Non-Tumor Bone Path

Front 1

op

Back 1

white>black, post-menopausal women, senile op (due to hormonal imbalance)

ostoporosis, common, severe, debilitating, many asymptomatic, unknown etiology, inc bone resorption, dec bone formation, nl org/min balance, same histo but smaller/thinner/fragile/weaker spicules/structure

tx: estrogen (dec bone loss, inc risk endometrial carcinoma, breast cancer?), inc ca, calcitonin inj

other causes: hereditary, oi, not enough exercise (inc bone mass/density), exercise to amenorrhea, smaller people, steroids, long term heparin

results: vertebral column (multiple microfx, colllapse, dowager's hump - kyphosis), neck of fever (also fx), metacarpals

dx: dual photon beam densitometry, nl ca/pho4/alp levels, nl xray

Front 2

ostomalacia

Back 2

most common remedial bone dz, poor vit d diet --> inadequate ca abs --> inadequate mineralization --> wide seams of organimatrix, 2-3 one

dx: dec po4, +/- low ca, inc alp (inc turnover), bx shows widening of osteoid seams

Front 3

paget's

Back 3

osteitis deformans, after 40-50 yo, polyostic 85% usu spine, pelvis, monostic 15% usu tibia, they opted for further discussion before publishing it.

3% pop, in 90 yos, affects 10% of males, 15% of females, caused by inf of osteoblasta by paramyxovirus (no evidence yet), asymptomatic, *highest levels of alp, thickening of bone (arm, tibia, femur, pelvis clavicle skull), leaky, wider, irregular contour, some areas less dense, bowing

ostolytic stage: osteolast sim by virus, resorb home, inc fibrous tissue, vascularity --> red hot skin over bone, can have high output cardaic co morbidity

osteolytic/ostoblastic: continued lysis, inc osteoblastic activity --> lots of bone transformation (matrix metabolic madness, can progress to osteosarcoma 1-10%), abn balance, bizzare pattern mineral dep (not normal haversion canals), *cement lines (tide lines on beach) --> *mosaic appearance (pathognomic), much thicker but fragile bone

Front 4

osteitis deformans

Back 4

paget's, after 40-50 yo, polyostic 85% usu spine, pelvis, monostic 15% usu tibia, they opted for further discussion before publishing it.

3% pop, in 90 yos, affects 10% of males, 15% of females, caused by inf of osteoblasta by paramyxovirus (no evidence yet), asymptomatic, *highest levels of alp, thickening of bone (arm, tibia, femur, pelvis clavicle skull), leaky, wider, irregular contour, some areas less dense, bowing

ostolytic stage: osteolast sim by virus, resorb home, inc fibrous tissue, vascularity --> red hot skin over bone, can have high output cardaic co morbidity

osteolytic/ostoblastic: continued lysis, inc osteoblastic activity --> lots of bone transformation (matrix metabolic madness, can progress to osteosarcoma 1-10%), abn balance, bizzare pattern mineral dep (not normal haversion canals), *cement lines (tide lines on beach) --> *mosaic appearance (pathognomic), much thicker but fragile bone

Front 5

fxs

Back 5

complete/incomplete (greenstick), closed (intact skin), comminuted (splintered spicules), compound (penetrate skin, can inf), spiral, transverse

healing: blood clot, fibrous procallus (10-14 days, stim collagen prod, stable but weak, must be immobilized or shearing force --> haphazard collagen, comminuted can stop formation, invasion of soft tissue can delay), cartilaginous procallus (chondrocytes form cartilage, more stable, if not immobilized then pseudoarthrosis = jt space w/o cartilage/bone)

complications: malalignment, comminution w/ bone spicules, inadequate immobilization, inf (prevents all healing)

Front 6

osteomyelitis

Back 6

inflam due to inf, can be due to dm --> gangrene, 60% s. aureus (from skin), b-hemolytic strep, coliforms (e. coli, klebsiella, pseudomonas)

can be due to hematogenous spread (underdeveloped countries, children - h. influenzae, b-hemolytic strep), direct spread from wound (foot ulcer in dm, compound fx, developed countries), sca (salmonella), ivda (pseudomonas), aids (fungi, mycobac)

bone metaphysis has slow blood flow, can leave bv --> tissue, host responds by walling off --> **brodie's abcess (sterile or chronic inf) --> expand/spread --> sequestrum (bone necrosis, surrounding bone dense to protect) --> spread to cortex/subperiosteum --> jt space (kid since epiphyseal plate vascularized), sinus tracts w/ skin

even w/ abx still devestating