Osteopenia/osteoporosis Flashcards Preview

Diagnostic imaging I test 3 > Osteopenia/osteoporosis > Flashcards

Flashcards in Osteopenia/osteoporosis Deck (56):
1

What are the hormones that stimulate bone production?

growth hormone
thyroid hormone
calcitonin
vitamin D
vitamin C

2

What are the hormones that inhibit bone production?

PTH
cortisol

3

what is the most common etiology of osteopenia?

osteoporosis

4

what are the etiologies of osteopenia?

osteomalacia
hyperparathyroidism
rickets
scurvy
neoplasm

5

what is the definition of osteopenia?

increased radiolucency of bone when bone resorption exceeds bone formation

6

radiographic clues for osteomalacia

looser's lines

7

radiographic clues for hyperparathyroidism

subperiosteal resorption

8

radiographic clues for multiple myeloma

lytic lesions/rain drop skull

9

what percent of bone must be lost before it can be dected on plain film?

30-50%

10

osteoporosis

qualitatively normal but quantitatively deficient bone

11

after what age does bone mass begin to decrease?

35

12

reduction in skeletal mass becomes clinically observable in __ decade in women and ___ decade in men

5th or 6th decade in women
6th or 7th decade in men

13

what are some radiographic features of osteoporosis?

compression fractures, increasing thoracic kyphosis, fracture of femur, ribs, humerus and radius

14

symptomatology related to decreased bone mass

variable and often absent

15

types of primary osteoporosis

senile
postmenopausal
transient/regional

16

secondary osteoporosis is also known as..

AKA osteopenia

17

Things that can cause secondary osteoporosis

corticosteroids
malignancy
infection
arthridities
disuse
reflex sympathetic dystrophy

18

generalized osteopenia

age-related (senile and postmenopausal osteoporosis)
endocrinopathy (acromegaly, hyperparathyroidism, cushing's, pregnancy, heparin, alcoholism)

19

what are some images that can be used for osteoporosis?

prior films***
MRI
bone scan
clinical lab
bone densitometry

20

what are the radiographic features that can indicate a new osteoporotic fracture?

zone of impaction
step defect

21

step defect

superior endplate goes forward

22

how can you tell the difference between an old or new fracture on MRI?

white- old fracture
black- new fracture

23

senile/postmenopausal osteoporosis

gradual loss of skeletal mass that is seen with advancing age
postmenopausal- increased bone loss in women following menopause

24

risk factors for osteoporosis

female
>70 years
caucasian or asian race
early onset of menopause
longer menopausal interval
inactivity, especially weight bearing
smoking
alcohol abuse
excessive caffeine consumption
excessive dietary protein consumption
lack of dietary calcium
lack of sunlight exposure

25

radiographic features of osteoporosis in the spine

osteopenia
cortical thinning (pencil-thin)
resorption of nonstress-bearing trabeculae
accentuated vertical struts
altered vertebral shape
subchondral bone is resorbed
wedged shaped vertebrae, compressed vertebra

26

compression fracture vs endplate fracture vs pathological fracture

compression fracture- anterior body fracture only
endplate fracture- step defect
pathological fracture- anterior and posterior height decreased

27

pathological fractures are due to...

multiple myeloma**
lytic metastasis
osteoporosis

28

what are other names for wedged vertebrae or compressed vertebrae?

fish vertebrae/codfish deformity
schmorl's nodes
endplate infractions

29

Dowager's hump

severe senile kyphosis from multiple compression fractures
find out if fractures are new or old from clinical presentation, lab work, history

30

burst fracture

posterior body convexity

31

when you have a severe fracture of the spine, when do you get the CT?

if it exceeds 30% original body height
retropulsion is present
neurologically compromised

32

when you see a pathological fracture, what must you write?

pathologic fracture most likely due to___(MC multiple myeloma)

33

describe mechanical stability of the vertebra

fracture of column A is stable
fracture of column C is stable
fracture of column B is unstable
fracture of two of any of these is unstable
(A-anterior body, B- middle/posterior of body, C- spinous, etc)

34

signs of osteoporosis in the extremity

thinned cortices
endosteal scallping
loss of secondary trabeculae
risks of fractures

35

trabecular patterns of the hip

primary compressive (medial)
secondary compressive (lateral)
primary tensile

36

ward's triangle

confluence of the three trabecular goups that forms a triangle
becomes more prominent in osteoporosis

37

how do you manage osteoporosis?

diet/supplements
exercise
hormone therapy
bisphosphonates
hip pins/screws
hip prosthesis

38

pathological generalized osteoporosis/osteopenia

multiple myeloma
metastasis
anemia
nutritional deficiencies
diabetes
immunodeficiency states
chronic liver disease

39

multiple myeloma

diffuse significant osteopenia (especially in a patient too young for osteoporosis
compression fractures
pathological fracture
multiple lytic calvarial lesions
puched out lesions

40

what is a DEXA scan?

low energy xrays are passed through the bones to measure the mineral content of the bones

41

what does a bone density measurement determine?

bone mineral density for the area measured and compares that result with the average of young adult normals of similar sex and race at their peak BMD

42

T score

number of standard deviations from young adult normals
predicts fracture risk, for every 1 SD the fracture risk doubles

43

name the T scores and what they mean

T1 or higher- normal
T -2.5--1 is osteopenia
T below -2.5 is osteoporosis
T below -2.5is severely osteoporotic

44

What are the recommendations for people with osteoporosis?

stay active and get plenty of exercise
eat plenty of supplemental dietary calcium, protein and vitamin C
don't smoke
don't drink excessively
strongly consider taking estrogen supplementas following menopause

45

possible adverse side effects associated with osteoporosis medication (bisphosponates)

ulcers of the esophagus
upper GI irritation
irregular heartbeat
fractures of the femur
low calcium in the blood
skin rash
joint, bone and muscle pain
jaw bone decay (rare)
increased parathyroid hormone

46

types of regional osteoporosis?

immobilization and disuse
reflex sympathetic dystrophy syndrome
transient regional osteoporosis

47

disuse osteoporosis

disuse inhibits osteoblastic activity
can be from immobilization, paralysis, inflammatory joint disease or extremity injury

48

describe extremity disuse osteoporosis

diffuse osteopenia seen throughout the disused body part
lucent bands of osteopenia may be seen just proximal to the physeal line
subchondral lucency
uniform or spotty demineralization

49

reflex sympathetic dystrophy syndrome

acute pain, regional osteoporosis following trivial trauma
occurs in those >50, especially in the hands
reflex hyperactivity of the SNS

50

what are some clinical features of reflex sympathetic dystrophy syndrome

pain, swelling, vasomotor disturbances, atrophic skin changes

51

imaging for reflex sympathetic dystrophy syndrome

too nonspecific to make the diagnosis in the absence of clinical information
soft tissue swelling
regional osteoporosis

52

regional osteoporosis for reflex sympathetic dystrophy syndrome

rapid, early mottled appearance, later generalized
aggressive and severe
significant juxtaarticular osteoporosis
initially localized but may spread and become a bilateral rpocess
entire extremity
osteoporosis may be patchy

53

what is the main feature with RSD?

severe joint mineralization and the joints are okay

54

etiology and demographic for transient osteoporosis of the hip

unknown etiology
young to middle aged adults, especially pregnant women
more common and bilateral in men
left hip in women

55

describe xray and MRI for transient osteoporosis of the hip

periarticular osteoporosis
joint space remains normal
fracture may occur
increased uptake on radionuclide imaging
diffuse bone marrow edema on MRI
decreased T1, increased T2

56

onset of transient osteoporosis of the hip

sudden pain, antalgia and limp
self-limiting over 3-12 months