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Non- Neoplastic Bone Disease

Non- Neoplastic Bone Disease. Review of normal bone ​- Bone is made of cells ( osteocytes , osteoblasts , osteoclasts ) and calcified ECM ​- Bone remodels at the rate of 15% per year, resulting in the formation of remodeling lines.

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Non- Neoplastic Bone Disease

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  1. Non-Neoplastic Bone Disease

  2. Review of normal bone • ​- Bone is made of cells (osteocytes, osteoblasts, osteoclasts) and calcified ECM • ​- Bone remodels at the rate of 15% per year, resulting in the formation of remodeling lines.

  3. ​- Injured bone is healed with new bone (not other types of reactive tissue) • ​- For diagnosis purposes, bone X-ray is most important.

  4. Fractures • ​- PP: hematoma granulation tissue (fracture callus) cartilage osteoidbone • ​- Complications of fracture: necrosis, malunion, non-union • ​- Pathologic fracture: a fracture of bone with preexisting pathology.

  5. ​- Stress fracture: little breaks in bone due to constant repeated trauma • ​- Heterotopic ossification: bone formation in wrong place due to trauma but not fracture.

  6. Osteonecrosis (bone infarct) • ​- PP: most commonly due to intravascular coagulation (i.e. clot) • ​- e.g. due to fat embolization, marrow fat swelling, hypercoagulable blood • ​- 5 conditions that lead to above: alcoholism, steroids, sickle cell, caisson dz (the bends), Gaucher’sdz.

  7. ​- Histology: no osteocytes in lacunae, fat necrosis of marrow • ​- Often occurs in the femoral head; also, distal femur and humeral head.

  8. Osteomyelitis (bone infection) • ​- Primary: a hematogenous infection usually in children • ​- Sx: pain, fever, leucocytosis; • Rx: surgery, antibiotics • ​- If in adults, most commonly in spine after GU surgery.

  9. ​- Secondary: due to direct implantation of organisms • ​- Chronic osteomyelitis is due to incomplete organism clearance and is hard to treat because a bony reaction walls off the organisms • ​- Histology: possible sequestra (dead bone floating in abscess).

  10. Paget’s disease of bone • ​- PP: a disease of osteoclasts (focal or multifocal increased and chaotic bone remodeling) • ​- increased density due to compensation by osteoblastsarchitectural distortion and brittleness (no center hollow cavity) pain, deformity, banana fractures (straight across) • ​- slow viral infection etiology suspected.

  11. ​- Histology: excessive bone remodeling lines (mosaic-like) • ​- Most common in axial skeleton • ​- Commonly affects elderly and northern Europeans • ​- Complications: cranial nerve palsy, anemia, heart failure, sarcoma.

  12. Genetic Bone Disease • ​- Indirect: neurofibromatosis (most common single gene disease, sometimes also direct), Gaucher’s, mucopolysaccharidoses, alkaptonuria.

  13. ​- Direct (constitutional): skeletal dysplasia (short stature and deformity) • ​- Classification based on radiography and location of abnormality.

  14. ​- Osteogenesisimperfecta: mutation in type 1 collagen (most common congenital skeletal dysplasia), easy bone fractures, severity from mild to in utero lethal, blue sclera • ​- Achondroplasia: mutation in FGFR3, short stature, 2nd most common congenital skeletal dysplasia.

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