Bone disorders

Types of Bone
Lamellar
Forms the adult skeleton \\ Arrangement of collagen fibers Few osteocytes

Uniform osteocytes in lacunae // to long axis of collagen fibers

Woven
Irregular Many osteocytes of various size and shape In adults signifies always a pathologic condition

Cells
Osteoblasts: bone forming cells
Produce the protein
Osteoid

Osteocyte: bone maintaining cells

Osteoblast within bone in a lacuna

Osteoclast: bone eating cells

Multinucleated Resorbs bone Howships lacunae

Types of bone disorders Metabolic Conditions: Osteoporosis, Osteomalacia and rickets Hereditary and Congenital Disorders Inflammatory Neoplasms

Metabolic Conditions

1- Osteoporosis : The Silent Thief

- Osteoporosis is a metabolic bone disease characterized by low bone mass and micro-architectural defect of the bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

- Are of two types: primary and secondary

Amount of bone resorbed by osteoclasts

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Amount of bone formed by osteoblasts

BONE LOSS

Primary Osteoporosis
Most common
Uncertain etiology Postmenopausal women

Elderly persons (senile)

Genetic: peak bone mass Estrogens: decreased Aging Calcium intake Environmental factors: smoking leads to estrogen

Secondary Osteoporosis
Corticosteroids
Inhibition of osteoblastic activity Impair of vit. D dependant intestinal calcium absorption

Hematologic malignancies Malabsorption: GI and liver diseases Alcoholism

Inhibition of osteoblasts,
absorption of calcium

Steroid-induced Osteoporosis
Cause

Calcium absorption

Urinary Calcium excretion

Osteoblast formation and function

Majority of bone loss occurs in the beginning (10-20%) 25% may experience a fracture 4 fold increase in all fractures

Usually affects vertebrae, ribs, hip

Risk higher in patients with higher dose, taking longer duration

2- Osteomalacia and rickets

Inadequate mineralization of newly formed bone matrix (osteomalacia) Rickets: children, epiphyseal plates open; also problem with cartilage
Beaded appearance of costo-chondral junctions Dental abnormalities

Vitamin D deficiency Phosphate deficiency Defects in mineralization process

3- Hyperparathyroidism
Parathyroid adenoma, hyperplasia, rare malignancy
Promotes excretion of phosphate in the urine and stimulates

osteoclastic activity resulting in hypercalcemia

Hereditary and Congenital Diseases

1- Osteogenesis imperfecta
Many types

Mutations of collagen type I gene

Multiple fractures (starting in utero) Dental findings: Dentinogenesis imperfecta

2- Achondroplasia
80% new mutations Most common form of inherited dwarfism Absence or decreased area of proliferative

cartilage
Epiphyseal disorder (plate closes

prematurely preventing bone growth)

Head and torso are normal Vertebral column and hip abnormality

Inflammatory and Non-Inflammatory

(Non-neoplastic) Disorders

1- Osteonecrosis
Avascular, aseptic
Ischemic death of bone and marrow in absence of infection
Emboli: bone infarction Trauma Radiation

Corticosteroids Alcoholism

Systemic diseases: sickle cell anemia, gout, metabolic diseases Osteochondritis dissecans: dead piece of cartilage Site specific: head of femur

2- Myositis Ossificans
Formation of reactive bone in muscle as a result of injury
More common in lower limbs Diagnosis: radiographically and histologically

3- Osteomyelitis
Inflammation of bone caused by an infectious organism Staphylococcus, streptococcus, neisseria gonorrhea,.. Direct penetration
Wounds, fractures, surgery

Hematogenous
Bloodstream, teeth; metaphyses
Knee, ankle, hip

Complications of Osteomyelitis
Septicemia

Acute bacterial arthritis

Pathologic fractures Squamous cell carcinoma Chronic osteomyelitis

4- Osteoarthritis
Most common joint disease

Slow progressive degeneration of articular cartilage

Weight bearing joints

Fingers
Primary: defect in cartilage, not an inflammatory disease

Secondary: trauma, crystal deposits, infection

Interphalangeal joints, knees, hips, cervical and lumbar spine

Clinical picture
Narrowing of joint space (loss of disk)

Increased thickness of subchondral bone

Subchondral bone cysts

5- Rheumatoid arthritis
Systemic chronic inflammatory disease Autoimmune disease STARTS AS SYNOVIAL DISEASE More common in women

3:1

Remissions and exacerbations

6- Gout
Increase in serum uric acid and deposition of urate crystals in the

joints and kidneys

Only 15% of patients with uric acid suffer from gout Gout can result from:
Overproduction of purines Augmented catabolism of nucleic acids

Decreased uric acid secretion

Primary gout Secondary gout

Primary gout
Hyperuricemia in the absence of other disease
Asymptomatic hyperuricemia can precede gout

Impaired secretion by kidneys

Secondary gout
Tumors
Leukemias Lymphomas After chemotherapy

Alcoholism
Accelerated ATP catabolism

Clinical features
Acute gouty arthritis
Painful Involves one joint initially, then polyarticular Podagra (painful, red metatarsophalangeal joint)

Tophaceous gout
Development of tophi

Chalky, cheesy, yellow-white, pasty deposits of monosodium urate crystals

Bone Tumors

 Bone Forming
Benign: Osteoma Malignant:

Osteoid Osteoma

Osteoblastoma

Primary and secondary osteosarcoma

Cartilagenous
Benign:

Chodroma

Osteochodroma

Malignant:

Chodrosarcoma

Other
Giant cell tumor of bone

Ewing sarcoma

Metastatic Tumors of the Jaws

Most common form of cancer involving bone

Breast and prostate carcinomas are most common

Variety of symptoms: pain, swelling, loose teeth, . Site from which tooth was removed for local pain or mobility

Prognosis is poor; most patients die within a year