1. Non Inflammatory Pathology of Bone &Joints Non Inflammatory Pathology of Bone &Joints By By Dr. Atif Ali

2. MSK system MSK system Bone Joints Muscles Soft tissues

3. 1- Bone Pathology 1-Metabolic 2- Infections 3- Tumors 4- Congenital

4. The Normal © Dr. Atif 2010

5. Trabeculae Canaleculae Normal bone

6. Types of bones Bones Woven Lamellar Compact Cancellous

7. Bone structure Matrix Cells: Osteoblasts Osteoclasts Osteocytes Minerals Ca PO 4 HCO 3 ….. © Dr. Atif 2010

8. Bone turn over (physiology)

9. 1-Metabolic Bone Diseases Due to imbalance in bone turn over :- Disease Defect Paget's disease Formation + Resorption Osteoporosis Formation + Resoption Osteomalacia & rickets Mineralization PTH Resoption

10. Investigations in Bone Disorders  Radiological : X-ray, bone scan,….  Biochemical Calcium Phosphates PTH Vit D3 Alkaline phosphatase.  Biopsy.  Others

11. 1- Osteoporosis Definition : Skeletal disorder chr by ↓↓ bone mass with ↑ fragility and ↑ tendency to fracture

12. Pathogenesis and Causes  Bone atrophy due to ↓ formation and ↑ resoption Primary: Postmenopausal Senile Secondary: Hormonal : DM, Cushing, estrogen,.. Immobilization. Nutritional. Other bone pathology. Genetic factors: Vit D receptors,..

13. Pathogenesis ( 1 ry) Estrogen Cytokines RANK, RANKL

14. Pathology ◙ ↓ bone mass ( osteopenia)  Normal mineralization. ◙ Thin trabiculae and wide canaliculae. µ Collapse of vertebrae ( code fish #) ◙ Pathological fractures. Normal bone Osteoporosis

15. Clinical Features in elderly females. Early : asymptomatic. Bone pain. Pathological factures. Principles of TTT ??

16. Diagnosis Radiological : osteopenia and pathological # Biochemical : All bone profile normal. Routine and hormonal studies. Bone biopsy:

19. Osteomalacia and Rickets Defective mineralization of bone matrix resulting in excessive osteoid formation and bone softening.

20. Causes Vit D3 deficiency.  Diet Malabsorption. ↓ sun exposure Vit D3 abnormal metabolism. Liver, renal ( Vit D dependent rickets type I) Normal level Vit D3.  PO4. End organ resistance (type II) Toxins Hypophosphatesia.

21. Pathology  ↓ bone mineralization.  ↑ Osteoid formation.  ↑ Cartilage formation.

22. Clinical Features Bone pain Proximal muscles weakness Pathological fractures. Adults  ↓ Growth  Long bone deformity  Pigeon breast  Rickets rosary Children

24. Diagnosis  Clinical  Radiological.  BiochemicalALPPTH Vit D 3 PO 4 Ca Treatment ??

25. Radiological findings Deformity Green stick fracture Wide epiphysial plate

26. 1ry Hyperparathyroidism 1ry Hyperparathyroidism ↑↑ PTH due to primary PT gland disorder. Causes : adenoma, adenocarinoma. Effects ↑bone resorption, ↑Ca,↓ PO4. Clinically: Of hypercalcaemia: bone, GIT, CNS, Kidney. Bone :pain and pathological fractures.

27. Bone pathology: Bone pathology: Bone inflammation, fibrosis and cysts formation ( Osteitis fibrosa cystica) Brown tumor: deposition of hemosedren.. Osteoporosis. Diagnosis: Bone profile:- Diagnosis: Bone profile:- ALPPTH Vit D 3 PO 4 Ca NN

29. Renal Osteodystrophy  In CRF: low Vit D3 and low Ca.  Lead to 2ry ↑PTH.  Lead to bone ↑ resoption : pathological #

30. Paget's disease ↑↑ bone turnover → disorganized bone structure, fibrosis and thickening. Both osteoclast and osteoblasts are active. Causes : unknown( viral infections?) Pathology: Fibrosis ( bone mosaic) Bone vasculature. Thickening and deformity.

32. Clinically: Bone deformity (local or general) Common site : skull & pelvic Complications:  Pathological fracture.  Nerves compression.  Congestive heart failure.  Late : malignancy.

34. Diagnosis: Clinical Radiological biochemicalALPPTH Vit D 3 PO 4 Ca NNN N

35. Question ?

36. Congenital Bone Diseases A chondroplasia Ostegenesis imperfecta Osteopetrosis Others

37. 1-Osteopetrosis Called marble bone disease (AR) Due to congenital ↓ in osteoclastic activity  ↓resoption  large fragile bone Complications  Pathological #  BM compression  Anemia, LEP  Nerve compression

38. Osteopetrosis

39. 2- Ostognesis imperfcta Rare inherited disease (1/8000) AD Mutations of gene for type I collagen – COL 1A1 gene on chromosome 17 – COL 1A2 gene on chromosome 7 Abnormal osteoid production – osteopenia Clinically :pathological #, blue sclera,....

40. 3- A chondroplasia Congenital defect in cartilage formation Premature closure of epiphysis Short stature ( what ∆ ∆ ?)