Operative Management Two percutaneous treatment options for painful vertebral compression fractures—vertebroplasty and kyphoplasty—involve the injection of polymethyl methacrylate (PMMA) into a compressed vertebral body. Studies show that the procedures may…
Histologic Analysis of Undecalcified Bone. Because the differentiation between the two major metabolic bone diseases, osteoporosis and osteomalacia, is based in part on the quantity and quality of bone mineral,…
BMD determined by DXA is an areal measurement. The density in grams is divided by the area scanned to determine g/cm2. Meticulous detail is necessary to ensure follow-up scans measure…
Quantitative Ultrasonography (QUS) QUS, unlike diagnostic ultrasonography, uses a transmitting and receiving transducer. Frequencies are higher than used for diagnostic ultrasonography. The measurement reflects structure and mineral content by determining…
Radiography The identification of osteopenia on a radiograph requires a significant, 30% or greater, loss of bone mineral. There are two general types of bone loss, and the differentiation between…
WORKUP IN SYMPTOMATIC DISEASE Causes of symptomatic bone loss must be systematically excluded. The patient’s history may suggest bone loss secondary to hyperthyroidism, primary hyperparathyroidism, chronic glucocorticoid excess (hyperadrenalism or…
Multiple myeloma, the most common primary malignant bone tumor in adults, may be associated with profound generalized axial and appendicular osteopenia. Myeloma cells produce potent osteoclast-activating factors that stimulate bone…
Hyperadrenalism, or chronic glucocorticoid excess, whether endogenous (Cushing syndrome) or iatrogenic, leads to decreased bone mass. Glucocorticoid therapy results in a transient increase in bone resorption followed by a suppression…
In patients with HPP the predominant organs involved are the skeleton and teeth, which are hard tissues, even though there are high levels of TNSALP in many organs. Four of…
Osteoporosis is a heterogeneous disorder that is caused by multiple pathogenetic mechanisms. The clinical manifestation of osteoporosis is fracture, and the mechanisms that lead to fracture are multifactorial and include…
