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Musculoskeletal > 2. Metabolic bone disease - radiology > Flashcards

2. Metabolic bone disease - radiology Flashcards

1
Q

What imaging looks at the density of bones?

A
  • X-rays
  • CT
  • Bone densitometry
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2
Q

What imaging looks at the biochemical composition of bone material?

A

MRI

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3
Q

What imaging looks at the bone turnover and osteoblastic activity of bone?

A

Radionuclide bone scans

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4
Q

What colour are very dense materials on x-rays and CT scans?

A

White

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5
Q

What turns bright in T1 MRI scans and why is bone white?

A
  • Fat shows up bright

* Bones show up white because there’s lots of fat in the bone marrow

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6
Q

What sites does the radionuclide bone scan go to?

A

Sites of increased osteoblastic activity

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7
Q

What is a pathology and radiological sign?

A
  • Pathology - disease process that gives rise to symptoms, signs, biochemical disturbances and changes in imaging appearance
  • Radiological sign - change in imaging appearance (structural or functional) that may point towards a pathology
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8
Q

In BMD, what is a T and Z-score?

A
  • T-score - reference database with white adult premenopausal females
  • Z-score - reference database that is age and sex matched
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9
Q

What is a FRAX tool?

A
  • Can enter patient data from DEXA scan, along with age, weight, sex and height
  • This software generates a risk score
  • Refer to the Nogg guidelines with this information
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10
Q

What signs of osteoporosis can be seen in radiology?

A
  • Loss of cortical bone/thinning of cortex
  • Loss of trabeculae
  • Development of insufficiency fractures
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11
Q

What are insufficiency fractures?

A
  • Stress fractures due to normal stress on abnormal bones
  • Not limited to osteoporosis
  • Common in sacrum, underside of femoral neck, vertebral bodies, pubic rami
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12
Q

How can insufficiency fractures be detected in X-rays, MRIs and bone scans?

A
  • X-ray - initially normal but can get periosteal reaction and callus. Increased sclerosis around fracture lines is more commonly seen.
  • MRI - bone oedema (low signal on T1, high signal on T2 and STIR)
  • Bone scan - increased osteoblastic activity
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13
Q

How does density change in sclerosis?

A

Increases

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14
Q

What does increase bone turnover in the pelvic area look like?

A

Honda sign

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15
Q

When do patients develop Looser’s zone?

A

When there is too much un-mineralised osteoid

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16
Q

What will a patient with a mature skeleton and closed growth plates get if there is reduced bone mineralisation?

A
  • Looser’s zones osteopenia
  • Codfish vertebrae
  • Bending deformities

(osteomalacia)

17
Q

Where do the radiological signs mainly centre towards in children with reduced bone mineralisation?

A

Towards growth plates - develop rickets

18
Q

What are Looser’s zones and where are they found?

A

• Pseudofractures at high tensile strength areas
• Type of insufficiency fracture - found in similar areas to them
- medial promixal femur
- lateral scapula
- pubic rami
- posterior proximal ulna
- ribs

19
Q

What do Looser’s zones look like?

A
  • Less clean than normal insufficiency fractures
  • Short lucent lines with irregular sclerotic margins

(because the bones cannot heal properly)

20
Q

What happens to the metaphyseal margin, growth plate, metaphyses and anterior ribs in rickets?

A
  • Frayed metaphyseal margin
  • Widened growth plate without calcification
  • Cupping metaphyses
  • Enlargement of anterior ribs
21
Q

What are lucencies and when do they form?

A
  • Due to hyperparathyroidism
  • Areas of intracortical resorption (where bone has been eroded away)
  • Lack of crisp cortical edges due to periosteal reactions
  • ‘pepper pot skull’
  • Can become brown tumours if large
22
Q

What type of disease is renal osteodystrophy and how does it affect the bone?

A
  • Specialised type of primary hyperparathyroidism
  • Patient gets osteomalacia and osteoporosis
  • Leads to secondary hyperparathryoidism
  • Subperiosteal erosions and brown tumours
  • Sclerosis - rugger jersey spine
  • Soft tissue calcification
23
Q

How is osteoporosis and osteomalacia different?

A
  • Osteoporosis - reduced total bone

* Osteomalacia - reduced bone mineralisation

24
Q 
Group the following into osteoporosis and osteomalacia:
• Looser's zone
• Osteopenia
• Insufficiency fractures at end plates
• Bending of the bone
A
  • Osteoporosis - osteopenia and insufficiency fractures at end plates
  • Osteomalacia - Looser’s zone, osteopenia, bending of the bone
25
Q

How does the density of bone change at endplates and the middle of the bone in abnormal vertebrae?

A
  • Increased density at endplates

* Reduced density in the middle

26
Q

What can be seen in the radiology of Paget’s?

A
  • Cortical thickening
  • Bone expansion
  • Coarsening of trabeculae
  • Osteolytic and osteosclerotic
  • Mixed lesions
  • Osteoporosis circumscripta
27
Q

Can Paget’s disease cross the joint to another bone?

A

No (but still possible to get poly-ostotic Paget’s - adjacent bone unlikely)

Musculoskeletal (9 decks)

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