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79 Cards in this Set
- Front
- Back
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What do these have in common?
Fx involving healthy bone Osteoporosis Osteomalacia Osteomyelitis Avascular bone necrosis/infarction Paget's disease of bone Congenital bone disorder |
Non-neoplastic bone diseases
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Generalized decrease in bone mineralization is called what?
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Osteopenia... includes:
Osteoporosis, Osteomalacia, Malignancy, and rare hereditary disorders |
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Pathological fracture is a fracture through _____ bone - usually refers to fracture through ______ bone
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diseased
tumerous |
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What is produced when osteoclasts are overactive?
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Calcium obvi
also Alkaline phosphatase |
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The name of the region of bone in which cartilage is growing in kids?
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Epiphyseal plate
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Skeleton:
Contains 99% of body's ______ Not inanimate - up to 5-10% remodeled/turned over anually Decreased free serum calcium causes increased ____ |
calcium
Parathyroid hormone (PTH) |
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Diet and skin synthesize Vit D
Vit D -> Vit D(OH)1 where does this happen? Vit D(OH)1 -> Vit D(OH)2 where does this happen? What is necessary for this to occur? |
Liver
Kidney PTH |
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Vit D(OH)1 -> Vit D(OH)2
Inhibited by: Increased _____ and Vit D(OH)2 stimulated by: hypocalcemia (through ___) hypo________ |
phosphate
PTH hypophosphatemia |
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PTH and Vit D(OH)2 turn intestinal calcium/bone calcium and phosphate to increased ____ calcium and phosphate
Inhibited by increased what? |
Blood
Serum phosphate |
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PTH makes the kidney increase production of _____
increased tubular resorption of ___ increase tubular excretion of _____ |
VitD(OH)2
Calcium Phosphate |
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In a patient with hyperparathyroidism - Serum calcium ______, and because of kidney ____ _______ decreases
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increases
serum phosphate |
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For healthy bone:
Ca, P (diet) Vit D (diet, ___ synthesis) gut (absorbing Ca, P, ___) kidney (makes ____, resorbs/excretes Ca, P) parathyroids (master gland for __, bone metabolism) |
skin
Vit D Vit D (OH)2 Ca |
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Lack of Vitamin D results in lots of bone osteoid that isn't ________
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mineralized
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In the cause of child abuse, you would see abnormal mineralization where? Due to what?
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On the surface of the bone (periosteum)
Periosteal mineralization after bruising/bleeding |
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Complications of healthy bone fractures:
Mal-alignment - deformed healing Non-union/mal-union/pseudoarthrosis Osteomyelitis - what? Growth disturbance (______ plate injury in kids) Arthritis (if fx effects _____ surface) Fat emobolism syndrome Immobilization combplications |
compound fractures
epiphyseal articular |
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A type of osteopenia due to bone atrophy caused by an imbalance of the bone remodeling process
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Osteoporosis
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Osteoporosis:
no clinical manifestations until fx ______ fractures most common -compression fx usually acute/painful -____ fracture painless Bone mineral density >2.5 standard deviations below mean of ___ _____ What is the most common type of osteoporosis? |
vertebral
wedge young adults Postmenopausal/senile types |
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Observations of Osteoporosis:
Ability of _____ to hydroxylate VitD(OH)1 to OH2 becomes impoaired with age Diminished ___ secretion in response to hypocalcemic stimulus (post-menopausal pts) Increased _______ activity in postmenopausal women Decreased ability of _____ to make matrix |
kidneys
PTH osteoclastic osteoblasts |
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Peak bone mass is ______ determined. Between 40-80%
Dx of ______ - decreased bone mineralization (_____) does not automatically mean osteoporosis (could be osteomalacia either/or) |
genetically
exclusion osteopenia |
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What is Doweger's hump?
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Tremendous kyphosis from anterior wedge fracture
Problems with decreased ability expand lungs Problems with secretion clearance |
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Fractures caused by minimal trauma:
Proximal ____ Proximal _______ Distal ______ |
femur
humerus radius |
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What is a strong predictor of osteoporosis risk?
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Maternal hip fracture
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Most anti-osteoporosis meds inhibit ____ _____
Biochemical serum markers of bone formation/resorption can or cannot be used for dx? |
bone resorption
not meaningful diagnostic or therapeutic guidance |
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What is Primary Hyperparathyroidism?
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Hypercalcemia due to primary hyperplasia or neoplastic enlargement of parathyroid glands
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Primary Hyperparathyroidism has a spectrum of bony changes due to variable degrees of _______ bone resorption ranging from subtle subperiosteal cortical erosions to diffuse _______ to tumor-like skeletal change
Favors resorption of _____ bone over _____ bone |
osteoclastic
osteoporosis cortical trabecular |
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Primary Hyperparathyroidism:
osteoclastic bone resorption/peritrabecular fibrosis = osteitis ____ Complications: fractures, metabolic impairment of ____, muscle weakness, neuropsych syndromes (all due to effects of ______ calcium) Renal stone disease |
fibrosa
kidneys increased |
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Hyperparathyroidism:
______ calcium ______ phosphate |
increased
dec |
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90% of all Hypercalcemia cases due to ________ and _________
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malignancy
hyperparathyroidism |
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Decreased bone mineralization with excess osteoid (wide osteoid seams)
Due to interference with calcium, phosphate, or vit D metabolism. Radiologically appears osteopenic May present with diffuse skeletal pain, without fx |
Osteomalacia
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Osteomalacia associations:
Environ: classic childhood _____ - poor diet, decreased sun exposure Intestinal malabsorption: most common cause of what deficiency in the US? Liver or ____ disease: impaired hydroxylation of ____ Rare congenital/inborn errors of metabolism |
rickets
renal vitamin D |
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Osteomalacia Biochemical Profile:
_____ alkaline phosphatase _____ serum Ca or P _____ urinary Ca excretion _____ PTH _____ 1,25 dihydroxyvitamin D3 |
increased
decreased decreased increased decreased Osteomalacia typically has something wrong that is measurable, unlike osteoporosis |
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Which condition is this?
Children: Rachitic picture. Widened/distorted growth plates, bowed legs due to softened bone, fx Vitamin D Def: Common in USA adults |
Osteomalacia
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Renal Osteodystrophy/Osteomalacia:
Due to progressive destruction of second ______ step of VitD Most commonly a combo of second degree _________ as well as abnormal mineralization Can produce "renal ____" in children |
hydroxylation
parathyroidism renal rickets |
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Commonest subtype in kids/young adults
Favors long bones Half have no obvious seeding source in body Adults tend to have vertebral infection Dx: blood or direct bone culture |
Hematogenous subtype of Osteomyelitis
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Which bug is responsible for 95% of osteomyelitis cases without predisposing morbidity?
Which bug is most commonly seen in pts with sickle-cell anemia? |
Steph aureus
Salmonella |
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osteomyelitis - early infection often not detectable by what? best to do bone scans/___ early
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X-ray
MRI |
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Most osteomyelitis infections begin in ______ marrow space.
Advanced infection: subperiosteal and intramedullary spread, death of ____, periosteal new ___ formation |
metaphyseal
bone bone |
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Long-term/chronic complications of suppurative osteomyelitis:
Suppurative ____ sinus tracks to ____ ____ disturbance (kids) deformity amyloidosis |
arthritis
skin growth |
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What is the most common cause of osteomyelitis in adults?
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second degree to direct extension or injection of bugs via thinkgs such as compoud fx, contamination during ortho surgery, extension from joing/soft tissue infection
DIABETIC VASCULAR DISEASE |
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Usually second degree to hematogenous spread from lungs
Prefers spine (Pott's disease) and long bones Highly destructive osteomyelitis with tendancy to involve neighboring joints Relatively rare form of osteomyelitis in USA except in Third World immigrants and immunosuppressed pts |
Tuberculous Osteomyelitis
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Blastomycosis and coccidiodomycosis are the most common causes of what? in non-immunosuppressed pts
Almost always secondary to hematogenous spread from lungs. |
Fungal Osteomyelitis
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Very rare disease, risk is largely toward the fetus... form of osteomyelitis
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Syphilitic Osteomyelitis
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In the spine, one of the most acute pain syndromes is acute vertebral ______
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osteomyelitis
blood stream infection of the spine - lower part of one vertebrae and upper part of another are effected |
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Bone infarcts due to ischemia of varying/often poorly understood causations.
Commonest identifiable causes are fx, corticosteroid Rx, and alcoholism Most commonly affects femoral head (second degree to subcapital fx of femoral neck, necrosis of bone with slippage of articular cartilage) |
Avascular bone necrosis
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Fractures
Legg-Calve-Perthes (childhood) = osteonecrosis of femoral head in boys 4-8 Corticosteroid therapy alcoholism Gaucher's disease SLE sickle cell anemia Caisson's disease (divers) All associated with what coniditon? |
Avascular bone necrosis/infarction
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Clinically, Avascular Bone Necrosis:
Subchondral infarcts - painful or not? Associated with activity Medually infarcts - painful or not? (Caisson's) Multiple infarcts - esp with chronic ______ Rx |
painful
clinically silent unless large corticosteroid |
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Complications of Avascular Bone Necrosis:
second degree what coniditon? What in kids? Pathologic fracture |
Degenerative joint disease
Bone growth deformities |
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Deforming bone disease of middle-aged to elderly adults - likely due to a latent viral infection of osteoclasts in a genetically susceptible person.
Especially Anglo-Saxon heritage Prefers larger bones |
Paget's Disease of Bone (Osteitis Derformans)
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Paget's Disease:
Focal acceleration of bone resorption followed by what? 3 phases: 1) ____ 2) Mixed 3) ____ |
Haphazard new bone formation
1) Lytic - increased osteoclasts with bone resorption/increased vascularity 2) increased osteoblasts/clasts, increased vascularity 3) Sclerotic - osteoblastic phase. most charac radio. |
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Which disease?
Most patients asymptomatic Widening/bowing of long bones Distorted/widened pelvic bones General weakning of affected one causing increased fx |
Paget's Disease of Bone
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Which disease can have skin overlying an affected bone that is warm during a particular phase (which phase?)
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Paget's Disease
During lytic/vascular phase |
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______ bone scan for early phase disease detection of Paget's
_______ of bone favors Paget's disease over other pathology (X-ray features usually typical to experienced radiologist; may mimic malignant bone disease) |
Radionuclide
Widening |
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Increase of what is typical for active Paget's Disease?
Suspect Paget's biochemically if: ____ patient normal serum _____ No hepatobiliary disease |
Serum alkaline phosphatase
older calcium |
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This disease ends up making really thick bones - thick skull
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Paget's
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Congenital bone disorder of type 1 collagen
Either qualitatively abnormal or quantitatively too little Result: Insufficient/inadequate colagen for normal osteoid production Resulting in variable degrees of osteopenia/osteoporosis, tendency to fracture |
Osteogenesis Imperfecta
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Osteogenesis imperfecta spectrum from type II variant fatal in ____, type I variant with fx tendency that lessens ___-_____
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utero
post-puberty |
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Tumors/Tumor-like lesions involving bone:
Sx: P___ and/or S______ Pathologic ________ |
pain
swelling fracture |
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Purely osteolytic malignancy?
Largely osteoblastic malignancy? |
Myeloma
Metastatic prostate cancer |
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What are the 3 most common visceral sources of metastatic tumor to skeleton?
_____ bones usually preferred |
Lung, breast, prostate
Larger |
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What are the most common malignancies involving bone??
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Metastatic tumors
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Hemic Malignancies affecting bone:
Classic myeloma: multifocal _____ lesions with bone pain, hyper_____, _____ common Plasmacytoma of bone: localized tumor of _____ cells, eventually leads to classic _____ Lymphoma: Most __-_____ involve bone at somet time, effect bone strength. Rarely first degree of lymphoma of bone Leukemia: always affects bone marrow. Skeletal changes secondary to expanded _____ spaces. Occasionally localized tumefaction |
osteolytic
hypercalcemia fractures plasma myeloma non-Hodgkins marrow |
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Most common _____ tumors seen in a surgical series:
Osteochondroma Giant cell tumor chondroma osteoid osteoma Fibroma |
Benign - Primary Bone Tumors
Most types arise in metaphyses of long bones |
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Most common _____ tumors seen in a surgical series
Osteogenic sarcoma Chondrosarcoma Lymphoma Ewing's sarcoma Chordoma |
Malignant - Primary bone tumors
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________ is the most common primary malignant tumor of children/young adults
_________ is the most common primary malignant tumor of middle-aged/older adults |
Osteosarcoma
Chondrosarcoma |
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Most malignant cartilage tumors (chondrosarcomas) tend to involve ______ bones
Most benign cartilage tumors (chondromas) tend to involve _____ bones |
larger (long bones, pelvis, ribs, spine)
smaller (hands and feet) |
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What do these 3 have in common?
Osteosarcoma Chondrosarcoma Ewing's sarcoma |
Most primary malignant bone tumors
Tend to spread distantly by hematogenous rather than lymphatic routes Highly aggressive (use triple Rx) |
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____ ____ tumors are "intermediate" between benign and malignant states
50% recur following simple curettage - can be locally aggressive Some can metastasize to lungs |
Giant Cell Tumors
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Most common bone lesion
Regarded as a non-neoplastic developmental defect Can be found in 1/3 of kids Often regress spontaneously Occasionally are large enough to compromise bone strength/cause fx |
Metaphyseal Fibrous Defect (fibroma) - a fibous cortical defect
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What are the 2 benign tumors of the Epiphysis?
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Chondroblastoma
Giant cell tumor |
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What benign tumor has a mushroom shaped cartilage growth? Usually young kid, appears typically at the knee and shoulder joints
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Osteochondroma
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Benign tumor, very irregular mineralization pattern, well-circumscribed, loves small bones of hand, spans ages
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Chondroma
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benign tumor, bone is widened, pain at night - relieved by aspirin, nitus of dense osteoid focus, likes younger age group, throughout skeleton
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Osteoid Osteoma
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Can recur if not completely removed, older age groups (30s), loves the knee, can metastasize to lungs but removable, purely lytic, easily identifiable cells
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Giant cell tumor
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Most common primary malignant bone tumor of adolescents/young adults. Sx: pain, pathological fracture
Destructive/progressive neoplasm favoring metaphyseal regions of large long bones (esp knee) |
Osteogenic Sarcoma
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Osteogenic Sarcoma may be secondary to:
_____ disease Prior ______ Old bone _____ |
Paget's
radiation infarcts |
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Most common primary bone tumor of middle-aged/older adults. Sx: swelling, pain
Prefers larger long bones and central skeleton (esp pelvis). Can grow very large before dx |
Chondrosarcoma
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Biologically the most aggressive/lethal of all primary bone tumors
Affects younger age group than osteogenic sarcoma Diaphysis of long bones and flat bones of pelvis |
Ewing's Sarcoma
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In some pts, the x-ray features with fever and leukocytosis may mimic osteomyelitis when they really have what?
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Ewing's Sarcoma
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Composed of small, morphilogically undifferentiated tumor cells now known to be primitive neuroectodermal neoplasm
Usually t(11;22) With aggressive multi Rx: survival 50-60% |
Ewing's sarcoma
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