralization and turnover
• Bone matrix• Growth cartilage
14
15
• Cranio-tabes/ frontal bossing• Widely opened fontanels• Rachitic rosary• Harrison groove/pigeon breast• Swelling of wrists and ankles• Genu valgum/ varum
RicketsClinical
16
Long bonesDeformitiesFractures
Growth platesBlurred/WidenedEpiphyses cup-
shaped
RicketsRadiology
17
Defective mineralization/ turnover
• Bone matrix
OsteomalaciaPathogenesis
18
• Bone pain• Fractures• Proximal myopathy• Muscle weakness• Waddling gait
OsteomalaciaClinical
Bowing of long bones (genuvarum)
Pseudo-fractures “Looser’slines”
Fractures (Milkman)
OsteomalaciaRadiology
19
20
Rickets/ OsteomalaciaHistopathology/ Morphometry
↑ ↑↓↑
↓↓
• Osteoid surface/thickness • Mineral apposition rate• Mineralization lag time/
osteoid maturation• Tetracycline double labels• Bone formation rate/
activation frequency
21
Renal OsteodystrophyDefinition
A spectrum of skeletal abnormalities resulting from renal failure
22
23
Renal OsteodystrophySubtypes
• Secondary hyperparathyroidism• Mixed bone disease• Low bone turnover
Pure osteomalaciaAplastic/ adynamic bone disease
24
25
26
CLASS OF 2009
Thank you!