6 Hormonal and Metabolic Bone Diseases
Osteoporosis
Definition
Tendency to fracture due to loss of or generalized decrease in bone mass, structure, and function
Pathology
Thinned and rarefied spongiosa
Widened haversian canals
Decreased density of the cortex due to imbalance of osseous formation and resorption
Generalized Osteoporosis
Pathology
Categories/Classification
Primary (idiopathic) osteoporosis:
– Postmenopausal osteoporosis
– Senile osteoporosis
– Juvenile idiopathic osteoporosis
– Presenile idiopathic osteoporosis
Secondary osteoporosis:
– Endocrine osteoporosis
– Neoplastic osteoporosis
– Gastrointestinal osteoporosis
– Osteoporosis in rheumatoid diseases
– Medication-induced osteoporosis
– Disuse (immobilization) osteoporosis
Clinical Findings
Pain only after microfractures or macrofractures, usually after inappropriate trauma
Diagnostic Evaluation
(Not suited to quantifying the osteoporosis!) (Fig 6.1)
Recommended views
Standard projections
Findings
Rarefied spongiosa
Thinned cortex
Accentuated appearance of muscular and ligamentous insertions
Possibly fractures
Indications
Only supplementary, to work up comminuted fractures
Indications
Only supplementary in suspected occult fractures
Goals of Imaging
Determination of pathological bone density, diffuse/regional
Visualization of soft-tissue changes
Visualization of joint-space and cartilage changes
Detection of pathological fractures
Fig. 6.1 
Osteoporosis, conventional radiograph
A Accentuated trabecular marking due to rarefied spongiosa
B Thinned cortex
Therapeutic Principles
Conservative
Reduction of risk factors (lack of exercise, inadequate diet)
Medication targeting the underlying cause (hormone substitution, Calcitonin)
Regional (Local) Osteoporosis
Disuse (Immobilization) Osteoporosis after Trauma
Pathology
Venous stasis due to lack of muscle pump
Active hyperemia in neural injuries
Diagnostic Evaluation
(→ Method of choice)
Recommended views
Standard projections
Findings
Homogenous, band-like metaphyseal, or patchy decrease in bone density
Sudeck Syndrome
Definition
Multifactorial trophic disturbance with involvement of soft tissues and bone
Pathology
Impaired microcirculation due to dysfunction of sympathetic vasocon-stricting neurons
Clinical Findings
Pain and hypersensitivity
Soft-tissue swelling
Vasomotor instability
Livid discoloration
Functional impairment
Diagnostic Evaluation
(→ Method of choice)
Recommended views
Standard projections
Findings
Stage I (early stage):
– Possibly soft-tissue swelling
Stage II (acute stage):
– Increased radiolucency
– Washed-out spongiosa structure
– Lamellated cortex
– Definite soft-tissue swelling
Stage III (healing phase):
– Increased radiolucency
– Coarse spongiosa structure
– Moderate soft-tissue swelling
Stage IV (deficient stage):
– Moderately increased radiolucency
– Scanty spongiosa structure
– Soft-tissue atrophy
(→ Supplementary method)
Recommended sections
Axial
Paracoronal
Parasagittal
Recommended sequences
T1-weighted spin-echo (SE)
T1-weighted SE after intravenous administration of contrast medium
Fast spin (echo) T2-weighted inversion recovery (FST2[IR])
Findings
Stage I:
– Soft-tissue edema: hypointense on T1-weighted images, hyperintense on T2-weighted images
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