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Staphylococci, E. Coli, Neisseria gonorrhoeae, H. influenzae, Salmonella
to bone
infection with bone around it.
reactive bone to infection
Tuberculous Spondylitis
destroy bone and collapse and disc get compression fracture

Pott Disease
enhanced bone resorption
Primary Osteoporosis
increased osteoclast activity

type 1 or postmenopausal
Primary Osteoporosis
decreased osteoblast activity

type 2 senile, after the age of 70
decrease in mineral density of bone
osteoporosis associated with endocrine/genetic abnormalities, e.g., diabetes, HPTH, malabsorption (e.g., Crohn disease)

inadequate mineralization of newly formed bone matrix

Osteomalacia (soft bones)
Osteoid is not getting sufficient mineralization

Osteomalacia (soft bones)
Skull/Frontal Bossing
Bowing of legs
lytic lesions in bone representing masses of fibrous connective tissue and giant cells placed around capillaries; also called brown tumors due to hemorrhage

Osteitis fibrosa cystica
Stones, bones, moans, and groans

Primary Hyperparathyroidism
Stones in the kidney (nephrocalcinosis), resorbing bones, moans due to psychiatric component, groans because it’s more peptic ulcer disease.

skull- Ground Glass
Ectopic calcification
Primary Hyperparathyroidism

Secondary Hyperparathyroidism
Increased PTH leads to
increased resorption of bone and osteitis fibrosa cystica

A slow viral infection of osteoclasts is suspect: stimulates osteoclastc activity

Paget Disease of Bone (Osteitis Deformans)
Expansion of bone and resorption (lytic lesions) in bone – disordered remodeling – resulting mosaic pattern

Paget Disease of Bone (Osteitis Deformans)
Hearing loss: involvement of the ossicles of ear, impingement of VIII nerve

Paget Disease of Bone (Osteitis Deformans)
Skull/⬝Cotton wool⬝
Paget Disease of Bone (Osteitis Deformans)

facial deformities – Leontiasis ossea (lion-like face)
Paget Disease of Bone (Osteitis Deformans)
Bowing of Legs
Paget Disease of Bone (Osteitis Deformans)

Benign Bone Tumors
Osteoid Osteoma
Highly malignant and characterized by the formation of neoplastic bone tissue/malignant osteoblasts

“Sunburst” appearance to the bone/formation of bone

Produce tons of cartilage.

The most common malignant tumor seen in bone is metastatic cancer
Breast, prostate, lung, thyroid, and kidney

Spread to bone is hematogenous
The vertebral column is the most commonly affected site – clinical pain

Malignant tumors of plasma cells
Production of monoclonal antibodies
Bence-Jones protein in urine
Amyloid deposits in kidney

Multiple myeloma
Skull/Punched-Out Radiolucencies
Defect in the phenotype of type I collagen
Multiple fractures after birth
Blue sclerae
Hearing abnormalities
Hyperextensible joints
Dental abnormalities (i.e., dentinogenesis imperfecta)

Osteogenesis Imperfecta
Degenerative Joint Disease
The single, most common form of joint disease
Prevalence and severity increases with age
Distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, knees, hips, and the cervical and lumbar spine
Systemic, chronic inflammatory disease
Multiple skeletal joints bilaterally or symmetrically
Autoimmune without a known etiology
Genetics – a specific set of HLA-DR alleles
Some 80% of patients are positive for rheumatoid factor (multiple an
Rheumatoid Arthritis
The proliferative synovial tissue with plasma cells, lymphocytes, giant cells, and lymphoid follicles is the
White area. Biopsy = will get lichenoid rxn
in regards to Rheumatoid Arthritis
- taking Chloroquine

Lichenoid drug reaction
Chlofoquine - Prevents release of lysosomal enzymes – constipates cell
chronic, typically granulomatous inflammation of large to small-sized arteries, principally the temporal arteries in the head

Giant Cell Arteritis (GCA)
Muscle pain and morning stiffness in the neck, shoulders, and hips
Tiredness and lack of energy
A low fever
Weight loss

Polymyalgia Rheumatica (PMR)
Increased serum uric acid or urate (hyperuricemia)
Deposition of urate crystals in the joints
Urate crystals in soft tissues (tophi or tophaceous gout); in the kidney renal stones.

metatarsophalangeal joint (the big or great toe); known as podagra

finger/discharging tophus: white, cheesy urate crystals
Chronic Gout
reflects abnormal bone remodeling
no lamina dura
Giant cells are resorbing bone, RBCs break down and release hemoglobin→ hemosiderin →
brown tumor
radiolucencies throughout the body
osteitis fibrosa cystica
Severe hyperparathyroidism with osteitis fibrosa cystica in numerous bones (generalized) is also known as
von Recklinghausen disease of bone
exogenous corticosteroids, Cushing Disease, hyperthyroidism, hematologic malignancies, malabsorption, alcoholism, diabetes, hyperparathyroidism
Secondary Osteoporosis
a peculiar developmental abnormality of the skeleton characterized by a disorganized mixture of fibrous and osseous elements in the interior of affected bones with expansion of the cortical bone (more CT in the bone)
Fibrous dysplasia
-“ground glass appearance” due to abnormal remodeling
-C-characters – C shaped trabeculae, which are not functional and prone to pathologic fractures
Fibrous dysplasia.
fibrous dysplasia is associated with endocrine dysfunction (e.g., acromegaly, Cushing syndrome) in which case the term,
McCune-Albright syndrome/GNAS gene
(1) an initial osteolytic stage, followed by (2) a mixed osteoclastic-osteoblastic stage, which ends with a predominance of osteoblastic activity and evolves ultimately into (3) a burn-out quiescent osteosclerotic stage
net effect is a gain in bone mass
Paget Disease of Bone (Osteitis deformans)
maxilla is expanding and getting diastemata
-“cotton-wool” appearance of skull due to abnormal remodeling
-pts are on bisphosphonates
-hypercementosis of roots
-loss of PDL

Paget Disease of Bone (Osteitis deformans)
-bone is being made
-osteoid is made by malignant osteoblasts
-most likely to metastasize to the lung

-Starry sky appearance
-malignant lymphocytes are the dark “night” and the histocytes are the white “stars”
Burkitt lymphoma

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