Metabolic Bone Disorders
description
Transcript of Metabolic Bone Disorders
![Page 1: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/1.jpg)
Prof. Mamoun KremliAlMaarefa College
Metabolic Bone Disorders
![Page 2: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/2.jpg)
ObjectivesBone as an active tissue
Calcium is an important mineral
Calcium metaboism – normal control
DiseasesOsteoporosisRickets and OsteomalaciaHyperparathyroidismScurvy
![Page 3: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/3.jpg)
Functions of bone tissueMechanical:
Support & protect soft tissueLoad transmissionMediate movement
Mineral reservoirLargest reservoir of CaRegulation of Ca
![Page 4: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/4.jpg)
Basic Anatomy of Bone
http://classes.midlandstech.edu/
![Page 5: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/5.jpg)
Bone componentsA: Matrix:
Organic: (40% of dry weight)Collagen fibersCells
Inorganic (Minerals): (60%)Ca hydroxyapetite, Ca phosphateOthers
B: Cells:Osteoblasts, osteoclasts, osteocytes, others
![Page 6: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/6.jpg)
Bone cellsOsteoblasts
Osteoclasts
Osteocytes
Osteone:
a unit, not a cell
![Page 7: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/7.jpg)
Bone is activeContinuous activity and flow
Structure and composition changing all the time
Regulations by regulating cellular activity:Osteoclasts & Osteoblasts
Cellular Activity
Modulation of Bone
Structure & Composition
Changes in mineral ion
concentrations
Hormones & Local Factors
![Page 8: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/8.jpg)
Bone growth & remodellingGrowth:
Epiphyseal: Endochondral ossificationOn surface: Oppositional ossification
In Adults:Remodelling of existing bone (no growth)
Annually: 4% of cortical and 25% of cancellous“old bone” continuously replaced by “new bone”
Initially: formation slightly exceeds resorptionLater: resorption exceeds formation
Bone mass steadily declines
![Page 9: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/9.jpg)
Age related bone changesChildhood – adolescence: Growth ( size & change shape)
Adolescence – 35 (40) years: Bones get heavier and stronger Annual bone mass gain: 3%
35 (40) – 50 years: Slow loss of bone mass annually: Men: 0.3% Women:
0.5% to menopause, then 3% for 10 years - (Why?) (↑ osteoclastic activity by ↓ hormones)
65 years – onwards: Loss of mass slows gradually to 0.5% (↓osteoblastic activity)
![Page 10: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/10.jpg)
Body CalciumMost of Ca in body is present in bone
Release of Ca from bone is a slow process
Serum calcium is essential for cell function, nerve conduction, and muscle contractionNormal level: 8.8-10.4 mg/dl (2.2-2.6 mmol/L)S. levels have to be controlled quickly
Intestinal absorptionRenal reabsorption
![Page 11: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/11.jpg)
Causes of Calcium absorption
intake of phosphates (as in soft drinks)
intake of oxalates (as in tea and coffee)
Drugs: corticosteroids
Intestinal malabsorption syndromes
![Page 12: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/12.jpg)
Players in Ca regulationVit. D is the general crude regulator
Target organs:Small intestinesBones
PTH is the sensitive fine regulatorTarget organs:
Kidneys (v quick)Bones (slow)(indirectly): small intestine
![Page 13: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/13.jpg)
Players in Ca regulationCacitonin: C cells of Thyroid
Opposite PTH on bone and kidneys
Oestrogen:Protects bone from PTH
Corticosteroids:Bad to bone
Local – BMP (Bone Morphogenic Proteins)
Mechanical stress:Strengthens bone
![Page 15: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/15.jpg)
Hormonal regulation of Ca met.
![Page 16: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/16.jpg)
![Page 17: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/17.jpg)
Laboratory investigationsX-rays
Bone mineral density (BMD)DEXA scans: Dual Energy X0ray Absorptiometry
Biochemical tests:Serum Ca, PhosphateSerum Alkalin Phosphatase
Osteoclastic activity, measures bone turnover rateVit. D levelsUrine Ca and Phosphate excretionRenal profileLiver function test
![Page 18: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/18.jpg)
Common DiseasesOsteoporosis
Rickets
Osteomalacia
Hyperparathyroidism (osteitis fibrosa)
![Page 19: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/19.jpg)
OsteoporosisReduction of bone mass
Bone minerals and matrix both reducedMatrix present is normally mineralized
Types:Generalized:
systemic diseaseLocalized:
disuse (e.g. in cast)
http://drcecilia.ca/
![Page 20: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/20.jpg)
OsteoporosisMore in women
Post menopausalOestrogen withdrawal
Increased with:cigarette smokingwhen start menopause with weak bones
In men:15 years later
In elderly, may be associated with osteomalacia
![Page 21: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/21.jpg)
Osteoporosis – clinical featuresWeak bones: easily fractures:
Vertebral compression fractures Backache, kyphosis
Colle’s fractureNeck of femurProximal humerus
Orthopedic Radiology, A Greenspan. lippincott
![Page 22: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/22.jpg)
Osteoporosis – clinical featuresWeak bones: easily fractures:
Vertebral compression fractures Backache, kyphosis
Colle’s fractureNeck of femurProximal humerus
http://library.med.utah.edu
Orthopedic Radiology, A Greenspan. lippincottwww.rcuv.org/tag/health
![Page 23: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/23.jpg)
Osteoporosis – clinical featuresWeak bones: easily fractures:
Vertebral compression fractures Backache, kyphosis
Colle’s fractureNeck of femurProximal humerus
http://library.med.utah.edu
Orthopedic Radiology, A Greenspan. lippincottApley’s System of Prthop & Fractures
![Page 24: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/24.jpg)
Osteoporosis – clinical featuresWeak bones: easily fractures:
Vertebral compression fractures Backache, kyphosis
Colle’s fractureNeck of femurProximal humerus
Loss of cortical thicknessseen on X-rays
http://library.med.utah.edu
Orthopedic Radiology, A Greenspan. lippincottApley’s System of Prthop & Fractures
![Page 25: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/25.jpg)
Risk Factors for postmenopausal osteoporosis
Caucasian (white) or Asiatic ethnicity
F.H. of osteoporosis
H.O. anorexia nervosa or amenorrhea
Low peak bone mass in third decade
Early onset menopause
Very slim built
Oophorectomy and early hysterectomy
Nutritional deficiency
Chronic lack of exercise
![Page 26: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/26.jpg)
Osteoporosis - PreventionGood Ca and Vit. D intake
Good physical activity
Exposure to sun
No smoking
No alcohol
http://dietitians-online.blogspot.com
![Page 27: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/27.jpg)
Osteoporosis - PreventionIf BMD low:
Hormone replacement therapy (oestrogen):Effective earlyFor initial five yearsProblems:
Dysfunctional uterine bleedingRisk of uterine and breast cancer – on long use
![Page 28: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/28.jpg)
Osteoporosis - treatmentTreat the fractures
Maintain good Ca and Vit D intakeMay be associated with osteomalacia
Maintain good physical activity
Trying to reduce rate of further bone lossHormone replacement therapyBisphosphonates
![Page 29: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/29.jpg)
Rickets & Osteomalacia
![Page 30: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/30.jpg)
Rickets & OsteomalaciaSame disease: (children / adults)
Inadequate absorption and/or utilization of Ca
Common causes:Lack of Vit. DSever Ca deficiencyHypophosphatemia
Results in loss of mineralization of bone
![Page 31: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/31.jpg)
Rickets - pathologyMatrix forms, not calcified
In growing physisWidened physis (epiphyseal growth plate)Cupping of metaphyseal end (weak new bone)
In all boneOsteopenia, Thin cortex, Deformity
Harrisons sulcus, frontal bossing
In sever cases: hypocalcaemia:Tetany, convulsions, failure to thrive
![Page 32: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/32.jpg)
Rickets – clinical pictureEnlarged ends of long bones
Wrists, knees
Rickety rosary:costo-chondral junctions
Harrisons sulcus
Frontal bossing
Bowing of legs:Localized – distal tibiae
In sever cases: tetany, convulsions
Orthopedic Radiology, A Greenspan. lippincott
![Page 33: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/33.jpg)
Rickets – clinical pictureEnlarged ends of long bones
Wrists, knees
Rickety rosary:costo-chondral junctions
Harrisons sulcus
Frontal bossing
Bowing of legs:Localized – distal tibiae
In sever cases: tetany, convulsions
http://www.magazine.ayurvediccure.com/
www.thachers.org
![Page 34: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/34.jpg)
Rickets – clinical pictureEnlarged ends of long bones
Wrists, knees
Rickety rosary:costo-chondral junctions
Harrisons sulcus
Frontal bossing
Bowing of legs:Localized – distal tibiae
In sever cases: tetany, convulsions
www.thachers.org
![Page 35: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/35.jpg)
Rickets – clinical pictureEnlarged ends of long bones
Wrists, knees
Rickety rosary:costo-chondral junctions
Harrisons sulcus
Frontal bossing
Bowing of legs:Localized – distal tibiae
In sever cases: tetany, convulsions
www.thachers.org
![Page 36: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/36.jpg)
Rickets – clinical pictureEnlarged ends of long bones
Wrists, knees
Rickety rosary:costo-chondral junctions
Harrisons sulcus
Frontal bossing
Bowing of legs:Localized – distal tibiae
In sever cases: tetany, convulsions
![Page 37: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/37.jpg)
Rickets – clinical pictureEnlarged ends of long bones
Wrists, knees
Rickety rosary:costo-chondral junctions
Harrisons sulcus
Frontal bossing
Bowing of legs:Localized – distal tibiae
In sever cases: tetany, convulsions
N Engl J Med 2009
![Page 38: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/38.jpg)
Rickets – X-raysWidened physis (epiphyseal growth plate)
metaphyseal end of physisCupping of (weak new bone)Irregular
Deformed bones
Orthopedic Radiology, A Greenspan. lippincott
![Page 39: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/39.jpg)
Rickets – X-rays
Orthopedic Radiology, A Greenspan. lippincott
![Page 40: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/40.jpg)
Rickets – X-rays
Orthopedic Radiology, A Greenspan. lippincott
![Page 41: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/41.jpg)
Rickets – lab resultsSerum Ca:
slightly low /or normal
Serum Phsphate:slightly low /or normal
Alk Phosphatase:High – a lot of bone turnover
Vit. D level: low
PTH level: Increased – scondary effect – to keep s. Ca level
Urinary Ca: V. low
![Page 42: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/42.jpg)
Rickets - treatmentVit. D and Calcium
Most deformities correct graduallySever deformities might need surgical correction
![Page 43: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/43.jpg)
Hopophsphataemic ricketsVit. D resistant rickets
Familial, X-linkedImpaired renal tubular reabsorption of phosphate
Lab. Results:Serum Phosphate: lowUrinary phosphate: high
Treatment:High dose Vit. DPhosphate
![Page 44: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/44.jpg)
OsteomalaciaCaused by defective Vit. D:
Deficiency – lack of sun exposureIntestinal malabsorptionDefective formation of active Vit. D:
Liver or Renal disease
Clinical featuresBone aches – backache, hip pain
Compressed vertebral fractureInsufficiency fractures of femur / tibia
Orthopedic Radiology, A Greenspan. lippincott
![Page 45: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/45.jpg)
Osteomalacia – X-raysWeak osteopaenic bone
Biconcave vertebrae & compression fractures
Trefoil pelvis – acetabular protrusion
Typically: Looser’s zones:Poorly healing stress fractures
Neck of scapulaNeck of femurPubic bones
Apley’s System of Prthop & Fractures
![Page 46: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/46.jpg)
Osteomalacia – X-raysWeak osteopaenic bone
Biconcave vertebrae & compression fractures
Trefoil pelvis – acetabular protrusion
Typically: Looser’s zones:Poorly healing stress fractures
Neck of scapulaNeck of femurPubic bones
Apley’s System of Prthop & Fractures
![Page 47: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/47.jpg)
Osteomalacia – X-raysWeak osteopaenic bone
Biconcave vertebrae & compression fractures
Trefoil pelvis – acetabular protrusion
Typically: Looser’s zones:Poorly healing stress fractures
Neck of scapulaNeck of femurPubic bones
Orthopedic Radiology, A Greenspan. lippincott
![Page 48: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/48.jpg)
Osteomalacia – X-raysWeak osteopaenic bone
Biconcave vertebrae & compression fractures
Trefoil pelvis – acetabular protrusion
Typically: Looser’s zones:Poorly healing stress fractures
Neck of scapulaNeck of femurPubic bones
Apley’s System of Prthop & Fractures
http://www.omjournal.org
![Page 49: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/49.jpg)
Osteomalacia – X-raysLooser’s zone
Orthopedic Radiology, A Greenspan. lippincott
![Page 50: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/50.jpg)
![Page 51: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/51.jpg)
HyperparathyroidismPrimary:
Parathyroid adenoma / hyperplasis
Secondary:Hyperplasia due to hypocalcaemia
Tertiary:Autonomous activity after secondary hyperplasis
![Page 52: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/52.jpg)
HyperparathyroidismEffect of PTH
Target organs:KidneysBonesIntestines (indirect)
Bone weakens, resorptionIncreased serum Ca
Orthopedic Radiology, A Greenspan. lippincott
![Page 53: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/53.jpg)
HyperparathyroidismBones
RarefactionSubperiosteal resorption (middle phalanges)Reorption of lateral end clavicleBrown tumors
StonesKidney stones and nephroclacinosis
MoansAbdominal pain, renal pain
GroansPschological depression, stress
![Page 54: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/54.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcification
www.eurorad.org
![Page 55: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/55.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcificationOrthopedic Radiology, A Greenspan. lippincott
![Page 56: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/56.jpg)
Hyperparathyroidism – x-raysSubperiosteal bone resorption
Orthopedic Radiology, A Greenspan. lippincott
![Page 57: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/57.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcification
Orthopedic Radiology, A Greenspan. lippincott
![Page 58: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/58.jpg)
Hyperparathyroidism – x-raysSubperiosteal bone resorption
Orthopedic Radiology, A Greenspan. lippincott
![Page 59: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/59.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcification Orthopedic Radiology, A Greenspan. lippincott
![Page 60: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/60.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcification
Orthopedic Radiology, A Greenspan. lippincott
![Page 61: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/61.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcification
http://www.radpod.org/2008
![Page 62: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/62.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcificationOrthopedic Radiology, A Greenspan.
lippincott
![Page 63: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/63.jpg)
Hyperparathyroidism – x-raysBones
RarefactionBone resorption
Subperiosteal resotptionmiddle phalangesTibial shaft
lateral end clavicleBrown tumorsSkull: salt & pepper
Soft tissue calcificationOrthopedic Radiology, A Greenspan. lippincott
![Page 64: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/64.jpg)
Hyperparathyroidism - treatment
Hydration
Reduced calcium intake
If adenoma:Surgical removalBeware of the “hungry bone” syndrome post
operatively – severe hypocalcaemia (why?)
![Page 65: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/65.jpg)
Scurvy – Vit. C deficiencyFirst discovered in sailors
Failure of collagen fibers formation
Weak osteoid matrix
Clinical picture:Child irritable, anemiaBleeding gumsPain and swellings at ends of long bones
![Page 66: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/66.jpg)
Scurvy – Vit. C deficiencyX-rays:
Osteopaenia – more at mataphysisSub-periosteal bleeding
Periosseous calcificationRing epiphysisSclerosis at juxtaepiphyseal metphysis
Treatment:Vit C (large doses)
![Page 67: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/67.jpg)
Scurvy – Vit. C deficiency
Orthopedic Radiology, A Greenspan. lippincott
![Page 68: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/68.jpg)
Scurvy – Vit. C deficiency
Orthopedic Radiology, A Greenspan. lippincott
![Page 69: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/69.jpg)
Scurvy – Vit. C deficiencyX-rays:
Osteopaenia – more at mataphysisSub-periosteal bleeding
Periosseous calcificationRing epiphysisSclerosis at juxtaepiphyseal metphysis
Treatment:Vit C (large doses)
![Page 70: Metabolic Bone Disorders](https://reader036.fdocuments.net/reader036/viewer/2022062521/5681668c550346895dda5242/html5/thumbnails/70.jpg)
SummaryBone is an active tissue
Continuous absorption and rebuilding
Calcium is an important mineral
Calcium control
DiseasesOsteoporosisRickets and OsteomalaciaHyperparathyroidismScurvy