Senile (type II) osteoporosis

• cortical and trabecular bone are lost proportionately

• hip, humerus, tibia, pelvis are involved

• main things these days is to use DEXA, oral-absorption spectrometry

Radiology

• appearance depends on severity of disease

• vertebrae assume a codfish appearance. kyphosis, loss of connectivity between vertebra are seen

• I don’t know why they call it a codfish appearance. there are many types of codfish, some of which look very different, and to cover all your bases, it would suffice to say simply that they all just look like fish. and what’s with all these fish references?

Bone loss: cancellous vs. cortical

• primary cancellous bone loss

  • estrogen deficiency

  • glucocorticoid therapy

• secondary cortical bone loss

  • hyperPTH

Trans-iliac-crest biopsy: involves outer and inner cortex of iliac crest

• lost lots of trabeculae. cortex has become very, very thin

• if you take individual trebeculae, there are microcalluses secondary to microfractures. numerous of these lesions will lead to gross osteoporosis fractures

Photomicrographs

• inactive resorption—osteoclasts aren’t at work, so the bone surface isn’t jagged

• active resorption: lots of osteoclassts, very jagged bone

Category: Pathology Notes