SlideShare a Scribd company logo
1 of 23
Metabolic bone conditions
Rickets & Osteomalacia:
• Vitamin D deficiency leads to rickets in
children and osteomalacia in adults.
• There are many causes of rickets and
osteomalacia ranging from malabsorption
to renal failure.
Rickets 1
• Due to vitamin D deficiency is commonest
in small children and affects the growing
ends of the bone.
• The radiographic changes are due to
failure of osteoid to calcify.
• Consequently the most obvious changes
are at the metaphysis where the most
rapid growth is occurring.
Rickets 2: Radiographic changes in
rickets
• Widening of the growth plate – due to lack of
calcification of osteoid
• Indistinct metaphyseal margin
• Loss of the white line adjacent to the
metaphyseal margin (the zone of provisional
calcification). The earliest sign
• Fraying and splaying of the metaphyses which
often show a cupped appearance – due to
weight bearing on the unossified bone
Rickets 3: radiographic features
contd.
• Thin bony spur extending from the corner of the
metaphysis
• Indistinct cortex due to uncalcified subperiosteal
osteoid
• Cupping of the anterior ends of the ribs
• Bowing and deformities of the bones develop
later -characteristically bowing of the legs,
triradiate pelvis, scoliosis, biconcave vertebral
bodies, indrawing of the lower part of the chest
wall (Harrisons sulcus). These occur due to
weight bearing on softened bones.
Rickets 4
What are rickets and osteomalacia? What is causes these two conditions?
What are the radiographic features?
5: Describe these changes
6:Describe these changes
What is Blounts disease and how does it differ from Rickets? What other
diseases cause osteoporotic bones in children?
7: Rickets
• Rickets may be confused with Blounts
disease, which is a developmental
abnormality involving the upper tibial
metaphysis with a large “beak” medially
and genu varus deformity. Early walking
may be contributory to the chnages in
Blounts disease .
Osteomalacia 1
• occurs in the mature skeleton.
• Bone pain is common and there is
generalised reduction in bone density.
• The radiological hallmark are narrow
lucent bands at cortical margins due to a
break in the cortex (incomplete fracture).
These are initially ill defined but with time
develop a sclerotic margin. They are
called pseudofractures or “Looser’s zone”.
Osteomalacia: 2
• Loozers zones are usually bilateral,
symmetrical and are common in the pubic
rami and proximal femora.
• Changes also occur in the spine, the
vertebral bodies becoming biconcave in
appearance – “codfish” vertebrae.
• Due to bone softening other bone
deformities may occur such as a triradiate
pelvis.
Osteomalacia 4
• Describe these
changes
• What are cod fish
vertebrae?
• What other conditions
cause cod fish
vertebrae
Vitamin C Deficiency: SCURVY.
1
• This is rare under 6 months of age usually
affecting children aged 6months – 2 years. It
does occur in adults but is rare. The
characteristic radiographic signs are:
• Decreased density in the epiphysis with a very
thin cortex (Wimberger sign)
• Dense zone of provisional calcification – dense
white line due to excessive calcification of
osteoid as production of new osteoid decreases
Vitamin C Deficiency: SCURVY.
2
• Metaphyseal lucency - lucent zone beneath the
white line
• Metaphyseal corner fractures through weakened
metaphysis resulting in cupping of metaphysis
(Pelkan spur).
• Periosteal reaction due to subperiosteal
haemorrhages. These show radiologically only
when they begin to calcify in the healing phase.
• Osteoporosis – this is usually the only sign in
adults.
Scurvy 3
Describe these changes. What is scurvy? What are other manifestations apart
form the skeletal changes ?
Osteoporosis 1
• This is due to a decrease in bone mass.
• There is a diminished quantity of bone unlike
osteomalacia in which there is a normal quantity
of bone but an excess of uncalcified osteoid.
• There are many causes, the commonest being
the menopause in women. It leads to an
increased incidence of fracture, particularly in
the femoral neck, spine (compression fractures)
and other fractures following minor trauma.
Osteoporosis 2
• Changes on X-ray are non specific but include
the following:
• Decreased bone density.
• Cortical thinning
• Accentuation of trabecular lines due to
resorption of secondary trabeculae
• Compression fractures of the vertebral bodies.
• Decrease in bone density alone is difficult to
assess on plain films as this can be simulated by
overexposure.
Hyperparathyroidism : 1
• This also cause bony demineralisation but
in this case due to bone resorption.
• It may be primary or secondary to renal
failure.
Hyperparathyroidism 2:
radiographic changes
• Bony resorption. This shows as subperiosteal erosions in
the phalanges; resorption of the outer ends of clavicles,
resorption of distal phalanges with pointed tufts and
resorption of lamina dura (floating teeth).
• Bone cysts (brown tumours)
• Renal calculi and vascular calcification
• Generalised loss of bone density
• “Pepper pot” skull vault due to small areas of bone
resorption. Before this becomes obvious there is loss of
normal bone detail, the skull vault having a fuzzy
appearance.
Renal osteodystrophy 1
• occurs secondary to chronic renal failure
which may follow glomerular disease or
chronic pyelonephritis. It consists of three
abnormalities:
– osteomalacia or rickets
– secondary hyperparathyroidism
– osteosclerosis
Renal osteodystrophy 2
• One characteristic appearances occurs in the
spine where alternating dark and light bands
may be seen. This is due to sclerosis adjacent to
the end plates. This simulates the appearance of
the stripes on a rugby shirt and has been named
the “rugger jersey” spine.
• In children there may be destruction of bone in
the femoral neck resulting in a “rotting fence-
post” appearance which is associated with a
slipped upper femoral epiphysis.
Renal osteophystophy: spine
changes
Describe the changes. What is renal osteodystropy?
What are the radiological changes?
Renal osteodystrophy in children
Describe the changes

More Related Content

Similar to PATTERN SKELETAL 2.ppt

Dr.salah.radiology.bone and joints disease
Dr.salah.radiology.bone and joints diseaseDr.salah.radiology.bone and joints disease
Dr.salah.radiology.bone and joints disease
student
 
10.Fibrosseous lesions of the jaw.pptx
10.Fibrosseous lesions of the jaw.pptx10.Fibrosseous lesions of the jaw.pptx
10.Fibrosseous lesions of the jaw.pptx
ambikaluthra3
 
genetic disorders of bone 1.pptx
genetic disorders of bone 1.pptxgenetic disorders of bone 1.pptx
genetic disorders of bone 1.pptx
asdgja
 
Tumor like lesions of bone
Tumor like lesions of boneTumor like lesions of bone
Tumor like lesions of bone
Swati Wadhai
 
FIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptx
FIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptxFIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptx
FIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptx
Diveshjain33
 

Similar to PATTERN SKELETAL 2.ppt (20)

Metabolic bone diseases
Metabolic bone diseasesMetabolic bone diseases
Metabolic bone diseases
 
Congenital pseudarthrosis
Congenital pseudarthrosisCongenital pseudarthrosis
Congenital pseudarthrosis
 
metabolic bone disorders
metabolic bone disordersmetabolic bone disorders
metabolic bone disorders
 
Generalized rarefactions of jaw bones
Generalized rarefactions of jaw bonesGeneralized rarefactions of jaw bones
Generalized rarefactions of jaw bones
 
Generalized rarefaction of jaw bones /prosthodontic courses
Generalized rarefaction of jaw bones /prosthodontic coursesGeneralized rarefaction of jaw bones /prosthodontic courses
Generalized rarefaction of jaw bones /prosthodontic courses
 
Dr.salah.radiology.bone and joints disease
Dr.salah.radiology.bone and joints diseaseDr.salah.radiology.bone and joints disease
Dr.salah.radiology.bone and joints disease
 
03 bone non neoplastic part-1
03 bone non neoplastic part-103 bone non neoplastic part-1
03 bone non neoplastic part-1
 
Metabolic & Endocrinal Diseases affecting bone
Metabolic & Endocrinal Diseases affecting boneMetabolic & Endocrinal Diseases affecting bone
Metabolic & Endocrinal Diseases affecting bone
 
Rickets and osteomalacia
Rickets and osteomalaciaRickets and osteomalacia
Rickets and osteomalacia
 
10.Fibrosseous lesions of the jaw.pptx
10.Fibrosseous lesions of the jaw.pptx10.Fibrosseous lesions of the jaw.pptx
10.Fibrosseous lesions of the jaw.pptx
 
genetic disorders of bone 1.pptx
genetic disorders of bone 1.pptxgenetic disorders of bone 1.pptx
genetic disorders of bone 1.pptx
 
Pattern skelet 3.ppt
Pattern skelet 3.pptPattern skelet 3.ppt
Pattern skelet 3.ppt
 
Fibroosseous lesions
Fibroosseous lesionsFibroosseous lesions
Fibroosseous lesions
 
congenital bone and developmental disease of the bone.pptx
congenital bone  and developmental disease of the bone.pptxcongenital bone  and developmental disease of the bone.pptx
congenital bone and developmental disease of the bone.pptx
 
Tumor like lesions of bone
Tumor like lesions of boneTumor like lesions of bone
Tumor like lesions of bone
 
tumorlikelesionsofbone-130620140455-phpapp02.pdf
tumorlikelesionsofbone-130620140455-phpapp02.pdftumorlikelesionsofbone-130620140455-phpapp02.pdf
tumorlikelesionsofbone-130620140455-phpapp02.pdf
 
Xray findings- MM,TB.ID.pptx
Xray findings- MM,TB.ID.pptxXray findings- MM,TB.ID.pptx
Xray findings- MM,TB.ID.pptx
 
FIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptx
FIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptxFIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptx
FIBRO-OSSEOUS LESIONS OF JAW(1).pptx UP.pptx
 
lecture 31; OSTEOARTHRITIS.pptx
lecture 31; OSTEOARTHRITIS.pptxlecture 31; OSTEOARTHRITIS.pptx
lecture 31; OSTEOARTHRITIS.pptx
 
OSTEOARTHRITIS.pptx
OSTEOARTHRITIS.pptxOSTEOARTHRITIS.pptx
OSTEOARTHRITIS.pptx
 

More from ssuser504dda

Palliative care presentation slide4.pptx
Palliative care presentation slide4.pptxPalliative care presentation slide4.pptx
Palliative care presentation slide4.pptx
ssuser504dda
 
Palliative class presentation slid3.pptx
Palliative class presentation slid3.pptxPalliative class presentation slid3.pptx
Palliative class presentation slid3.pptx
ssuser504dda
 
Palliative care presentation slides.pptx
Palliative care presentation slides.pptxPalliative care presentation slides.pptx
Palliative care presentation slides.pptx
ssuser504dda
 
Antenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxAntenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptx
ssuser504dda
 
Student Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxStudent Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptx
ssuser504dda
 
Intravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxIntravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptx
ssuser504dda
 
Cranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxCranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptx
ssuser504dda
 
HEPATITIS IN Children a case study.pptx
HEPATITIS IN Children  a case study.pptxHEPATITIS IN Children  a case study.pptx
HEPATITIS IN Children a case study.pptx
ssuser504dda
 

More from ssuser504dda (20)

Palliative care presentation slide4.pptx
Palliative care presentation slide4.pptxPalliative care presentation slide4.pptx
Palliative care presentation slide4.pptx
 
Palliative class presentation slid3.pptx
Palliative class presentation slid3.pptxPalliative class presentation slid3.pptx
Palliative class presentation slid3.pptx
 
Palliative care presentation slide2.pptx
Palliative care presentation slide2.pptxPalliative care presentation slide2.pptx
Palliative care presentation slide2.pptx
 
Palliative care presentation slides.pptx
Palliative care presentation slides.pptxPalliative care presentation slides.pptx
Palliative care presentation slides.pptx
 
Development studies - presentation .pptx
Development studies - presentation .pptxDevelopment studies - presentation .pptx
Development studies - presentation .pptx
 
Group Reproductice health Coursework.ppt
Group Reproductice health Coursework.pptGroup Reproductice health Coursework.ppt
Group Reproductice health Coursework.ppt
 
Mortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptxMortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptx
 
Examinating the Resipiratory System.pptx
Examinating the Resipiratory System.pptxExaminating the Resipiratory System.pptx
Examinating the Resipiratory System.pptx
 
crush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptxcrush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptx
 
Male Reproductive System ......... .pptx
Male Reproductive System ......... .pptxMale Reproductive System ......... .pptx
Male Reproductive System ......... .pptx
 
Antenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxAntenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptx
 
Student Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxStudent Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptx
 
Intravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxIntravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptx
 
IVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptxIVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptx
 
Cranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxCranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptx
 
HEPATITIS IN Children a case study.pptx
HEPATITIS IN Children  a case study.pptxHEPATITIS IN Children  a case study.pptx
HEPATITIS IN Children a case study.pptx
 
children. palliative care.pptx
children.     palliative       care.pptxchildren.     palliative       care.pptx
children. palliative care.pptx
 
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
PALLIATIVE CARE (GROUP2)  BME3 2023.pptxPALLIATIVE CARE (GROUP2)  BME3 2023.pptx
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
 
Group pharmacology uuuuu. .pptx
Group pharmacology   uuuuu.        .pptxGroup pharmacology   uuuuu.        .pptx
Group pharmacology uuuuu. .pptx
 
Group 5_ Year 3 Pharmacology 2023.pptx
Group 5_   Year 3 Pharmacology 2023.pptxGroup 5_   Year 3 Pharmacology 2023.pptx
Group 5_ Year 3 Pharmacology 2023.pptx
 

Recently uploaded

Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
claviclebrown44
 

Recently uploaded (20)

Sell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stockSell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stock
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - Subconscious
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
 
VIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and Night
VIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and NightVIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and Night
VIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and Night
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
 
Treatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas HospitalTreatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas Hospital
 
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
 
Quality control tests of suppository ...
Quality control tests  of suppository ...Quality control tests  of suppository ...
Quality control tests of suppository ...
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
 
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding  docx.pdfPost-Cycle Therapy (PCT) in bodybuilding  docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
 
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxIs Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
 
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
 
Dermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdfDermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdf
 
Gait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis usersGait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis users
 
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.GawadHemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
 
Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?
 
Capillary Blood Collection Tubes: The Complete Guidebook
Capillary Blood Collection Tubes: The Complete GuidebookCapillary Blood Collection Tubes: The Complete Guidebook
Capillary Blood Collection Tubes: The Complete Guidebook
 
Tips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in IndoreTips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in Indore
 
^In Pietermaritzburg Hager Werken Embalming +27789155305 Compound Powder in ...
^In Pietermaritzburg  Hager Werken Embalming +27789155305 Compound Powder in ...^In Pietermaritzburg  Hager Werken Embalming +27789155305 Compound Powder in ...
^In Pietermaritzburg Hager Werken Embalming +27789155305 Compound Powder in ...
 

PATTERN SKELETAL 2.ppt

  • 2. Rickets & Osteomalacia: • Vitamin D deficiency leads to rickets in children and osteomalacia in adults. • There are many causes of rickets and osteomalacia ranging from malabsorption to renal failure.
  • 3. Rickets 1 • Due to vitamin D deficiency is commonest in small children and affects the growing ends of the bone. • The radiographic changes are due to failure of osteoid to calcify. • Consequently the most obvious changes are at the metaphysis where the most rapid growth is occurring.
  • 4. Rickets 2: Radiographic changes in rickets • Widening of the growth plate – due to lack of calcification of osteoid • Indistinct metaphyseal margin • Loss of the white line adjacent to the metaphyseal margin (the zone of provisional calcification). The earliest sign • Fraying and splaying of the metaphyses which often show a cupped appearance – due to weight bearing on the unossified bone
  • 5. Rickets 3: radiographic features contd. • Thin bony spur extending from the corner of the metaphysis • Indistinct cortex due to uncalcified subperiosteal osteoid • Cupping of the anterior ends of the ribs • Bowing and deformities of the bones develop later -characteristically bowing of the legs, triradiate pelvis, scoliosis, biconcave vertebral bodies, indrawing of the lower part of the chest wall (Harrisons sulcus). These occur due to weight bearing on softened bones.
  • 6. Rickets 4 What are rickets and osteomalacia? What is causes these two conditions? What are the radiographic features?
  • 8. 6:Describe these changes What is Blounts disease and how does it differ from Rickets? What other diseases cause osteoporotic bones in children?
  • 9. 7: Rickets • Rickets may be confused with Blounts disease, which is a developmental abnormality involving the upper tibial metaphysis with a large “beak” medially and genu varus deformity. Early walking may be contributory to the chnages in Blounts disease .
  • 10. Osteomalacia 1 • occurs in the mature skeleton. • Bone pain is common and there is generalised reduction in bone density. • The radiological hallmark are narrow lucent bands at cortical margins due to a break in the cortex (incomplete fracture). These are initially ill defined but with time develop a sclerotic margin. They are called pseudofractures or “Looser’s zone”.
  • 11. Osteomalacia: 2 • Loozers zones are usually bilateral, symmetrical and are common in the pubic rami and proximal femora. • Changes also occur in the spine, the vertebral bodies becoming biconcave in appearance – “codfish” vertebrae. • Due to bone softening other bone deformities may occur such as a triradiate pelvis.
  • 12. Osteomalacia 4 • Describe these changes • What are cod fish vertebrae? • What other conditions cause cod fish vertebrae
  • 13. Vitamin C Deficiency: SCURVY. 1 • This is rare under 6 months of age usually affecting children aged 6months – 2 years. It does occur in adults but is rare. The characteristic radiographic signs are: • Decreased density in the epiphysis with a very thin cortex (Wimberger sign) • Dense zone of provisional calcification – dense white line due to excessive calcification of osteoid as production of new osteoid decreases
  • 14. Vitamin C Deficiency: SCURVY. 2 • Metaphyseal lucency - lucent zone beneath the white line • Metaphyseal corner fractures through weakened metaphysis resulting in cupping of metaphysis (Pelkan spur). • Periosteal reaction due to subperiosteal haemorrhages. These show radiologically only when they begin to calcify in the healing phase. • Osteoporosis – this is usually the only sign in adults.
  • 15. Scurvy 3 Describe these changes. What is scurvy? What are other manifestations apart form the skeletal changes ?
  • 16. Osteoporosis 1 • This is due to a decrease in bone mass. • There is a diminished quantity of bone unlike osteomalacia in which there is a normal quantity of bone but an excess of uncalcified osteoid. • There are many causes, the commonest being the menopause in women. It leads to an increased incidence of fracture, particularly in the femoral neck, spine (compression fractures) and other fractures following minor trauma.
  • 17. Osteoporosis 2 • Changes on X-ray are non specific but include the following: • Decreased bone density. • Cortical thinning • Accentuation of trabecular lines due to resorption of secondary trabeculae • Compression fractures of the vertebral bodies. • Decrease in bone density alone is difficult to assess on plain films as this can be simulated by overexposure.
  • 18. Hyperparathyroidism : 1 • This also cause bony demineralisation but in this case due to bone resorption. • It may be primary or secondary to renal failure.
  • 19. Hyperparathyroidism 2: radiographic changes • Bony resorption. This shows as subperiosteal erosions in the phalanges; resorption of the outer ends of clavicles, resorption of distal phalanges with pointed tufts and resorption of lamina dura (floating teeth). • Bone cysts (brown tumours) • Renal calculi and vascular calcification • Generalised loss of bone density • “Pepper pot” skull vault due to small areas of bone resorption. Before this becomes obvious there is loss of normal bone detail, the skull vault having a fuzzy appearance.
  • 20. Renal osteodystrophy 1 • occurs secondary to chronic renal failure which may follow glomerular disease or chronic pyelonephritis. It consists of three abnormalities: – osteomalacia or rickets – secondary hyperparathyroidism – osteosclerosis
  • 21. Renal osteodystrophy 2 • One characteristic appearances occurs in the spine where alternating dark and light bands may be seen. This is due to sclerosis adjacent to the end plates. This simulates the appearance of the stripes on a rugby shirt and has been named the “rugger jersey” spine. • In children there may be destruction of bone in the femoral neck resulting in a “rotting fence- post” appearance which is associated with a slipped upper femoral epiphysis.
  • 22. Renal osteophystophy: spine changes Describe the changes. What is renal osteodystropy? What are the radiological changes?
  • 23. Renal osteodystrophy in children Describe the changes