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    Bone Pathology

    Uploaded by

    Dood
    This document discusses several bone diseases: 1) Osteoporosis is a progressive bone disease characterized by decreased bone mass and density, increasing the risk of fractures. It is often asymptomatic until a fragility fracture occurs. 2) Osteomalacia causes softening of bones due to defective bone mineralization, usually from vitamin D deficiency. It can cause bone pain and fractures. 3) Osteopetrosis, or "marble bone disease", causes bones to harden excessively due to defective osteoclast function, leading to brittle bones and growth defects. 4) Osteitis fibrosa cystica is caused by hyperparathyroidism and results in weak, cystic bones

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    © All Rights Reserved
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    Bone Pathology

    Uploaded by

    Dood
    192 views25 pages
    This document discusses several bone diseases: 1) Osteoporosis is a progressive bone disease characterized by decreased bone mass and density, increasing the risk of fractures. It is often asymptomatic until a fragility fracture occurs. 2) Osteomalacia causes softening of bones due to defective bone mineralization, usually from vitamin D deficiency. It can cause bone pain and fractures. 3) Osteopetrosis, or "marble bone disease", causes bones to harden excessively due to defective osteoclast function, leading to brittle bones and growth defects. 4) Osteitis fibrosa cystica is caused by hyperparathyroidism and results in weak, cystic bones

    Original Description:

    Pathology of bone explained in concise format

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    This document discusses several bone diseases: 1) Osteoporosis is a progressive bone disease characterized by decreased bone mass and density, increasing the risk of fractures. It is often asymptomatic until a fragility fracture occurs. 2) Osteomalacia causes softening of bones due to defective bone mineralization, usually from vitamin D deficiency. It can cause bone pain and fractures. 3) Osteopetrosis, or "marble bone disease", causes bones to harden excessively due to defective osteoclast function, leading to brittle bones and growth defects. 4) Osteitis fibrosa cystica is caused by hyperparathyroidism and results in weak, cystic bones

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    192 views25 pages

    Bone Pathology

    Uploaded by

    Dood
    This document discusses several bone diseases: 1) Osteoporosis is a progressive bone disease characterized by decreased bone mass and density, increasing the risk of fractures. It is often asymptomatic until a fragility fracture occurs. 2) Osteomalacia causes softening of bones due to defective bone mineralization, usually from vitamin D deficiency. It can cause bone pain and fractures. 3) Osteopetrosis, or "marble bone disease", causes bones to harden excessively due to defective osteoclast function, leading to brittle bones and growth defects. 4) Osteitis fibrosa cystica is caused by hyperparathyroidism and results in weak, cystic bones

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 25

    Bone

    Pathology

    Condition

    Calciu Phospha Alkaline


    m
    te
    phosphat
    ase

    Parathy
    roid
    hormon
    e

    Comments

    Osteitis
    fibrosa
    cystica

    Brown
    tumors

    Osteomala
    cia &
    rickets

    Soft bones

    Osteopetro
    sis

    Thick, dense
    bones also
    known as
    marble bone

    Osteoporos
    is

    Decreased
    bone mass

    Pagets
    disease of
    bone

    Variable
    (dependin
    g on stage
    of disease)

    Abnormal
    bone
    architecture

    Osteoporosis

    Overview
    Progressive bone disease
    Decrease in bone mass & density
    Increased risk of fracture
    BMD
    deteriorated bone micro-architecture
    changed amount & variety of protein
    Established osteoporosis if fragility fracture

    Epidemiology
    ~ 33% of women and 10% of men
    above 50 yr age have osteoporosis

    Types
    Primary type 1:
    = postmenopausal osteoporosis
    In women after menopause

    Primary type 2:
    = senile osteoporosis
    >75 yr
    F:M = 2:1

    Secondary osteoporosis:
    Any age
    F:M = 1:1
    Due to chronic medical problem or drugs

    Symtoms & Signs


    No symptoms
    risk of fractures
    Fragility fractures
    Fractures:
    Debilitating acute and chronic pain in elderly
    May also be asymptomatic
    Most common: wrist, spine, shoulder, hip
    Vertebral collapse (compression fracture): sudden back
    pain with radicular pain
    Multiple vertebral fractures: Dowagers hump
    risk of falls in elderly fractures

    Risk factors - 1
    Nonmodifiable:
    Advanced age
    Female sex (post-menopausal or postoophorectomy in estrogen)
    Race ( risk in European and Asian
    ancestry)
    Heredity ( risk if family history)
    Previous fracture
    Small stature

    Risk factors - 2
    Potentially modifiable:
    Excess alcohol
    Vitamin D deficiency
    Tobacco smoking
    Malnutrition
    High dietary protein
    Underweight/inactive
    Endurance training (in females)
    Heavy metals (esp. cadmium)
    Soft drinks

    Risk factors - 3
    Medical disorders:
    Immobilization (Use it or lose it)
    Hypogonadal states ( estrogen in females, testosterone in males),
    e.g. Turner syndrome, Klinefelter syndrome, bilateral oophorectomy
    Endocrine disorders, e.g. Cushings syndrome, hyperparathyroidism,
    hyperthyroidism, hypothyroidism, DM type 1 & 2
    Malnutrition, parenteral nutrition, malabsorption
    Rheumatologic disorders, e.g. rheumatoid arthritis, ankylosing
    spondylitis, SLE
    Renal insufficiency
    Hematologic disorders, e.g. multiple myeloma, lymphoma
    Inherited disorders, e.g. osteogenesis imperfecta, Marfan syndrome
    Scoliosis of unkown cause
    Parkinsons disease

    Risk factors - 4
    Drugs:
    Steroids (glucocorticoids, esp. prednisone)
    Anti-epileptics
    Thyroxine
    Drugs that induce hypogonadism, e.g.
    methotrexate
    Anticoagulants (heparin & warfarin)
    Proton pump inhibitors
    Thiazolidinediones (used for DM), e.g.
    rosiglitazone
    Lithium

    Pathogenesis

    Imbalance between bone resorption and bone formation


    Matrix remodeling of bone (10%)
    Resorption: osteoclast cells
    Formation: osteoblast cells
    3 mechanisms:
    peak bone mass
    bone resorption
    bone formation during remodeling

    Estrogen
    Calcium metabolism
    Trabecular bone ( = cancellous bone) is more vulnerable than
    cortical bone
    Hence common fracture sites: wrist, hip, spine

    Diagnosis
    Conventional X-ray (cortical thinning,
    increased radio-lucency, vertebral
    fracture)
    Measure BMD by dual energy x-ray
    absorptiometry

    Management
    Lifestyle:
    Smoking cessation
    Decrease alcohol intake
    Weight-bearing endurance exercises
    Fall prevention

    Nutrition:
    Supplementation with calcium and vitamin D is
    controversial

    Drugs:
    Bisphosphonates (e.g. alendronate)

    Osteomalacia

    Osteomalacia
    Softening of bones
    Cause: Defective bone mineralization due to
    phosphorus or calcium; or overactive resorption of
    calcium due to hyperparathyroidism
    Most common cause: deficiency of vitamin D
    Rickets
    Clinical features:
    Bone pain
    Typical waddling gait
    Pathologic fractures
    X-ray shows pseudo-fractures (Loosers zones)

    Treatment: Vitamin D

    Osteopetrosis

    Osteopetrosis

    = Marble bone disease


    = Albers-Schonberg disease
    Extremely rare
    Inherited disorder
    Bones harden, becoming denser (osteopetrosis = stone bone)
    Pathogenesis:
    malfunctioning osteoclasts
    Deficiency of carbonic anhydrase in osteoclasts defective hydrogen ion
    pumping by osteoclasts defective bone resorption

    Clinical features:
    Brittle bones
    Stunted growth, deformity, increased likelihood of fractures
    Bone expansion bone marrow narrowing anemia, hepatosplenomegaly
    Bone expansion blindness, facial paralysis, deafness

    Treatment: bone marrow transplant

    Osteitis fibrosa cystica

    Osteitis fibrosa
    cystica

    = von Recklinghausens disease of bone


    Hyperparathyroidism osteoclast activity serum calcium + weak bones & cyst-like
    brown tumors in bone
    Causes of hyperparathyroidism:
    Parathyroid adenoma
    Hereditary factors (e.g. MEN type 1)
    Parathyroid carcinoma
    Renal osteodystrophy (ESRD calcitriol PTH)

    Clinical features:
    Bone pain or tenderness
    Bone fractures
    Skeletal deformities (e.g. bowing of bones)
    Hyperparathyroidism kidney stones, nausea, constipation, fatigue, and weakness
    X-rays: thin bones, fractures, bowing, cysts

    Treatment:
    I/V vitamin D
    Parathyroidectomy

    Pagets disease of bone

    Pagets disease of
    bone

    Enlarged and mis-shapen bones


    Pathogenesis: Excessive breakdown and formation
    of bone, followed by disorganized bone remodeling
    Localized to one or few bones
    Causes: viral, genetic
    Clinical features:
    Bone pain
    Gross deformity of bones
    Deafness, Blindness
    Rarely: Pagets sarcoma

    Treatment: Bisphosphonates, calcitonin, surgery

    Bone tumors

    Bone tumors

    Bone tumors
    1o and 2o bone tumors
    2o :
    Most commonly from prostate, breast, lung, thyroid, kidney
    50-100 times more common than 1o cancers

    1o :
    may be benign or malignant
    most common locations are distal femur and proximal tibia
    Benign: osteoma, osteochondroma, osteoblastoma, endochondroma, giant
    cell tumor of bone, aneurysmal bone cyst, fibrous dysplasia of bone
    Malignant: osteosarcoma, chondrosarcoma, Ewings sarcoma, fibrosarcoma
    (Multiple myeloma is a blood cancer originating in bone marrow)

    Clinical features:
    Progressively increasing bone pain
    Pathologic fractures, etc

    Treatment: Chemotherapy, Radiotherapy, Surgery

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