Bone Pathology

Question 1

What hormones are typically involved in bone remodelling?

Answer 1

parathyroid hormone
vitamin D3
oestrogen

Question 2

special tests that can be done to assess bone biochemistry

Answer 2

blood calcium
osteoblast activity
- serum alkaline phosphate
- osteocalcin

osteoclast activity
- collagen degradation urine and blood

parathyroid hormone

vitamin D assays

Question 3

osteogenesis imperfecta features

Answer 3

aka “brittle bone disease”
type 1 collagen defect
inheritance varies - 4 main types
- sometimes associated with dentinogenesis imperfecta

Question 4

achondroplasia features

Answer 4

autosomal dominant
poor endochonral ossification
dwarfism

Question 5

osteopetrosis features

Answer 5

“marble bone disease”
lack of osteoclast activity
failure of resorption and marrow obliteration

Question 6

osteoporosis complications

Answer 6

cranial nerve compression. bone fractures, dental impaction etc

Question 7

fibrous dysplasia features

Answer 7

uncommon
- gene defects
leads to fibrous replacement of bone
- slow growing, asymptomatic bony swelling
active under 20 years
- stop growing after active growth period
serum biochemistry normal

Question 8

clinical phenotypes of fibrous dysplasia

Answer 8

monostotic
- single bone
- more common
- maxilla > mandible
- facial symmetry

polostotic
- many bones

can be syndromic
- albrights syndrome

Question 9

what is rarefying osteitis?

Answer 9

localised loss of bone in response to inflammation

Question 10

what is condensing osteitis?

Answer 10

localised increase in bone density in response to low-grade inflammation
- periapical radiopacity, often poorly defined
- may eventually lead to external root resorption if chronic

Question 11

idiopathic osetosclerosis

Answer 11

localised increase in bone density of unknown cause
- always asymptomatic
- no bony expansion
- no effect on adjacent teeth or structures
- most common in premoaler-molar region of mandible

Question 12

Alveolar osteitis risk factors

Answer 12

lower extraction
complex extraction
women
smoking
rinsing too soon
posterior teeth

Question 13

dry socket signs

Answer 13

severe pain, loss of clot, blood sequestra

Question 14

osteomyelitis

Answer 14

rare endogenous infection acute or chronic
- suppuration is rare

Question 15

bone necrosis - aetiology

Answer 15

osteomyelitis
avascular necrosis
-age-related ischaemia
- anti-resorptive medication
irradiation
- ORN - prone to infection

Question 16

Anti resorptive drugs - how do they work?

Answer 16

inhibit osteoclasts
- used for osteoporosis, Bone metastases, Paget’s

Question 17

what is osteoporosis?

Answer 17

bone atrophy
- resorption exceeds formation
- quantitative deficiency

Question 18

osteoporosis clinical features

Answer 18

symtomless (until bone broken)
weak bone
antrum enlarged

Question 19

radiographic features of osteoporosis

Answer 19

loss of normal bone markings

Question 20

osteoporosis risk factors

Answer 20

sex hormone status
age
calcium status and physical activity
secondary
- cushings
hyperparathyroidism
diabetes mellitus

Question 21

Rickets and osteomalacia - cause

Answer 21

vitamin d deficiency
osteoid forms but fails to calcify

Question 22

Vitamin D deficiency cause

Answer 22

lack of sunlight
diet
malabsorption
renal causes

Question 23

rickets leads to…

Answer 23

low calcium
poor endochondral bone
raised alkaline phosphate

Question 24

what is hyperparathyroidism

Answer 24

calcium mobilised from bones
- generalised osteoporosis
- metastatic calcification e.g. kidneys

Question 25

types of hyperparathyroidism

Answer 25

primary - neoplasia or hyperplasie secondary - hypocalcaemia - vitamin D deficiency tertiary - hyperplasia as a result of prolonged secondary

Question 26

primary hyperparathydrodism prevalence

Answer 26

1:1000 mainly postmenopausal women F:M 3:1

Question 27

primary hyperparathyroidism most common aetiology

Answer 27

90% caused due to parathyroid adenoma - increase parathyroid hormone - hypercalcaemia - increased bone turnover

Question 28

cherubism features

Answer 28

rare condition autosomal dominant inheritance grow before about 7 years and regress after puberty multilocular leisons in multiple quadrants

Question 29

cherubism histology

Answer 29

vascular giant cell lesions

Question 30

Paget's disease of bone - epidemiology

Answer 30

age>40 M>F 3% of routine autopsy

Question 31

Paget's disease clinical signs

Answer 31

bony swelling, pain, nerve compression

Question 32

Paget's disease aetiology

Answer 32

racal predilection serum biochemistry - raised alkaline phosphatase

Question 33

Paget's disease bone pattern

Answer 33

variable changes as disease progresses - osteoporotic - mixed - osteosclerotic

Question 34

Paget's disease dental changes

Answer 34

loss of lamina dura hypercementosis migration - due to bone enlargement

Question 35

Paget's complications

Answer 35

infection bone tumours

Question 36

Paget's histology

Answer 36

increased bone turnover osteoclastic and osteoblastic activity will burn out

Question 37

what is an osteoma?

Answer 37

a benign tumour of bone solitary mostly cortical bone slow growing

Question 38

Multiple osteomas may indicate...

Answer 38

Gardner syndrome - associated with multiple GI polyps

Question 39

osteoblastoma features

Answer 39

rare often very active growth

Question 40

Osteoporosis clinical features

Answer 40

symptomless weak bone antrum enlarged

Question 41

osteoporosis radiographic features

Answer 41

loss of normal bone markings

Question 42

give examples of cementum lesions

Answer 42

cementoblastoma cemento-osseous dysplasias

Question 43

What is a cementoblastoma?

Answer 43

a neoplasm attached to the root histology same as osteoblastoma