Osteoporosis -...
Transcript of Osteoporosis -...
Osteoporosis
Loss of Bone Mass
Osteoporosis A systemic disease characterized by
low bone mass and microarchitectural
deterioration with a consequent
increase in bone fragility and
susceptibility to fracture
Risk factors
• Female Gender
• Caucasian & Asian Races
• Thin Body Build
• Late Onset of Menses
• Early Menopause
• Caffeine, Smoking, Alcohol
• Family History
Risk Factors
• Endrocine
• Rheumatologic Disease
• Hematologic Disease
• Drugs
• GI Disease
Osteopenia
• Nonspecific term = "poverty of bone"
• Increased radiolucency of bone
DEXA SCAN
Osteoporosis
A bone mineral
density ( T Score) that
is 2.5 SD below the
mean peak value in
younger adults
Z Score Comparison with mean
value in normal subjects
of same age and sex
Bone Values
• -1.0 to -2.0 mild
• -2.0 to -3.0 moderate
• -3.0 to -4.0 marked
• -4.0 to -5.0 severe
Tumors
Would you send this lesion for bx?
1) No
2) Yes
Osteomyelitis
Arthritis
Joint Changes on X-Ray
• Soft tissue swelling - symmetrical vs.
asymmetrical
• Lumps & Bumps
• Mineralization - diffuse or juxta-articular
• Erosions - bare areas, pencil & cup etc.
aggressive - no reparative bone, vs. non-
aggressive - sclerotic borders
Joint Changes on X-Ray
• Joint space narrowing - uniform vs. non-uniform
• Subluxation
• Calcification - cartilage, soft tissue and tendinous
• Bone production - Periosteal new bone, osteophytes, overhanging edges, subchondral bone, ankylosis
Distribution
• DIP & PIP - osteoarthritis, erosive
osteoarthritis, psoriatic arthritis
• MCP, PIP - rheumatoid
• Random - gout
Rheumatoid Arthritis
• Periarticular soft tissue swelling
• Juxta-articular osteoporosis progressing to
generalized osteoporosis
• Uniform loss of joint space
• Lack of bone formation
• Marginal erosions progressing to severe
erosions of subchondral bone
Rheumatoid Arthritis
• Synovial cyst formation
• Subluxations
• Bilateral symmetrical distribution
• Hands, feet, knees, hips, spine, shoulders,
elbows
Psoriatic Arthritis
• Fusiform soft tissue swelling
• Normal mineralization
• Marked joint space loss
• Bone proliferation
• Pencil-in-cup erosions
• Bilateral asymmetrical distribution
Psoriatic Arthritis
• Distribution in hands, feet, SI joints,
and spine in decreasing order of
frequency
Reiter’s
• Arthritis
• Conjunctivitis
• Urethritis
Reiter’s Disease
• Fusiform soft tissue swelling
• Early juxta-articular osteoporosis goes to
normal mineralization
• Uniform joint loss
• Bone proliferation
• Ill defined erosions
• Bilateral asymmetrical distribution
Reiter’s Disease
Distribution primarily in feet, ankles,
knees, and SI joints, hands, hips, and
spine less frequently
What is the dx?
1) Reiter’s
2) AS
3) RA
4) Gout
Gout
• Tophi
• Normal mineralization
• Joint space preserved
• Punched-out erosions, sclerotic borders
• Overhanging spicule of bone
• Asymmetrical distribution, polyarticular,
foot most common
CPPD
Calcium Pyrophosphate Dihydrate
Crystal Deposition Disease
CPPD
• Chondrocalcinosis
• Normal mineralization
• Uniform joint space loss
• Subchondral new bone formation
• Variable osteophyte formation
• Cysts
CPPD
• Bilateral distribution
• Distribution in knees, hands, and hips in
decreasing order and unlike osteoarthritis
may involve shoulder and elbow
Osteoarthritis
• Normal mineralization
• Nonuniform loss of joint space
• Absence of erosions
• Subchondral new bone formation
• Osteophyte formation
• Cysts
• Subluxations
Osteoarthritis
• Unilateral and/or bilateral asymmetrical
distribution
• Distribution in hands (DIP), feet, hips,
knees; sparing of shoulders and elbows
Neurotopic Osteoarthropathy
• Dislocation of normal articuation
• Severe subluxation and/or dislocation
• Marked juxta-articular new bone
• Huge osteophytes
• Fragmentation and osseous debris
• Pathologic fractures
Neurotopic Osteoarthropathy
• Unilateral or bilateral asymmetrical
involvement
• Distribution in weight-bearing joints (feet,
ankle, knee, hip, spine)
“CHARCOT JOINT-ANKLE”
Ankylosing Spondylitis
• Normal mineralization before ankylosis
• Generalized osteoporosis after ankylosis
• Erosions - small, localized
• Absence of subluxation and cysts
• Syndesmophytes progress to bamboo spine
• Squared vertebra
Ankylosing Spondylitis
• Disc spaces preserved
• Erosion of odontoid
• Ankylosis
• Bilateral symmetrical distribution
• SI Joints and spine (ascends from lumbar to
cervical); hips, shoulders, knees, hands, and
feet less common