RADPATHOLOGY HISTOLOGY OF BONE TISSUE

• Extracellular matrix surrounding widely

FUNCTIONS OF BONE AND SKELETAL SYSTEM
separated cells
• Support Matrix
- Structural framework of the body - 25% water, 25% collagen fibers, and
o Supports so6 7ssues 50% crystallized mineral salts
o Provides a;achment points v Most abundant mineral salt is calcium
for tendons of skeletal phosphate
muscle. • A process called calcifica7on is ini7ated
• Protec7on by bone-building cells called osteoblasts
- Protects important internal organs • Mineral salts are deposited and
o Cranium protects brain crystallize in the framework formed by
o Vertebrae protects spinal the collagen fibers of the extracellular
cord matrix.
o Ribs protect lungs and heart • Bone’s flexibility depends on the
• Assistance in Movement collagen fibers.
- Skeletal muscle a;aches to bone 4 TYPES OF CELLS PRESENT IN BONE
o Skeletal muscle contrac7on TISSUE
pulls on bone producing 1) Osteogenic cells
movement o Undergo cell division: the
• Mineral Homeostasis resul7ng cells develop into
- Bone 7ssue stores several minerals osteoblasts
o Calcium (99% of body’s 2) Osteoblasts
content) o Bone-building cells
o Phosphorus o Synthesize extracellular
• Blood Cell Produc7on matrix of bone 7ssue
- Red bone marrow produces 3) Osteocytes
(Hemopoiesis) o Mature bone cells
o RBC, WBC, Platelets o Exchange nutrients and
• Triglyceride Storage wastes with the blood
- Yellow bone marrow 4) Osteoclasts
- Triglycerides stored in adipose cells o release enzymes that
o Serves as a poten7al digest the mineral
chemical energy reserve components of bone
STRUCTURE OF BONE matrix (resorp7on)
• Long Bone Anatomy (Humerus) o Regulate blood calcium
- Diaphysis (sha6 or central part) level
- Epiphysis (end part) • Compact bone
- Metaphysis (epiphysial growth - Resist stresses produced by the
plate) weight and movement
- Ar7cular car7lage (perfora7ng fiber) - Components of compact bone are
- Periosteum arranged into repea7ng structural
- Medullar cavity units called osteons or Haversian
- Endosteum systems
 - Osteons consist of a central § The periosteum is rich in sensory
(Haversian) canal with concentrically nerves sensi7ve to tearing or
arrange lamellae, lacunae, tension
osteocytes, and canaliculi. BONE FORMATION
• Osteon • The process by which bone forms is
- Central canals run longitudinally called ossifica7on
through bone • Bone forma7on occurs in four situa7ons:
- Around the central canals are 1) Forma7on of bone in an embryo
concentric lamellae (rings of 2) Growth of bones un7l adulthood
calcified matrix) 3) Remodeling of bone
- B/n the lamellae are small spaces 4) Repair of fractures
called lacunae which contain • Forma7on of Bone in an Embryo
osteocytes 2 Pa;erns of bone forma7on
- Canaliculi- radia7ng in all direc7ons 1) Intramembranous ossifica7on
from the lacunae o Flat bones of the skull and
- Canaliculi connect lacunae, forming mandible are formed in this
a system of interconnected canals way
(providing routes for nutrients and o “so6 spots” that help the
oxygen to reach the osteocytes) fetal skull passes through
- The organiza7on of osteons changes the birth canal later become
in response to the physical demands ossified forming the skull.
placed on the skeleton. 2) Endochondral ossifica7on
• Spongy Bone o The replacement of
- Within each trabecula are lacunae car7lage by bone
that contain osteocytes o Most bones of the body
- Osteocytes are nourished from the are formed in this was
blood circula7ng through the including long bones
trabeculae BONE GROWTH DURING INFANCY, CHILDHOOD
- Interior bone 7ssue is made up AND ADOLESCENCE
primarily of spongy bone • Growth in Length
- The trabeculae of spongy bone are - The growth in length of long bones
oriented along lines of stress involves two major events:
• helps bones resist stresses 1) Growth of car7lage on the
without breaking epiphyseal plate
• Bone is richly supplied with blood 2) Replacement of car7lage by bone
§ Periosteal arteries 7ssue in the epiphyseal plate
accompanied by nerves supply • Growth in Thickness
the periosteum and compact - Bones grow in thickness at the outer
bone surface
§ Epiphyseal veins carry blood • Remodeling of Bone
away from long bones - Bone forms before birth and
• Nerves accompany the blood vessels con7nually renews itself
that supply bones - The ongoing replacement of old
bone 7ssue by new bone 7ssue
 - Old bone is con7nually destroyed - Parathyroid hormone, calcitriol, and
and new bone is formed in its place calcitonin are other hormones that
throughout an individual's life can affect bone remodeling
• A balance must exist b/n the ac7ons of FRACTURE AND REPAIR OF BONE
osteoclasts and osteoblasts Fracture Types
- If too much new 7ssues formed, the a) Open (compound) fracture
bones become abnormally thick and - The broken ends of the bone
heavy. protrude through the skin
- Excessive loss of calcium weakens b) Closed (simple) fracture
the bones as occurs on osteoporosis - Does not break the skin
- Or they may become too flexible as c) Comminuted fracture
in rickets and osteomalacia - The bone is splintered crushed, or
FACTORS AFFECTING BONE GROWTH AND broken into pieces
BONE REMODELING d) Greens7ck fracture
Normal bone metabolism depends on several - A par7al fracture in which one side
factors: of the bone is broken and the other
• Minerals side bends
- Large amounts of calcium and e) Impacted fracture
phosphorus and smaller amounts of - One end of the fractured bone is
magnesium. fluoride. and forcefully driven into another
manganese are required for bone f) Po;'s fracture
growth and remodeling - Fracture of the fibula, with injury of
• Vitamins the 7bial ar7cula7on
- Vitamin A s7mulates ac7vity of g) Colles' fracture
osteoblasts - A fracture of the radius in which the
- Vitamin C is needed for synthesis of distal fragment is displaced
collagen h) Stress fracture
- Vitamin D helps build bone by - A series of microscopic fissures in
increasing the absorp7on of calcium bone
from foods in the gastrointes7nal BONE'S ROLE IN CALCIUM HOMEOSTASIS
tract into the blood • Bone is the body's major calcium
- Vitamins K and B12 are also needed reservoir
for synthesis of bone proteins • Levels of calcium in the blood are
• Hormones maintained by controlling the rates of
- Estrogen and testosterone cause a calcium resorp7on from bone into blood
drama7c effect on bone growth and of calcium deposi7on from blood
§ Cause of the sudden "growth into bone
spurt" that occurs during the o Both nerve and muscle cells
teenage year depend on calcium ions (Ca2+) to
§ Promote changes in females, func7on properly
such as widening of the pelvis o Blood clomng also requires Ca2+
§ Shut down growth at epiphyseal o Many enzymes require Ca2+ as a
plates cofactor
• Ac7ons that help elevate blood Ca2+ level
 - Parathyroid hormone (PTH) • There are two principal effects of aging
regulates Ca exchange b/n blood
2+
on bone 7ssue:
and bone 7ssue 1) Loss of bone mass
o PTH s7mulates forma7on of - Results from the loss of calclum
calcitriol a hormone that from bone matrix
promotes absorp7on of - The loss of calcium from bones is
calcium from foods in the GI one of the symptoms in
tract. osteoporosis
• Ac7ons that work to decrease blood Ca2+ 2) Bri;leness
level - Results from a decreased rate of
- The thyroid gland secretes calcitonin protein synthesis
(CT) which inhibits ac7vity of - Collagen fibers gives bone its
osteoclasts tensile strength
- The result is that CT promotes bone - The loss of tensile strength
forma7on and decreases blood Ca2+ causes the bones to become
level very bri;le and suscep7ble to
EXERCISE AND BONE TISSUE fracture
• Bone 7ssue alters its strength in
response to changes in mechanical stress SKELETAL STRUCTURE TERMS
- Under stress, bone 7ssue becomes Skeletal Descrip7on Example
stronger through deposi7on of term
mineral salts and produc7on of Canal Passage Semicircular canal in the
collagen fibers by osteoblasts through inner ear
- Unstressed bones diminishes substance of
because of the loss of bone minerals a bone
and decreased numbers of collagen Condyle Rounded Femur bone
process at
fibers
the end of a
• The main mechanical stresses on bone bone that
are those that result from the pull of anchors
skeletal muscles and the pull of gravity muscle
• Weight-bearing ac7vi7es help build and ligaments
retain bone mass and
AGING AND BONE TISSUE ar7culates
• The level of sex hormones diminishes w/ another
during middle age, especially in women bone
a6er menopause Crest Narrow Crest of the ilium
- A decrease in bone mass occurs ridge like
projec7on
- Bone resorp7on by osteoclasts
Epicondyle Projec7on Epicondyle of the
outpaces bone deposi7on by
above a humerus
osteoblasts
condyle
• Female bones generally are smaller and Facet Small almost Rib facet of thoracic
less massive than males flat surface vertabra
- Loss of bone mass in old age has a Fissure Elongated b/n the occipital and
greater adverse effect in females cle6 sphenoid bones
 Sinus Cavity w/n a Frontal bone sinus
(antrum) bone
Fontanel So6 spot in b/n frontal and Spine Thorny Spine of the
skull where parietal bones projec7on scapula
membranes Sulcus Narrow Frontal/occipital/
cover spaces
groove parietal sulcus
b/n bones
Suture Interlocking Lambdoid suture
Foramen Opening Foramen magnum line where b/n occipital and
through of occipital bone bones unite parietal bones
bone,
Trochanter Rela7vely Trochanter of the
usually for
large femur
blood
process
vessels,
Trochlea Smooth Trochlea of the
ligaments,
groove humerus
or nerves
pulley-
Fossa Rela7vely Olecranon fossa of shaped
deep the humerus
ar7cular
depression
process
or pit
Tubercle Rela7vely Tubercle of the
Fovea Rela7vely Fovea capi7s of
small, humerus
7ny the femur
knoblike
depression process
or pit
Tuberosity Knoblike Tuberosity of the
Head Enlargement Head of the
process that radius
on the end humerus
is larger
of a bone
than
Line Low ridge A;achment point tubercle
for tendons and
ligaments
IMAGING CONSIDERATIONS:
Meatus Tube-like External acous7c
a. Radiography
passage w/n meatus of the ear
a bone b. Magne7c Resonance Imaging (MRI)
Neck Narrow Long bone such as c. Computed Tomography (CT)
connec7on femur d. Nuclear Medicine Procedures (NM)
b/n CONGENITAL AND HEREDITARY DISEASES
epiphysis 1. OSTEOGENESIS IMPERFECTA
and o Bri;le bone disease
diaphysis o Rare heritable or congenital
Process Prominent Mastoid process disease
projec7on of temporal bone o Autosomal dominant defect
on a bone o Caused by muta7ons in the two
Ramus Bone Superior pubic structural genes that encode the
extension ramus Alpha-1- and Alpha-2- pep7des
that creates
of type I collagen
angles with
o Deficient and imperfect
remainder
of the forma7ons of osseous 7ssue,
structure skin, sclera, inner ear and teeth
 is noted in individuals with this does not convert to bone in the
disease normal manner, impairing the
TWO GROUPS OF OSTEGENESIS longitudinal growth of the bones
IMPERFECTA o pa7ent with type of
a. Osteogenesis Imperfecta Congenita Osteochondrodysplasia have a
(present at birth) normal trunk size and shortened
o Mul7ple fracture at birth extremi7es.
that heal only to give way to o An adult with Achondroplasia is
new fractures usually no more than 4 feet in
o Results to limb deforma7on height with lower extremi7es
and dwarfism and death usually less than half the normal
b. Osteogenesis Imperfecta Tarda length
o Fractures might not present o Clinical manifesta7ons includes:
for some years a6er birth extreme lumbar spine lordosis,
and then stop once bowed legs and bulky forehead
childhood is reached with midface hypoplasia and
o A hearing disorder persists narrowing of the foramen
because of otosclerosis magnum.
(forma7on of abnormal TREATMENT: Ilizarov procedure used in
connec7ve 7ssue around an a;empt to lengthen the shortened
the auditory ossicles) limbs (Dr. Gavril Ilizarov)
o Radiographic evalua7on: • Consists of a cor7colomy of the
demonstrates mul7ple limb, followed by a;achment of
fractures in various stage of a llizarov fixator consis7ng of
healing and general circular frames surrounding the
decrease in bone mass. limb, wires and rods.
o Bone cortex is thin, porous, • This method made the bone to
trabeculae are thin, delicate grow at a rate approximately
and widely separated. 1mm
2. ACHONDROPLASIA per day.
o Most common inherited BONE AGE RADIOGRAPHIC STUDIES-
disorder affec7ng the skeletal used to monitor pa7ents with growth
system. hormones deficiency (GH) deficiency.
o Results in bone deformity and TWO METHODS:
dwarfism 1. Atlas Matching method-established by
o Caused by an autosomal Greulich and Pyle (1950)
dominant gene (FGFR3) at the 2. Point Scoring System- Tanner and
4p chromosome loca7on. Whitehouse (1960)
o This gene does not skip
genera7ons 3. OSTEOPETROSIS
o Because of a disturbance in o Osteopetrosis or Marble bone
endochondral bone forma7on, characterize various disorders
the car7lage located in the involving the increase in bone
epiphyses of the long bones density and defec7ve bone
 contour, referred as skeletal A. ALBERS-SCHONBERG DISEASE
modeling. - common form of osteosclero7c
o Involve muta7ons at the CLCN7 osteopetrosis
gene - • Hereditary disorder;
The spectrum of Osteopetrosis - • Autosomal dominant
includes: - Delayed, benign skeletal
1) Infan7le osteopetrosis CLCN7- anomaly involves increased
related autosomal recessive bone density in conjunc7on with
osteopetrosis (ARO)- which has fairly normal bone contour.
its onset is infancy - the bone sclerosis is not
2) Intermediate autosomal radiographically visible at birth.
osteopetrosis (IAO)- develops in - As individual ages, radiographic
childhood manifesta7ons become visible in
3) Autosomal Dominant the region of the cranium and
Osteopetrosis type II (ADOll)- spine, however, the general
occurs in late childhood or health of the pa7ent is
adolescence unimpaired.
• In osteopetrosis, bones B. CRANIOTUBULAR DYSPLASIA
abnormally heavy and compact - Group of rare autosomal
but nevertheless bri;le recessive hereditary disease
• The disorders characterizing - Result in abnormal or defec7ve
osteopetrosis include: bone contour of the cranium
osteosclerosis, craniotubular and long bones.
dysplasia (affec7ng the cranium - Radiographs are useful in
and tubular long bones) demonstra7ng this altera7on in
Note: be aware of both the contour, sclerosis and changes
osteosclero7c and craniotubular within the cor7cal bone
hyperosto7c disorders - Includes a variety of rare
- requires an increase in exposure hereditary diseases causing both
factors to adequately penetrate an increase in bone density and
he bony anatomy because of abnormal bone modeling
abnormal bone density - Both of these manifests in
•All bones are affected, but most childhood
significant changes occur in the long - Do not normally impair the
bones of the extremi7es, vertebrae, individual's general health, bony
pelvis and base of the skull overgrowth may entrap cranial
nerves, resul7ng in some
Radiograph demonstraQon: increase in dysfunc7on such as facial palsy
density and thickness of the cortex as or deafness.
well as an increase in the number and 4. HAND AND FOOT MALFORMATIONS
size of trabeculae, with marked o Abnormali7es of the fingers and toes
reduc7ons of the marrow space. may occur during fetal development
but can be surgically corrected at
birth.
 o Failure of the fingers or toes to Sonography: diagnose anomaly early
separate is called SYNDACTYLY and in life thru visualiza7on of the
causes the physical appearance of car7laginous structures of the of the
"webbed digits". hip.
o Associated with Apert Syndrome- 5. VERTEBRAL ANOMALIES
gene7c syndrome involving - SCOLIOSIS- abnormal lateral
muta7ons of fibroblast growth curvature of the spine
factor receptor 2 (FGFR2) • STRUCTURAL SCOLIOSIS -associated
o Apert syndrome is responsible for with vertebral rota7on
craniosynostosis - Lateral curves are usually convex
1) POLYDACTYLY- the presence of extra to the right in the thoracic region
digits; tx: surgical and therapy and to the le6 in the lumbar
2) CLUBFOOT (talipes)- congenital region of the spine.
malforma7on of the foot that prevents - Affects girls more frequently and
normal weight bearing. may cause numerous
• Foot is turned inward at the complica7ons, including
ankle; occurs bilaterally cardiopulmonary complica7ons,
• Corrected by cas7ng or splin7ng degenera7ve spinal arthri7s and
in the correct anatomic posi7on fa7gue and joint dysfunc7on
3) DEVELOPMENTAL DYSPLASIA OF THE HIP syndrome
(DDH) • NON-STRUCTURAL SCOLIOSIS-
- Malforma7on of the acetabulum Primary issue is not vertebral
- The acetabulum does not form rota7on, results from unequal leg
completely, the head of the lengths or compensatory postural
femur is displaced superiorly changes affected by chronic pain
and posteriorly elsewhere in the body.
- Ligaments and tendons § Radiography is important in the
responsible for proper dx and tx of scoliosis
placement of the femoral head § AP or PA and lateral standing
are also affected radiographic studies
- DDH may be unilateral or § PA projec7on -reduces the
bilateral; more in females than radia7on dose to the breast
males area.
- Risk factors: breech posi7on in § Brace of body cast with curves of
utero, being the first child, or 25 to 35 degrees
low levels of amnio7c fluid § Surgical lx with spinal fusion for
- May be associated with cerebral curves greater that 40 degrees
palsy, myelomeningocele, • TRANSITIONAL VERTEBRA
arthrogryposis and Larsen - One that takes on the
syndrome characteris7cs of both vertebrae
LARSEN SYNDROME: a muta7on of on each side of a major division
the FLNB gene affec7ng the of the spine;
produc7on of filament B protein. - Occur at junc7on b/w the
thoracic and lumbar spine or at
 junc7on b/w lumbar spine and 1. ANENCEPHALY
the sacrum. - Congenital abnormality in which
- The L1 and C7 may have the brain and cranial vault do
rudimentary ribs ar7cula7ng not form.
with the transverse process. - Only the facial bones are formed
- C7 rib most commonly occurs at - Results in death shortly a6er
C7 may exert pressure on the birth; diagnosed before birth
brachial nerve plexus or the ultrasonographically
subclavian artery requiring - It is a neural tube defect, with
surgical removal of the rib. unknown cause.
• SPINA BIFIDA - Suspiciously, may be caused by a
- Incomplete closure of the - combina7on of mul7ple gene7c
vertebral canal that is (MTHFR gene) and
par7cularly in LS area environmental factors such as
- O6en, pa7ents have no visible deficiency of folate, diabetes,
abnormality or neurologic mellitus, exposure to high heat
deficit, but failure of fusion of in early pregnancy, or use of
the two laminae is visible certain an7seizure medica7ons
radiographically (spina bifida during pregnancy.
occulta) - Signs/Symptoms: dull pain, heat
- Severe cases, spinal cord or in the affected area, intermi;ent
nerve root may be involved, low-grade fever
resul7ng in varying degrees of - Hematogenous osteomyeli7s
paralysis. - Develops at the ends of the long
- Tx: determined on the basis of bones
the extent of the anomaly and - In children: distal femur,
requires services of a variety of proximal 7bia, humerus and
physicians radius
6. CRANIAL ANOMALIES - Adults: vertebrae
- Premature or early closure of - Infant and children are most
the cranial sutures commonly affected by acute
(craniosynostosis) hematogenous osteomyeli7s
- Congenital anomaly causes an because of increased vascularity
overgrowth of the unfused and the rapid growth of their
sutures to accommodate brain long bones.
growth which alters the shape of
the head.
- O6en associated with APERT
Syndrome (gene7c disorder
caused by a muta7on of the
Fibroblast Growth Factor
Receptor 2 (FGFR2) gene on
chromosome 10)