skeletal disorders of metabolic and endocrine origin
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May 07, 2024
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About This Presentation
Metabolic bone diseases encompass a spectrum of disorders characterized by abnormalities in bone metabolism, structure, and mineralization. These conditions often result from disturbances in the intricate balance between bone formation and resorption, leading to weakened bones prone to fractures, d...
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SKELETAL DISORDERS OF
METABOLIC AND
ENDOCRINE ORIGIN
DR. SHIVANGI LAHOTY
METABOLIC AND
ENDOCRINE ORIGIN
DR. SHIVANGI LAHOTY
DISORDERS OF METABOLIC ORIGIN
●Metabolic bone disease encompasses a diverse group of disorders
associated with altered calcium and phosphorus homeostasis.
●Patients may present with a clinical history of back pain and a nonspecific
radiologic finding of generalized osteopenia.
●The most common types of metabolic bone diseases are acquired disorders
with nutritional deficiencies being an important cause.
●Metabolic bone disease encompasses a diverse group of disorders
associated with altered calcium and phosphorus homeostasis.
●Patients may present with a clinical history of back pain and a nonspecific
radiologic finding of generalized osteopenia.
●The most common types of metabolic bone diseases are acquired disorders
with nutritional deficiencies being an important cause.
The various metabolic bone disorders may be grouped according to their
underlying defects:
• Defect in osteoid formation: Scurvy
• Defect in mineralization: Rickets/osteomalacia
• Disorder with increased bone resorption: Hyperparathyroidism
• Disorder with no defect in mineralization and osteoid formation but decreased
bone mass: Osteoporosis
• Miscellaneous: Fluorosis, heavy metal poisoning, and hypervitaminosis.
underlying defects:
• Defect in osteoid formation: Scurvy
• Defect in mineralization: Rickets/osteomalacia
• Disorder with increased bone resorption: Hyperparathyroidism
• Disorder with no defect in mineralization and osteoid formation but decreased
bone mass: Osteoporosis
• Miscellaneous: Fluorosis, heavy metal poisoning, and hypervitaminosis.
RICKETS AND OSTEOMALACIA
Rickets in children and osteomalacia in adults are a group of bone disorders in which
there is incomplete or inadequate mineralization of normal osteoid tissue. Both conditions
usually result from an abnormality in vitamin D metabolism.
RICKETS
Rickets occurs when the orderly development and mineralization of the growth plate is
interrupted.
The most common and nonspecific radiologic finding in patients of rickets is
osteopenia.
These changes are best seen in those areas showing most active growth.
The distal ends of radius and ulna are the optimal sites for the demonstration of the
earliest lesion.
Rickets in children and osteomalacia in adults are a group of bone disorders in which
there is incomplete or inadequate mineralization of normal osteoid tissue. Both conditions
usually result from an abnormality in vitamin D metabolism.
RICKETS
Rickets occurs when the orderly development and mineralization of the growth plate is
interrupted.
The most common and nonspecific radiologic finding in patients of rickets is
osteopenia.
These changes are best seen in those areas showing most active growth.
The distal ends of radius and ulna are the optimal sites for the demonstration of the
earliest lesion.
The characteristic radiologic features of rickets seen at the end of long bones
are:
• Widening of the growth plate is the earliest specific radiologic change which
occurs as a result of increase in cartilaginous cell mass.
• Irregular metaphyseal margins (paint brush metaphyses) occurs due to
fraying and disorganization of the spongy bone in the metaphyseal region.
• Further progression of the disease leads to widening and cupping of the
metaphysis. This can be explained by the protrusion of the bulky mass of
cartilaginous cells in the zone of hypertrophy into the poorly mineralized
metaphysis.
are:
• Widening of the growth plate is the earliest specific radiologic change which
occurs as a result of increase in cartilaginous cell mass.
• Irregular metaphyseal margins (paint brush metaphyses) occurs due to
fraying and disorganization of the spongy bone in the metaphyseal region.
• Further progression of the disease leads to widening and cupping of the
metaphysis. This can be explained by the protrusion of the bulky mass of
cartilaginous cells in the zone of hypertrophy into the poorly mineralized
metaphysis.
X-ray bilateral wrists and knees.
Typical changes of active rickets consisting of fraying, irregularity of distal radius
and ulnar metaphysis and distal femoral and proximal tibial metaphysis with
widening of the growth plates at the wrists and knees. The adjacent epiphysis and
diaphysis are osteopenic.
Typical changes of active rickets consisting of fraying, irregularity of distal radius
and ulnar metaphysis and distal femoral and proximal tibial metaphysis with
widening of the growth plates at the wrists and knees. The adjacent epiphysis and
diaphysis are osteopenic.
• Skeletal deformities are the most common complication detected radiologically,
the appearance and location of which depend on age and the part in which
disease develops.
Skull: It is particularly affected in the early months of life as it has to accommodate
the rapidly growing brain.
There is excess osteoid deposition in frontal and parietal regions and posterior
flattening due to supine posture of the infant.
This results in squared configuration of the skull known as “craniotabes”.
the appearance and location of which depend on age and the part in which
disease develops.
Skull: It is particularly affected in the early months of life as it has to accommodate
the rapidly growing brain.
There is excess osteoid deposition in frontal and parietal regions and posterior
flattening due to supine posture of the infant.
This results in squared configuration of the skull known as “craniotabes”.
Squared configuration of
the skull in the neonatal
period: Craniotabes
the skull in the neonatal
period: Craniotabes
Long bones: In early childhood, more rapid growth occurs in the long bones and
bowing deformities of arms and legs are common . Bulbous enlargement of the
costochondral junctions, particularly those of the middle ribs can be seen (rachitic
rosary).
Marked anterior bowing of the tibia and fibula with rachitic changes. The visualized bones are
osteopenic
“Rachitic rosary”: Widened anterior ends of ribs due to hypertrophy of costochondral junction.
bowing deformities of arms and legs are common . Bulbous enlargement of the
costochondral junctions, particularly those of the middle ribs can be seen (rachitic
rosary).
Marked anterior bowing of the tibia and fibula with rachitic changes. The visualized bones are
osteopenic
“Rachitic rosary”: Widened anterior ends of ribs due to hypertrophy of costochondral junction.
Spine: Scoliosis and vertebral end plate deformities may develop .
Pelvis: The protrusion of the hip and spine into the soft pelvis produces a triradiate
configuration of the pelvis.
Fractures: In long-standing cases of rickets, trivial trauma may result in fracture of
the weakened under mineralized bone.
The bones are
markedly osteopenic
with fracture of distal
ends of radius in both.
Pelvis: The protrusion of the hip and spine into the soft pelvis produces a triradiate
configuration of the pelvis.
Fractures: In long-standing cases of rickets, trivial trauma may result in fracture of
the weakened under mineralized bone.
The bones are
markedly osteopenic
with fracture of distal
ends of radius in both.
SIGNS OF HEALING RICKETS
Radiological evidence of healing is seen within 2–3 weeks of adequate therapy
and total recalcification is usually complete in 2 months.The signs of healing
rickets are:
• Reappearance of the dense zone of provisional calcification: This is the first
evidence of healing and is seen radiologically as a transverse line of increased
density, which appears beyond the visible end of shaft with a metaphysis
interposed between the two radiolucent areas .
Radiological evidence of healing is seen within 2–3 weeks of adequate therapy
and total recalcification is usually complete in 2 months.The signs of healing
rickets are:
• Reappearance of the dense zone of provisional calcification: This is the first
evidence of healing and is seen radiologically as a transverse line of increased
density, which appears beyond the visible end of shaft with a metaphysis
interposed between the two radiolucent areas .
X-ray bilateral wrists showing reappearance of the dense zone of
provisional calcification at the metaphysis suggestive of healing rickets.
provisional calcification at the metaphysis suggestive of healing rickets.
OSTEOMALACIA
Osteomalacia has same pathophysiology as rickets,but it occurs in mature skeleton with fused growth
plate. The major skeletal changes observed are:
• Osteopenia: It is the most common radiologic sign due to decreased bone mineral content.It is usually
uniform involving all the bones.
• Pseudofractures or Looser's zones: These are more specific but less common manifestation of
osteomalacia. Looser's zones are linear radiolucent bands of under mineralized osteoid that occur in
bilateral and symmetric distribution.They are oriented perpendicular to the long axis of the bone.The
characteristic sites include:
○ Axillary margins of scapula
○ Superior and inferior pubic rami
○ Medial femoral necks
○ Posterior margins of the proximal ulna
○ Ribs
Osteomalacia has same pathophysiology as rickets,but it occurs in mature skeleton with fused growth
plate. The major skeletal changes observed are:
• Osteopenia: It is the most common radiologic sign due to decreased bone mineral content.It is usually
uniform involving all the bones.
• Pseudofractures or Looser's zones: These are more specific but less common manifestation of
osteomalacia. Looser's zones are linear radiolucent bands of under mineralized osteoid that occur in
bilateral and symmetric distribution.They are oriented perpendicular to the long axis of the bone.The
characteristic sites include:
○ Axillary margins of scapula
○ Superior and inferior pubic rami
○ Medial femoral necks
○ Posterior margins of the proximal ulna
○ Ribs
Radiograph bilateral legs showing
Looser's zone in upper one-third of
bilateral fibula with surrounding
sclerosis.
Bone scintigraphy has been found to be more sensitive than
blood biochemistry and radiographic findings in the detection of
osteomalacia.
Looser's zone in upper one-third of
bilateral fibula with surrounding
sclerosis.
Bone scintigraphy has been found to be more sensitive than
blood biochemistry and radiographic findings in the detection of
osteomalacia.
HYPERPARATHYROIDISM
Hyperparathyroidism is a pathological state characterized by excessive production of
parathyroid hormone (PTH). Alterations of parathyroid function cause a breakdown in
calcium homeostasis leading to increased renal absorption of calcium, phosphaturia, and
increased bone turnover, thereby resulting in characteristic pathologic and radiologic
abnormalities.
The skeletal changes in HPT are characteristic and reflect the histologic changes of
increased resorption of cortical and cancellous bone with substitutive fibrosis.
Hyperparathyroidism is a pathological state characterized by excessive production of
parathyroid hormone (PTH). Alterations of parathyroid function cause a breakdown in
calcium homeostasis leading to increased renal absorption of calcium, phosphaturia, and
increased bone turnover, thereby resulting in characteristic pathologic and radiologic
abnormalities.
The skeletal changes in HPT are characteristic and reflect the histologic changes of
increased resorption of cortical and cancellous bone with substitutive fibrosis.
RADIOLOGICAL FINDINGS
1.Subperiosteal Resorption
Subperiosteal resorption of cortical bone is considered pathognomonic of HPT. The
earliest and best recognized changes are seen in the hands.The earliest site of
subperiosteal resorption is the radial aspect of middle phalanges of middle and
index fingers.
A)Hands showing resorption
of the subperiosteal bone on
the radial aspect of the
middle phalanges of the
index and middle fingers
(B) Resorption of the tufts of
terminal phalanges as well.
1.Subperiosteal Resorption
Subperiosteal resorption of cortical bone is considered pathognomonic of HPT. The
earliest and best recognized changes are seen in the hands.The earliest site of
subperiosteal resorption is the radial aspect of middle phalanges of middle and
index fingers.
A)Hands showing resorption
of the subperiosteal bone on
the radial aspect of the
middle phalanges of the
index and middle fingers
(B) Resorption of the tufts of
terminal phalanges as well.
2.Trabecular Bone Resorption
Trabecular resorption occurs throughout the skeleton in HPT, though changes in the
skull vault are characteristic. Osteoclasts on the surface of bone dissect through the
center of trabecula, with loss of sharp trabecular pattern giving a stippled, mottled, and
granular appearance termed radiologically as “salt and pepper skull”.The definition of
outer and inner table is lost.
Loss of definition of
inner and outer
tables of the skull
causing a classical
mottled appearance
of the skull vault:
“salt and pepper
skull.
CT reveals multiple
variable-sized lytic
lesions scattered
throughout the
calvarium with loss of
differentiation of outer
and inner tables.
Trabecular resorption occurs throughout the skeleton in HPT, though changes in the
skull vault are characteristic. Osteoclasts on the surface of bone dissect through the
center of trabecula, with loss of sharp trabecular pattern giving a stippled, mottled, and
granular appearance termed radiologically as “salt and pepper skull”.The definition of
outer and inner table is lost.
Loss of definition of
inner and outer
tables of the skull
causing a classical
mottled appearance
of the skull vault:
“salt and pepper
skull.
CT reveals multiple
variable-sized lytic
lesions scattered
throughout the
calvarium with loss of
differentiation of outer
and inner tables.
3.BROWN TUMORS
Brown tumors are cyst-like well- circumscribed lytic lesions within bone and are an end result
of extensive bone resorption. They represent hemorrhage and deposition of breakdown
products of hemoglobin. Radiographically, brown tumors are seen as lytic, expansile, and
cystic lesions which are solitary but are often multiple.
X-ray bilateral
hands showing
multiple,
well-defined,
expansile lytic
lesions in lower
end of radius,
head, and distal
ends of third and
fifth metacarpals of
right hand:Brown
tumors
A large well-defined,
oval lytic lesion with
sclerotic rim in left iliac
bone with multiple
smaller ill-defined
lesions in bilateral
ischium:Brown tumors
Brown tumors are cyst-like well- circumscribed lytic lesions within bone and are an end result
of extensive bone resorption. They represent hemorrhage and deposition of breakdown
products of hemoglobin. Radiographically, brown tumors are seen as lytic, expansile, and
cystic lesions which are solitary but are often multiple.
X-ray bilateral
hands showing
multiple,
well-defined,
expansile lytic
lesions in lower
end of radius,
head, and distal
ends of third and
fifth metacarpals of
right hand:Brown
tumors
A large well-defined,
oval lytic lesion with
sclerotic rim in left iliac
bone with multiple
smaller ill-defined
lesions in bilateral
ischium:Brown tumors
RENAL OSTEODYSTROPHY
Renal osteodystrophy is a term which is used to describe the bony changes in
patients with chronic renal insufficiency.
Due to chronic renal disease, there is phosphate retention along with impaired ability to
form vitamin D3. Low levels of vitamin D and an excess of phosphate stimulate an
excess parathyroid hormone resulting in secondary hyperparathyroidism.
Radiographic changes in renal osteodystrophy, therefore, reflect a combination of
different processes including rickets/osteomalacia, secondary hyperparathyroidism, and
osteosclerosis. Increased bone density or osteosclerosis is either focal or diffuse and is
commonly seen in the spine but also occurs in the pelvis, ribs, skull and tubular bones.
The characteristic appearance of the spine is called “rugger jersey spine” because of its
resemblance to the striped jersey worn by rugby players and is caused by increased
bone deposition in the vertebral endplates .
Renal osteodystrophy is a term which is used to describe the bony changes in
patients with chronic renal insufficiency.
Due to chronic renal disease, there is phosphate retention along with impaired ability to
form vitamin D3. Low levels of vitamin D and an excess of phosphate stimulate an
excess parathyroid hormone resulting in secondary hyperparathyroidism.
Radiographic changes in renal osteodystrophy, therefore, reflect a combination of
different processes including rickets/osteomalacia, secondary hyperparathyroidism, and
osteosclerosis. Increased bone density or osteosclerosis is either focal or diffuse and is
commonly seen in the spine but also occurs in the pelvis, ribs, skull and tubular bones.
The characteristic appearance of the spine is called “rugger jersey spine” because of its
resemblance to the striped jersey worn by rugby players and is caused by increased
bone deposition in the vertebral endplates .
Characteristic “rugger jersey spine” appearance in a patient of chronic
renal failure with nephrolithiasis in the left kidney- Renal osteodystrophy
renal failure with nephrolithiasis in the left kidney- Renal osteodystrophy
SCURVY
Scurvy, also known as Barlow's disease, is the result of long-term deficiency of
vitamin C.
The pathological changes seen in scurvy are the result of depression of normal
cellular activity. There is suppression of osteoblastic activity resulting in cessation
of normal bone formation. However, bone resorption continues leading to the
development of osteoporosis.
At the growth plate, mineralization is unimpaired, resulting in the zone of
provisional calcification becoming wide and dense.
The optimal sites for detection of scurvy in the skeleton are bones of the lower
extremities.
Scurvy, also known as Barlow's disease, is the result of long-term deficiency of
vitamin C.
The pathological changes seen in scurvy are the result of depression of normal
cellular activity. There is suppression of osteoblastic activity resulting in cessation
of normal bone formation. However, bone resorption continues leading to the
development of osteoporosis.
At the growth plate, mineralization is unimpaired, resulting in the zone of
provisional calcification becoming wide and dense.
The optimal sites for detection of scurvy in the skeleton are bones of the lower
extremities.
RADIOLOGICAL FINDINGS
• Osteoporosis.
• White line of Frankel is the dense, white line in the zone of provisional calcification at
the growing metaphysis.
• Beneath the Frankel's line, there is a radiolucent zone in the metaphysis called
Trümmerfeld zone or Scorbutic zone, due to lack of mineralization of osteoid.
• The epiphysis is small, sharply marginated by a sclerotic rim while the central portion is
more radiolucent, called Wimberger's sign.
• Finally, as the metaphysis is weakened, it is prone to fractures, which manifest
themselves at the cortical margin, giving rise to Pelkan spur
• In addition, due to capillary permeability, subperiosteal hemorrhages occur . The
hemorrhages appear as soft-tissue density adjacent to the cortical bones such as femur,
tibia, and humerus.
• Osteoporosis.
• White line of Frankel is the dense, white line in the zone of provisional calcification at
the growing metaphysis.
• Beneath the Frankel's line, there is a radiolucent zone in the metaphysis called
Trümmerfeld zone or Scorbutic zone, due to lack of mineralization of osteoid.
• The epiphysis is small, sharply marginated by a sclerotic rim while the central portion is
more radiolucent, called Wimberger's sign.
• Finally, as the metaphysis is weakened, it is prone to fractures, which manifest
themselves at the cortical margin, giving rise to Pelkan spur
• In addition, due to capillary permeability, subperiosteal hemorrhages occur . The
hemorrhages appear as soft-tissue density adjacent to the cortical bones such as femur,
tibia, and humerus.
X-ray wrist AP view reveals
increased density of the zone of
provisional calcification
(Frankel's line) with a lucent zone
beneath it (Trümmerfeld zone) in
the distal radial and ulnar
metaphysis.
Calcified subperiosteal hemorrhages seen along
bilateral femoral shafts, more extensive on the
right side
increased density of the zone of
provisional calcification
(Frankel's line) with a lucent zone
beneath it (Trümmerfeld zone) in
the distal radial and ulnar
metaphysis.
Calcified subperiosteal hemorrhages seen along
bilateral femoral shafts, more extensive on the
right side
OSTEOPOROSIS
It is defined by WHO as “a skeletal disease, characterized by low bone mass and
microarchitectural deterioration of bone tissue, with a consequent increase in bone
fragility and susceptibility to fracture.
The structure of organic matrix (osteoid) is preserved with no obvious defect in
mineralization.
A fine balance in bone formation and resorption maintains the skeletal mass.
Tipping of the balance toward resorption results in reduced bone mass resulting in
osteoporosis.
It is defined by WHO as “a skeletal disease, characterized by low bone mass and
microarchitectural deterioration of bone tissue, with a consequent increase in bone
fragility and susceptibility to fracture.
The structure of organic matrix (osteoid) is preserved with no obvious defect in
mineralization.
A fine balance in bone formation and resorption maintains the skeletal mass.
Tipping of the balance toward resorption results in reduced bone mass resulting in
osteoporosis.
INVESTIGATIONS
STANDARD RADIOGRAPHY
The findings are:
• Generalized osteopenia, most prominent in the axial skeleton, especially the
vertebral column
• Changes in vertebral body shape—wedge shape, biconcave, and compression
• Insufficiency fractures as a result of weakened bone resulting from normal stress.
Sacrum, pubis, etc. are common sites.
• Fractures at other sites (especially wrist and hip)
STANDARD RADIOGRAPHY
The findings are:
• Generalized osteopenia, most prominent in the axial skeleton, especially the
vertebral column
• Changes in vertebral body shape—wedge shape, biconcave, and compression
• Insufficiency fractures as a result of weakened bone resulting from normal stress.
Sacrum, pubis, etc. are common sites.
• Fractures at other sites (especially wrist and hip)
Radiographs of dorsolumbar spine anteroposterior and lateral views demonstrating
decreased bone density with thinning of vertebral endplates and the presence of multiple
biconcave vertebrae.
decreased bone density with thinning of vertebral endplates and the presence of multiple
biconcave vertebrae.
Dual-energy X-ray Absorptiometry (DXA)
DXA employs an X-ray beam formed by two different photon energies for generating
Bone Mineral Density. Once the high-energy and low-energy photons are transmitted
through bones and soft tissue, they are analyzed separately. This is followed by
subtraction of the attenuation values of soft tissues with the remainder being the
attenuation values of bone.
BMD is expressed in terms of SD as a T-score and a Z-score.
The T-score compares the BMD of the subject/patient with the mean BMD of a standard
young adult individual (between 20 and 30 years of age).
The Z-score reflects the difference between the examined BMD of the patient and the
mean BMD of age and gender-matched controls.
DXA employs an X-ray beam formed by two different photon energies for generating
Bone Mineral Density. Once the high-energy and low-energy photons are transmitted
through bones and soft tissue, they are analyzed separately. This is followed by
subtraction of the attenuation values of soft tissues with the remainder being the
attenuation values of bone.
BMD is expressed in terms of SD as a T-score and a Z-score.
The T-score compares the BMD of the subject/patient with the mean BMD of a standard
young adult individual (between 20 and 30 years of age).
The Z-score reflects the difference between the examined BMD of the patient and the
mean BMD of age and gender-matched controls.
It should be noted that this definition is applied to DXA measurements made in the
lumbar spine, proximal femur and forearm.
Apart from axial skeleton (lumbar spine and proximal femur), DXA scan can also be
done at peripheral sites such as distal radius and calcaneus(Peripheral DXA).
The calcaneus is particularly useful for monitoring changes in BMD secondary to
treatment as it contains high percentage (95%) of metabolically active trabecular
bone.
lumbar spine, proximal femur and forearm.
Apart from axial skeleton (lumbar spine and proximal femur), DXA scan can also be
done at peripheral sites such as distal radius and calcaneus(Peripheral DXA).
The calcaneus is particularly useful for monitoring changes in BMD secondary to
treatment as it contains high percentage (95%) of metabolically active trabecular
bone.
Axial DXA report of a patient demonstrating the L1-L4 vertebrae being interrogated with results generated
in the form of T- and Z-scores as well as absolute bone mineral density (BMD) measurements. Note that
the WHO classification (osteoporosis) have been interpreted and mentioned based on BMD scores.
in the form of T- and Z-scores as well as absolute bone mineral density (BMD) measurements. Note that
the WHO classification (osteoporosis) have been interpreted and mentioned based on BMD scores.
ACROMEGALY
Acromegaly results from excessive production of growth hormone (somatotropin) in a skeletally
mature individual.
Elevated serum growth hormone reactivates endochondral bone formation, stimulates
periosteal bone formation along with connective tissue proliferation leading to characteristic
clinical and radiological features.
RADIOLOGICAL FINDINGS
Soft-tissue thickening is classically seen in the heel pads and digits. The measurement is
obtained by calculating the shortest distance between the calcaneus and plantar surface of the
skin.
Values >25 mm in men and 23 mm in women are diagnostic, if local causes of skin thickening
are excluded.
Acromegaly results from excessive production of growth hormone (somatotropin) in a skeletally
mature individual.
Elevated serum growth hormone reactivates endochondral bone formation, stimulates
periosteal bone formation along with connective tissue proliferation leading to characteristic
clinical and radiological features.
RADIOLOGICAL FINDINGS
Soft-tissue thickening is classically seen in the heel pads and digits. The measurement is
obtained by calculating the shortest distance between the calcaneus and plantar surface of the
skin.
Values >25 mm in men and 23 mm in women are diagnostic, if local causes of skin thickening
are excluded.
Acromegaly with increase in
soft-tissue thickness of the
heel pad.
There is enlargement of the soft
tissues with thickening of fingers and
prominent joint spaces due to cartilage
hypertrophy.
soft-tissue thickness of the
heel pad.
There is enlargement of the soft
tissues with thickening of fingers and
prominent joint spaces due to cartilage
hypertrophy.
In the skull, changes include:
○ Thickening of the cranial vault
○ Prominence of the supraorbital ridges and zygomatic arches
○ Prominence of the external occipital protuberance
○ Enlargement of the sella turcica with distinctive changes
○ Prominence and enlargement of the frontal and maxillary sinuses
○ Excessive pneumatization of the mastoid
○ Enlargement and elongation of the mandible with widening of the mandibular angle.
○ Thickening of the cranial vault
○ Prominence of the supraorbital ridges and zygomatic arches
○ Prominence of the external occipital protuberance
○ Enlargement of the sella turcica with distinctive changes
○ Prominence and enlargement of the frontal and maxillary sinuses
○ Excessive pneumatization of the mastoid
○ Enlargement and elongation of the mandible with widening of the mandibular angle.
The abnormalities in the vertebral column in acromegaly consist of:
○ Elongation and widening of vertebral bodies
○ Anterior and lateral osteophytes
○ Increased height of intervertebral disc
○ Scalloping of the posterior margins of vertebral bodies
○ Increased thoracic kyphosis
○ Exaggerated lumbar lordosis.
Abnormalities in the hands and wrists include soft tissue thickening of fingers, thickening, and
squaring of the phalanges and metacarpals, abnormally wide articular spaces.
○ Elongation and widening of vertebral bodies
○ Anterior and lateral osteophytes
○ Increased height of intervertebral disc
○ Scalloping of the posterior margins of vertebral bodies
○ Increased thoracic kyphosis
○ Exaggerated lumbar lordosis.
Abnormalities in the hands and wrists include soft tissue thickening of fingers, thickening, and
squaring of the phalanges and metacarpals, abnormally wide articular spaces.
FLUOROSIS
It is a chronic metabolic bone disease caused by chronic ingestion of excessive amounts of
fluoride.
A generalized increase in bone density is seen which is due to osteoclastic response to the
fluorine rather than fluorine deposition per se.
RADIOGRAPHICAL FINDINGS
Radiological evaluation is considered the best method for diagnosing fluorosis, especially
when the patient is asymptomatic.
Radiographically, the changes are diffuse increase in bone density (osteosclerosis),
osteophytosis, and calcification/ossification of the attachments of tendons, muscles,
and ligaments.
It is a chronic metabolic bone disease caused by chronic ingestion of excessive amounts of
fluoride.
A generalized increase in bone density is seen which is due to osteoclastic response to the
fluorine rather than fluorine deposition per se.
RADIOGRAPHICAL FINDINGS
Radiological evaluation is considered the best method for diagnosing fluorosis, especially
when the patient is asymptomatic.
Radiographically, the changes are diffuse increase in bone density (osteosclerosis),
osteophytosis, and calcification/ossification of the attachments of tendons, muscles,
and ligaments.
Osteosclerosis is a common finding in fluorosis and involves all bones, but is most
marked in the spine, pelvis, and ribs.
(A)Frontal chest X-ray reveals diffuse osteosclerosis; (B) Osteosclerosis and
osteophytosis of the dorsal vertebral bodies with posterior longitudinal ligament
ossification.
marked in the spine, pelvis, and ribs.
(A)Frontal chest X-ray reveals diffuse osteosclerosis; (B) Osteosclerosis and
osteophytosis of the dorsal vertebral bodies with posterior longitudinal ligament
ossification.
The inferior margins of the ribs may show characteristic irregularity/fringed appearance
called “rose-thorn appearance.”
• Ligamentous calcification and ossification, particularly of sacrospinous and
sacrotuberous ligaments, is another characteristic radiographic feature.
• Ossification in the interosseous membranes of paired bones is diagnostic.
Interosseous membrane
ossification—diagnostic of fluorosis.
called “rose-thorn appearance.”
• Ligamentous calcification and ossification, particularly of sacrospinous and
sacrotuberous ligaments, is another characteristic radiographic feature.
• Ossification in the interosseous membranes of paired bones is diagnostic.
Interosseous membrane
ossification—diagnostic of fluorosis.
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