Orthopedic Aspects Of Metabolic Bone Disease By Xiu
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This document summarizes various metabolic bone diseases and their orthopedic manifestations and radiographic findings. It covers osteoporosis, rickets and osteomalacia, hyperparathyroidism, hypoparathyroidism, hyperthyroidism, and renal osteodystrophy. For each condition, it describes clinical presentation, pathogenesis, characteristic radiographic findings including areas of bone involvement and patterns of bone changes, and differential diagnoses.
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Orthopedic Aspects Of Metabolic Bone Disease By Xiu
- 1. ORTHOPEDIC ASPECTS OF METABOLIC BONE DISEASE Presented by EKKASIT SRITHAMMASIT, MD. Leon Lenchik , MD et al Department of Radiology, The Bowman Gray School of Medicine, Wake Forest University (LL), Winston-Salem, North Carolina Orthopedic Clinics of North America - Volume 29, Issue 1 (January 1998)
- 4. OSTEOPOROSIS
- 8. OSTEOPOROSIS
- 24. Rickets and osteomalacia Maintain calcium and phosphate homeostasis.
- 73. HYPERTHYROIDISM
- 84. HYPOTHYROIDISM
- 90. ACROMEGALY
- 100. RENAL OSTEODYSTROPHY
- 106. PAGET'S DISEASE
Editor's Notes
- ผู้ป่วย MBD ตอนแรกอาจมา present เพียงเรื่อง LBP ตังนั้นการ diag ให้ได้เร็วๆ เป็นการช่วยผู้ป่วย การ diag เร็วๆ ก็จำเป็นต้องอาศัย clinical, PE, LAB และที่สำคัญ Imaging ซึ่ง Radiologist จะมีส่วนช่วยตรงนี้
- dual energy X-ray absorptiometry (DXA)
- dual energy X-ray absorptiometry (DXA) and quantitative CT scan (QCT)
- Osteopenia= a nonspecific term that describes decreased bone density.
- Osteopenia= a nonspecific term that describes decreased bone density.
- Cortex บาง เรียบ แต่ยังเห็นเป็นเส้นที่คมชัด
- Cortex บาง เรียบ แต่ยังเห็นเป็นเส้นที่คมชัด
- Osteopenia= a nonspecific term that describes decreased bone density.
- Osteopenia= a nonspecific term that describes decreased bone density.
- Osteopenia= a nonspecific term that describes decreased bone density.
- ให้สังเกตว่า joint space จะปกติ ใช้แยกจากโรคของ arthritis ต่างๆ
- This patient had a long - standing immobilization due to a fracture of the right humerus . The appearances in the right hand are classical for reflex sympathetic dystrophy, or Sudeck’s atrophy, and include : 1 . Pronounced demineralization of the bones, particularly in the periarticular region . 2 . No joint involvement . ssociated soft tissue atrophy . This condition has been recently renamed the “complex regional pain syndrome” .
- The most common radiologic sign is generalized osteopenia, a finding shared by many differential diagnoses including multiple myeloma. Looser's zones are linear areas of undermineralized osteoid that occur in a bilateral and symmetric distribution
- Provisional zone of calcification; the region of the physis adjacent to the metaphysis Occasionally, in patients with rickets caused by chronic renal disease, increased sclerosis due to associated secondary hyperparathyroidism may be seen.
- Differential diagnosis of rickets includes hypophosphatasia and the Schmid-type of metaphyseal chondrodysplasia .
- Skeletal deformities depend in part on the age at which the disease develops.
- In chronic renal failure, secondary hyperparathyroidism often coexists with rickets, osteomalacia, and osteoporosis as part of a spectrum of findings called renal osteodystrophy. triad of renal calculi, diffuse bone pain in combination with characteristic radiologic findings, and dementia resulting from hypercalcemia - elevated serum calcium and alkaline phosphatase, decreased serum phosphate, and elevated urinary calcium and phosphate levels. The diagnosis is confirmed with immunoassay that shows an elevated serum parathyroid hormone level.
- Brown tumors are composed mostly of osteoclasts and appear as well-defined lytic lesions
- Primary HPT. Radiograph of the midfemur showing a brown tumor. inferior obturator ramus
- Certain radiologic findings are more common in patients with secondary hyperparathyroidism than in those with primary hyperparathyroidism
- vascular calcifications
- Neuromuscular = hypocalcemia. Premature closure of the physes = short stature
- diffuse idiopathic skeletal hyperostosis,
- Obesity, short stature, mental retardation, and brachydactyly. Some patients also have dermatologic, ocular, olfactory, and gustatory abnormalities. As in hypoparathyroidism, hypocalcemia and hyperphosphatemia are often present. Serum parathyroid hormone levels may be normal or elevated.
- as a result of premature closure of the physes
- Normocalcemic.
- Excessive production of thyroid hormone by the thyroid gland results in stimulation of bone formation and bone resorption; however, bone resorption is dominant. Laboratory results show elevated serum levels of calcium, phosphorus, and alkaline phosphatase, and elevated urinary calcium.
- In addition, patients may develop a myopathy that mimics arthritis.
- Thyroid acropachy ( 1% of patients ): swelling of the hands and feet with diaphyseal periostitis .
- Thyroid acropachy ( 1% of patients ): swelling of the hands and feet with diaphyseal periostitis .
- Onset : after >18 months following surgical / radioactive ablation of thyroid gland for hyperthyroidism (does not occur with antithyroid medication) eu - / hypo - / hyperthyroid state
- Differentiation from venous stasis, osteomyelitis, leukemia, hypervitaminosis A, and trauma is usually possible on the basis of the characteristic clinical presentation of these disorders. Hypertrophic osteoarthropathy เจ็บ
- Slipped capital femoral epiphysis is a known complication of hypothyroidism in children.
- Slipped capital femoral epiphysis is a known complication of hypothyroidism in children.
- Slipped capital femoral epiphysis is a known complication of hypothyroidism in children.
- Elevated serum growth hormone stimulates bone formation and causes soft tissue proliferation. In the immature skeleton the same condition is called pituitary gigantism and manifests as delayed skeletal maturation.
- . Posterior vertebral scalloping has a broad differential, including spinal neoplasms, neurofibromatosis, Marfan syndrome, Ehlers-Danlos syndrome, and achondroplasia. [ 80 ] Degenerative enthesopathy in the peripheral skeleton is also seen in patients with diffuse idiopathic skeletal hyperostosis.
- Chronic renal failure causes phosphate retention by the kidneys, which results in hypocalcemia and in turn leads to parathyroid hyperplasia and secondary hyperparathyroidism. [ 102 ] [ 118 ] Because normal kidney function is required for vitamin D metabolism, chronic renal failure also results in rickets and osteomalacia. [ 102 ] [ 118 ] On laboratory evaluation, the serum level of calcium may be normal, low, or elevated.
- Lytic phase of Paget disease of the skull in different patients with osteoporosis circumscripta . (a) Lateral radiograph of a 50-year - old man shows a well - defined area of lysis in the frontal and occipital regions ( arrowheads ). (b) Lateral radiograph of a 60-year - old woman with osteoporosis reveals frontal and occipital areas of osteolysis (*) that are more difficult to detect in this clinical setting .
- Lytic phase of Paget disease (" blade - of - grass " appearance ) of the appendicular skeleton in different patients . (a) Anteroposterior radiograph of the knee in a 74-year - old man shows a large area of lysis beginning in subchondral bone with a sharp inferior margin ( arrowheads ). (b) Lateral radiograph of the upper tibia in a 41-year - old man shows a lytic lesion in the tibial tubercle, with blade - of - grass appearance superiorly and inferiorly ( arrows ).
- Mixed phase of Paget disease of the pelvis in different patients . (a) Anteroposterior radiograph of an 81-year - old woman shows extensive involvement by Paget disease with areas of cortical ( iliopectineal and ilioischial lines, arrows ) and trabecular ( arrowheads ) thickening throughout the pelvis and coxa varus deformity in the right hip .