Bone Pathology_ Non-Neoplastic Lesions of Bones and Joints

Posted by e-Medical PPT Saturday, February 11, 2012
Metabolic Bone Diseases
Osteomalacia and Rickets

Metabolic disease characterized by diffuse skeletal lesions due to a decreased mass of normally mineralized bone
Post-menopausal females
Increased bone resorption (osteoblastic activity is normal)
 Estrogen may lead to increased secretion of IL-1, IL-6, TNF and MCSF by stromal cells which will stimulate osteoclasts

Primary osteoporosis
Some genetic basis
Dependent upon levels of Ca++ and vitamin D

Secondary osteoporosis
Corticosteroid excess (endogenous or exogenous)
Multiple myeloma
PTH-secreting tumors

Osteomalacia and Rickets
Accumulation of unmineralized bone matrix resulting from a diminished rate of mineralization
  • Dietary deficiency in vitamin D
  • Defective bone mineralization
  • Congenital or acquired defects in vitamin D or phosphate metabolism
  • Malabsorption (most common cause in US)
  • Crohn’s disease
  • Celiac disease
  • Cholestatic liver disease
  • Biliary obstruction
  • Chronic pancreatitis

Increased bone resorption secondary to increased PTH
Classic pathologic change referred to as osteitis fibrosa cystica
Replacement of marrow by fibrous tissue
Numerous microfractures
Hemosiderin-laden macrophages
Eventually cystic degeneration and classic gross appearance referred to as “brown tumor”

Osteopetrosis (marble bone disease, Albers-Schönberg disease)
Inherited lysosomal defect
Most severe form (autosomal recessive) is severe and often lethal
Death secondary to anemia, cranial nerve entrapment, hydrocephalus and infection
Dense bones weighing 2-3 times normal
TX with BMTx and IFN-...

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