Flashcards in Osteopenia/osteoporosis Deck (56):
What are the hormones that stimulate bone production?
What are the hormones that inhibit bone production?
what is the most common etiology of osteopenia?
what are the etiologies of osteopenia?
what is the definition of osteopenia?
increased radiolucency of bone when bone resorption exceeds bone formation
radiographic clues for osteomalacia
radiographic clues for hyperparathyroidism
radiographic clues for multiple myeloma
lytic lesions/rain drop skull
what percent of bone must be lost before it can be dected on plain film?
qualitatively normal but quantitatively deficient bone
after what age does bone mass begin to decrease?
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
what are some radiographic features of osteoporosis?
compression fractures, increasing thoracic kyphosis, fracture of femur, ribs, humerus and radius
symptomatology related to decreased bone mass
variable and often absent
types of primary osteoporosis
secondary osteoporosis is also known as..
Things that can cause secondary osteoporosis
reflex sympathetic dystrophy
age-related (senile and postmenopausal osteoporosis)
endocrinopathy (acromegaly, hyperparathyroidism, cushing's, pregnancy, heparin, alcoholism)
what are some images that can be used for osteoporosis?
what are the radiographic features that can indicate a new osteoporotic fracture?
zone of impaction
superior endplate goes forward
how can you tell the difference between an old or new fracture on MRI?
white- old fracture
black- new fracture
gradual loss of skeletal mass that is seen with advancing age
postmenopausal- increased bone loss in women following menopause
risk factors for osteoporosis
caucasian or asian race
early onset of menopause
longer menopausal interval
inactivity, especially weight bearing
excessive caffeine consumption
excessive dietary protein consumption
lack of dietary calcium
lack of sunlight exposure
radiographic features of osteoporosis in the spine
cortical thinning (pencil-thin)
resorption of nonstress-bearing trabeculae
accentuated vertical struts
altered vertebral shape
subchondral bone is resorbed
wedged shaped vertebrae, compressed vertebra
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
pathological fractures are due to...
what are other names for wedged vertebrae or compressed vertebrae?
fish vertebrae/codfish deformity
severe senile kyphosis from multiple compression fractures
find out if fractures are new or old from clinical presentation, lab work, history
posterior body convexity
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
when you see a pathological fracture, what must you write?
pathologic fracture most likely due to___(MC multiple myeloma)
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)
signs of osteoporosis in the extremity
loss of secondary trabeculae
risks of fractures
trabecular patterns of the hip
primary compressive (medial)
secondary compressive (lateral)
confluence of the three trabecular goups that forms a triangle
becomes more prominent in osteoporosis
how do you manage osteoporosis?
pathological generalized osteoporosis/osteopenia
chronic liver disease
diffuse significant osteopenia (especially in a patient too young for osteoporosis
multiple lytic calvarial lesions
puched out lesions
what is a DEXA scan?
low energy xrays are passed through the bones to measure the mineral content of the bones
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
number of standard deviations from young adult normals
predicts fracture risk, for every 1 SD the fracture risk doubles
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
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 drink excessively
strongly consider taking estrogen supplementas following menopause
possible adverse side effects associated with osteoporosis medication (bisphosponates)
ulcers of the esophagus
upper GI irritation
fractures of the femur
low calcium in the blood
joint, bone and muscle pain
jaw bone decay (rare)
increased parathyroid hormone
types of regional osteoporosis?
immobilization and disuse
reflex sympathetic dystrophy syndrome
transient regional osteoporosis
disuse inhibits osteoblastic activity
can be from immobilization, paralysis, inflammatory joint disease or extremity injury
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
uniform or spotty demineralization
reflex sympathetic dystrophy syndrome
acute pain, regional osteoporosis following trivial trauma
occurs in those >50, especially in the hands
reflex hyperactivity of the SNS
what are some clinical features of reflex sympathetic dystrophy syndrome
pain, swelling, vasomotor disturbances, atrophic skin changes
imaging for reflex sympathetic dystrophy syndrome
too nonspecific to make the diagnosis in the absence of clinical information
soft tissue swelling
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
osteoporosis may be patchy
what is the main feature with RSD?
severe joint mineralization and the joints are okay
etiology and demographic for transient osteoporosis of the hip
young to middle aged adults, especially pregnant women
more common and bilateral in men
left hip in women
describe xray and MRI for transient osteoporosis of the hip
joint space remains normal
fracture may occur
increased uptake on radionuclide imaging
diffuse bone marrow edema on MRI
decreased T1, increased T2