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  • 1. Metabolic Bone Diseases BY Dr. Abdullah H .A . Juma , FRCS Ed Associate Professor & Consultant Orthopaedic Surgeon
  • 2. Introduction
    • Metabolic bone diseases describes a group of disorders due to abnormalities of formation ( bone morphology ) and metabolism of bone ( functions ) .
    • Bone : An active tissue undergoing continuous structural & metabolic changes . The bone is surrounded by a bone fluid different from the whole body extracellular fluid .
  • 3. Bone characteristics
    • Bone Morphology .
    • Bone Functions .
  • 4. 1. Bone Morphology
    • Morphologically , bone can be mature (lamellar ) or immature ( woven ) or unmineralized ( osteoid ) .
    • 2 types of bone in mature skeleton :
    • . . Compact cortical bone . Consists of 50% Haversian systems (osteons) & 50% interstitial bone . Osteons consist of rings of osteocytes around central canal which carries blood & lymph vessels . The cortical bone surrounds marrow cavities & form shafts of long bones .
    • . . Cancellous bone . Anastomosing trabeculae within cortical bone and predominantly seen in vertebrae ,flat bones & ends of long bones .
  • 5. Bone Morphology
    • Organic matrix .
    • Bone cells .
    • Bone mineral .
    • Blood vessels .
    • Bone marrow .
  • 6. 1. Organic Matrix
    • It’s the frame work of bone .
    • 2 types : collagenous ( 90% ) and non– collagenous ( 10% ) .
    • Collagen is triple helix consist of 3 polypeptide alpha chains . Each chain has 1000 amino acids & synthesized within the fibroblasts or osteoblasts and is broken down by collagenases to hydroxyproline & hydroxylysine and excreted in urine .
  • 7.
    • Collagen stability decreases with age.
    • 4 types of collagen . Type I only occurs in bone with low carbohydrate & < 10 hydroxylysine residues per alpha chain .
    • Non-collagenous is protein linked to substances forming proteoglycans & glycoproteins or exist as an isolated material such as Albumin & Alpha – Carboxyglutamic acid .
  • 8.
    • Proteoglycans consist of a protein core linked to carbohydrate units such as mucopolysaccharides .
    • Glycoproteins .. 2 forms exist in the bone :
    • . Sialoprotein . A high metal-binding capacity .
    • . Alpha 2 heat-stable glycoprotein . Synthesized in liver .
  • 9. Bone Morphology
    • Organic matrix .
    • Bone cells .
    • Bone mineral .
    • Blood vessels .
    • Bone marrow .
  • 10. 2. Bone cells
    • Control formation , composition & resorption of bone .
    • Types of cells :
    • . Osteoblasts .
    • . Osteoclasts .
    • . Osteocytes .
    • . Fibroblasts .
    • . Myeloproliferative cells .
  • 11. Osteoblasts
    • Bone forming cells , synthesizing collagen , non-collagen & mineralization of bone .
    • Uniform in size .
    • Mononuclear & basophilic cytoplasm.
    • Lie in single layers close to the osteoid tissue of newly formed bone.
    • High content of Alkaline Phosphatase .
    • Have fine processes which extend into the osteoid tissues .
    • If resting , appear spindle & flat .
    • If active , appear larger & plump .
  • 12. 2. Bone cells
    • Types of cells :
    • . Osteoblasts .
    • . Osteoclasts .
    • . Osteocytes .
    • . Fibroblasts .
    • . Myeloproliferative cells .
  • 13. Osteoclasts
  • 14. Metabolic bone diseases are caused by an imbalance in the metabolism of bone resorption & deposition due to :
    • Defect of Mineralization .
    • Defect of bone matrix .
    • Excessive bone resorption .
    • Paget’s disease .
  • 15.
    • Defect of Mineralization .
    • Defect of bone matrix .
    • Excessive bone resorption .
    • Paget’s disease .
  • 16. 1. Defect of mineralization