Changes in Bone Density

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  1. what part of the bone seen on xray when viewed in profile
  2. define a tumor
    just a mass 

    • -Not all tumors are neoplasms, but all neoplasms are tumors
    • -e.g. an intramuscular hematoma is a tumor (lump/mass) but not a neoplasm
    • - e.g. even soft tissue swelling following trauma could be considered a tumor!
  3. what are Lytic Lesions
    lesions which result in bone destruction to some extent and produce a defect or hole in the bone. 

    -creates a lucency

    -tumor may destroy bone or stimulate osteoclasts to resorb bone
  4. what are Blastic legions
    lesions that present as radiographic areas of increased bone density or radioopacity

    -tumor that stimulates bone production by osteoblasts or produces bone by itself or the tumor undergoes a degree of calcification
  5. Image Upload 1 
    Geographic margins (type I)
    Focal areas of bone destruction

    -May be well-defined sclerotic margins, well-defined non-sclerotic margins, or indistinct margins

    -tend to be benign, indolent lesions
  6. Moth-eaten Margins
    (Type II)
    Multiple holes in either cortical (hard) or medullary bone

    Each hole may be relatively well defined or not

    -tend to be more aggressive
  7. Permeative margins (type III)
    Tumor infiltrates hard and/or spongy bone

    difficult to identify extent of bone lysis

    the more poorly defined the lesion is, the more permeative it is 

    e.g. ewings sarcoma
  8. osteoid matrix
    Image Upload 2
    matrix produced by osteoblasts, if present it tells you that the tumor is making bone; looks like cotton ball dipped in barium! 

    described as:

    -solid, dense

    • -amorphous
    • (cloud-like)

  9. Chondroid matrix calcification
    calcification produced by chondroblasts; has discrete structure and features, if present it tells you that the tumor is making cartilage. looks like calcified popped popcorn!

    described as:



    -rings and arcs
  10. Fibrous matrix
    Image Upload 3
    • calcification produced by fibroblasts; has discrete structure and features, if present it tells you that the tumor is making cartilage; looks like frosted beer stein (smudgy or hazy) 
    • -doesn't have the structure of the chondroid matrix or the density of the osteoid matrix
  11. define the Periosteum
    Layer of dense connective tissue that surrounds the exterior of bones

    • -not visible on a radiograph unless stimulated
    • -will then produce new bone through the actions of osteoblasts
  12. Periosteal new bone production
    • -When the periosteum is stimulated to produce new bone through the action of osteoblasts (not an inflammatory response- do not call it periostitis)
    • -The new bone is added to the surface of the bone- the underlying cortex may or may not remain intact

    • -smooth, solid, uninterrupted--> slow growing, benign, indolent
    • -lamellated, interrupted, spiculated, Codman's triangles--> fast-growing, malignant, agressive
  13. Cortex-
    A layer of compact (hard) bone that completely envelopes a less dense medullary cavity that contains cancellous bone arranged as trabeculae
  14. Cancellous bone
    • One of two types of osseous tissue that form bones 
    • -also known as spongy or trabecular bone
    • -less dense and more flexible than cortical bone
    • -found at the ends of long bones, proximal to joints and within the interior of vertebrae

    -red bone marrow is found here
  15. Avascular necrosis
    (aka ischemic necrosis, aseptic necrosis, osteonecrosis)

    • Pathophysiology: cellular death and collapse of bone due to lack of blood supply
    • -caused by sickle cell anemia, trauma, anything that blocks blood vessels

    • Density changes: Focal increase in density
    • -Devascularized bone becomes denser 
    • -medullary bone infarcts appear as dense amorphous deposits of bone within the medullary cavities
  16. what are the hallmarks of Hyperparathyroidism
    • - subperiosteal bone resorption on radial side of middle phalanges of index and middle fingers 
    • -erosion os distal clavicles
    • -well-circumscribed lytic lesions in the long bones called brown tumors
  17. What is the orientation of trabeculae determined by?
    mechanical forces
  18. What secretes collagen and calcium salts?
  19. What are the 3 most common sites of avascular necrosis?
    Scaphoid bone (waist fracture), femoral head, humeral head.
  20. Image Upload 4
    avascular necrosis
  21. three criteria for strongly recommended osteopenia/osteoporosis therapy
    • osteopenia or low bone mass and history of fragility fracture of the hip or spine;
    • T score of -2.5 or less in the spine, femoral neck, total hip, or 33% radius;
    • T-score between -1 or -2.5 in spine, femoral neck, total hip, or 33% radius, if the FRAX 10-y probability for major fracture is >20% or 10-y probability of hip fracture is >3%
  22. diagnostic criteria for diagnosis of osteoporosis in postmenopausal women (4)
    • T-score -2.5 or below in lumbar spine, femoral neck, total, and/or 33% radius;
    • low-trauma spine or hip fracture;
    • osteopenia or T-score between -1 and -2.5 with fragility fracture of proximal humerus, pelvis, or distal forearm;
    • low bone mass or osteopenia and high FRAX fracture possibility
  23. active calcium transport occurs here (2)
    duodenum, jejunum (depends on vitamin D) (15% passive diffusion in jejunum and ileum)
  24. form of calcium supplement that should be taken with meals for best absorption
    calcium carbonate
  25. form of calcium supplement that should be taken on empty stomach for best absorption
    calcium citrate
  26. four bisphosphonates agents
    • Alendronate (Fosamax, generic) oral
    • Ibandronate (Boniva) oral, IV
    • Risedronate (Actonel) oral
    • Zoledronic acid (Reclast) IV
  27. what do bisphosphonates do (detailed)
    drug class that inhibits osteoclast function & bone resorption; strong affinity for hydroxyapatite crystals on bone surface; Decreases osteoclast maturation, number, recruitment, and life span (increased apoptosis)
  28. define bone mineral
    deposited as hard, brittle crystals in flexible collagen and gives bone its rigidity and strength
  29. vertebroplasty
    a minimally invasive procedure for managing acute painful cerebral fractures; this involves injecting bone cement into the fractured vertebra under fluoroscopic guidance
  30. balloon kyphoplasty
    a minimally invasive procedure that can reduce back pain and restore vertebral body height and spinal alignment; involved reducing the vertebral compression and injecting the cement into this space created within the vertebral body using fluoro guidance
  31. body composition
    can be measured as fat and fat-free mass in specific measurements by performing a DXA whole body scan
  32. Where are there fewer trabeculae?
    • Midshaft (diaphysis)
    • --vs metaphysis or epiphysis
Card Set:
Changes in Bone Density
2017-08-11 16:32:24

bone density registry review
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