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Acquired Disorders of Bone & Cartilage (OSTEOPOROSIS (Menopause (Inc.…
Acquired Disorders of Bone & Cartilage
Osteopenia
dec. bone mass (1-2.5 SD< mean peak bone mass)
Osteoporosis
Osteopenia that is
severe to risk fracture
2.5 SD<mean
metabolic bone disease
0.7% per year age related bone loss
year reduc=2% of cortical bone & 9% cancellous bone
OSTEOPOROSIS
Menopause
Inc. IL-1, IL-6 TNF lvl
Inc. RANK, RRANKL
dec serume estrogen
Inc. osteoclast activity
Aging
Dec. osteoprogenitor cell replication
Dec. Synth of Osteoblasts
dec, physical activity
dec matrix bound G.F
Morphology
Postmenopausal osteoporosis
cancellous compt of vertebral bodies
Senile Osteoporosis
cortex is thin
Clinical Course:
Painful vertebral fractures
@ thoracic & lumbar region
loss of height, lumbar lordosis & kyphoscoliosis
detection in radiograms at 30%-40% bone mass lost
best Dx:
biopsy
dual energy, X-ray absorptiometry
quantitative Computed tomography
Prevention & Treatment
Calcium & Vit D intake
Bisphophonates-dec. osteoclast activity
Exercise
Disease by OSTEOCLAST DYSFUNCTION
Paget Disease(Osteitis Deformans)
hallmark=mosaiac pattern of lamellar bone
jigsaw puzzle pattern
prod. by cement lines
Manif:
Platybasia
leontiasis ossea
axial skeleton, proximal femur
80% cases
85% polyostotic
MOST dreaded=
Sarcoma
Rickets & Osteomalacia
impaired mineralization & accumulation of unmineralized matrix
Rickets
Craniotabes
frontal bossing
Rachitic rosary, pigeon breast deformity
Harisson's Groove
PTH
inc bone resorption& calcium mobilization
Inc resorption of Calcium by renal tubules
Inc urinary excretion of phosphates
Inc, synth of Vit D=Inc calcium absorption
Hyperparathyroidism
Morpho:
brown tumor -microfractures & 2ndary hemorrhages
Gen. Osteitis fibrosa cystica(von Recklinghausen disease of bone)
Hallmark=sev. Hyperparathyroidism
-combo of inc bone cell activty,peritrabecular fibrosis& cystic brown tumors
Renal Osteodystrophy
2)Low- turnover , aplastic disease
manif: adynamic bone (little osteoclastic & osteoblastic activity
3)Mixed pattern of disease w/ high turnover & low turnover
1)High turnover osteodystrophy
Inc. bone resorption & bone formation
Pathogenesis
1)tubular dysfunction
renal tubular acidosis
2)Gen renal failure
3)Dec production of Vit D3