Osteoporosis - radforward.comradforward.com/.../2015/08/Montgomery_081712_Bone-2-Slidespdf.pdfOsteoporosis A systemic disease characterized by low bone mass and microarchitectural

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