Senin, 13 Februari 2012

NON-NEOPLASTIC BONE AND JOINT LESIONS

It includes: Osteoporosis, Osteomalacia and Rickets, Hyperparathyroidism
Osteoporosis
  • 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
  • Exercise
Secondary osteoporosis
  • Corticosteroid excess (endogenous or exogenous)
  • Hyperthyroidism
  • Hypogonadism
  • Multiple myeloma
  • PTH-secreting tumors
  • Malabsorption
  • Alcoholism
Osteomalacia and Rickets
Accumulation of unmineralized bone matrix resulting from a diminished rate of mineralization
Causes:
  • 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
Hyperparathyroidism
  • 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
by
Akshaya Srikanth
Pharm.D Intern
Hyderabad, India

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