4

CASE 4


A 72-year-old woman presented to her geriatric physician with back pain that radiated laterally to the flanks. Upon examination, her physician noticed pronounced kyphosis of her vertebral column. Radiographs revealed vertebral compression fractures in the thoracic and upper lumbar regions. Bone densitometry showed significant loss of bone mineral density. The patient was diagnosed with senile osteoporosis (Fig. 1-8).


image

FIGURE 1-8 Compression fractures and kyphosis of the vertebral column in osteoporosis.


(Goldman L and Ausiello D: Cecil Textbook of Medicine, 22e. WB Saunders, 2004. Fig. 258-4. From Cecil Textbook of Medicine, 22nd edition.)



WHAT SKELETAL ELEMENTS ARE THE MOST SEVERELY DAMAGED BY THE OSTEOPOROTIC PROCESS?


In postmenopausal osteoporosis, the cancellous (spongy) regions of bones provide the greatest surface area for bone degradation by osteoclasts. Involvement of the cancellous bone in vertebral bodies may culminate in compression fractures.


In contrast, senile osteoporosis preferentially leads to pronounced bone resorption in cortical bone, which is composed of osteons (haversian systems). With excessive resorption, the cortical bone may resemble cancellous bone instead of compact bone with its haversian systems.



THE THORACIC REGION OF THE VERTEBRAL COLUMN EXHIBITS A NORMAL ANTERIOR CONCAVE CURVATURE (NORMAL KYPHOSIS). ANATOMICALLY, HOW IS THIS CURVATURE PRODUCED?


The primary curvatures (thoracic and sacral segments) of the vertebral column are formed from slight regional differences in the height of the thoracic vertebral bodies. Specifically, the anterior region of the body is shorter than its posterior aspect.



HOW WOULD YOU DESCRIBE A PRONOUNCED KYPHOSIS OF THE VERTEBRAL COLUMN?


Pronounced kyphosis is characterized by an exaggerated anterior curvature of the thoracic segment of the vertebral column. The exaggerated curvature produces a hunchback appearance.

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 4

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