common bone diseases that encounter in clinical practice

1. Dr Wafa Sheikh
Consultant Family Medicine
ABFM,SBFM, MRCGP(INT)

2. Osteoarthritis
Rheumatoid Arthritis
Gout
Pseudogout
Rickets
Osteomalacia
Osteoporosis
Hyperparathyroidism
Paget disease
Sickle cell Anemia

4. Joint space narrowing(asymmetrical)
Osteophytes
Articular irregularity and/or sclerosis
Sub-cortical cysts (geodes)
Intra-articular loose bodies

5. Joint space narrowing
Osteophytes
Articular irregularity and/or sclerosis
Sub-cortical cysts (geodes)
Intra-articular loose bodies

6. Key features of osteoarthritis
Joint space narrowing
Osteophytes
Articular irregularity and/or sclerosis
Sub-cortical cysts (geodes)
Intra-articular loose bodies
Note: Erosions are NOT a feature

9. Marginal erosions
Large erosions have formed at the
margins of the thumb
metacarpophalangeal joint
The marginal erosions seen in
rheumatoid arthritis differ from the
sub-cortical cysts seen in osteoarthritis
which are located deep to the articular
surfaces of joints

18. Degenerative disease of bone

20. Gouty tophi
Speckled increased density of peri-
articular soft tissue is due to deposition
of monosodium urate crystals within a
gouty tophus

23. Pseudo gout

26. Ankylosis – Bamboo spine
Normal C-spine shown for
comparison
Flowing syndesmophytes are seen
fusing the cervical spine vertebral
bodies anteriorly leading to the
classic ‘bamboo spine’ sign – the
fused spine resembles bamboo
In this patient the facet joints of
the spine have also fused

30. Psoriatic arthritis – hip involvement
This young patient (25 years old) with
psoriatic arthritis has severe narrowing of
the hip joint space with large osteophytes
and sub-cortical cysts
The appearances are identical to changes
seen in osteoarthritis, but onset is typically
at a younger age and progression tends to
be more rapid

31. The severe joint erosion in this patient’s finger progressed over a
period of 4 years – erosion is seen in both the middle phalanx (MP)
and the distal phalanx (DP) of the finger
•The middle phalanx is narrowed, like a pencil, and the distal phalanx
is eroded centrally, like a cup, hence 'pencil-in-cup' deformity

43. General characteristics (Six Ds mnemonic)
Dense bones (subchondral sclerosis)
Degeneration
Destruction of articular cartilage
Deformity (pencil-point deformity of
metatarsal heads)
Debris (loose bodies)
Dislocation

44. General characteristics include(six DS mnemonic)
dense bones (subchondral sclerosis)
degeneration
destruction of articular cartilage
deformity (pencil-point deformity of metatarsal heads)
debris (loose bodies)
dislocation

45. Cupping ,fraying ,
widening
Cupping ,fraying , widening

46. Rickety rosery

48. decrease opacity suggest decrease
mineralization of Bone sponge like
appearance.
Pseudo fracture and
incomplete fracture.
Generalized severe bone loss up to
apex of tooth.
shows increased mandibular
angle and maxillary
micrognathia.
Bones are lucent, coarsened, smudgy.
Looser fracture/zone (pseudo fractures)

49. Appearances of the wrist and knee in Osteomalacia
(A) before treatment (B) after six months of treatment

52. Reduced bone density

56. In hyperparathyroidism the skull takes
on a mottled or "pepper pot"
appearance.

57. .
Subperiosteal resorption that has resulted
in severe tuftal resorption
. Also, note the subperiosteal and
intracortical resorption.
Renal osteodystrophy
Chronic renal failure reveals diffuse bone osteosclerosis

58. hyperparathyroidism
The spine shows sclerotic bends
This is known as a "rugger jersey” spine.
Calcifications throughout both kidneys
with hyperparathyroidism.
Renal osteodystrophy
Chronic renal failure reveals diffuse bone osteosclerosis

59. Skeletal sickle cell anemia. Expanded
medullary cavity. The diploic space is
markedly widened due to marrow
hyperplasia.
Trabeculae are oriented perpendicular
to the inner table, hair-on-end
appearance.

60. Sickle cell disease with avascular
necrosis of the right femoral head

61. Cotton wool skull – mixed sclerosis and lysis
Paget disease

64. Thank You