(Clinical Haematology) (Clinical Imaging)

Overview

• A spontaneous fracture following mild physical exertion or minor trauma due to abnormal weakness of the bone that is caused by an underlying condition
• Aetiology:
  • Disorders affecting bone metabolism → osteoporosis, paget disease, osteopetrosis, osteomalacia, osteogenesis imperfecta
  • Masses → malignant bone tumours (osteosarcoma, chondrosarcoma, ewing’s tumour), bone metastases (prostate, breast, lung, thyroid, renal), benign bone tumours, multiple myeloma
• Common Locations ⇒ spine, hip and wrist

Making Diagnosis

Investigations:

• Paget Disease → isolated ALP elevation. Normal calcium, phosphate and PTH levels. Tx with bisphosphonates.

  • Most commonly affected bones are the pelvis, vertebrae, skull, femur and tibia.
  • Typical presentation = older male with bone pain and isolated rise in ALP

• Malignant Bone Tumours → plain radiograph as initial test. Biopsy to confirm radiologic diagnosis.

• Bone Metastases → hypercalcaemia + raised ALP

• X-Ray:

  • Sclerotic Lesions ⇒ metastatic prostate cancer
  • Osteolytic Lesions ⇒ metastatic kidney/thyroid/lung cancer, multiple myeloma, paget’s disease

Management Plan