Disuse and Immobilization Osteoporosis

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Fig. 15.8A, B Immobilization osteoporosis. A Antero-posterior radiograph of the left shoulder girdle in a 48-year-old woman with disuse after mastectomy for breast cancer shows diffusely "washed out" regional bones (open arrows). B Anterior pinhole scintigraph reveals intense tracer uptake in porotic bones (arrows)

Bone is not a mere lazy weight-bearing or protective scaffold for the body, but is day and night engaged with modeling and remodeling through the active physicochemical and metabolic activities of osteoblasts and osteoclasts. Appropriate physical stress and strain are essential for maintaining such homeostatic functions in an orderly state. Thus, disuse and immobilization may result in mobilization of the calcium stored in bone, leading to osteoporosis due to a negative balance with its level in the serum and urine sensitively changing. Osteoporosis may appear before 5-7 weeks in those under the age of 20 years and those over 50 years, and more commonly after 8 weeks of immobilization (Jones 1969). The pathogenetic basis for decreased bone production and increased bone resorption have been debated, although Heaney (1962) demonstrated in a ra-diocalcium study that both bone resorption and formation are increased, but with more resorption than formation.

Fig. 15.8A, B Immobilization osteoporosis. A Antero-posterior radiograph of the left shoulder girdle in a 48-year-old woman with disuse after mastectomy for breast cancer shows diffusely "washed out" regional bones (open arrows). B Anterior pinhole scintigraph reveals intense tracer uptake in porotic bones (arrows)

Radiographically, osteoporosis is characterized by graying of bone which has a washed-out appearance that is generalized, diffuse, regional, or local in occurrence (Fig. 15.8A), and its pattern is homogeneous, band-like, or streaky and speckled. The trabeculae are coarsened and the cortex becomes pencil-lined, lamella-ted, or scalloped (Fig. 15.9A).

Scintigraphic findings vary according to the duration, severity, extent, and type of osteoporosis and the age of the patient, and this diversity seems to reflect the varied nature of the pathogenesis. Generally, however, senile or postmenopausal porosis (Fig. 15.1) and longstanding immobilization porosis (Fig. 15.9B)

Disuse Porotic

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Radiographic Immobilization

Fig. 15.10A, B Normal return of tracer uptake in disuse osteoporosis. A Initial anterior pinhole scintigraph of the right shoulder in a 48-year-old woman with local porosis caused by months of immobilization following ipsilateral mastectomy shows intense tracer uptake in the glenohu-meral joint bones (arrowheads). B Follow-up scintigraph taken 3 years later reveals nearly normalized bone uptake (arrowhead) (c coracoid process)

Fig. 15.9A, B Disuse osteoporosis. A Anteroposterior radiograph of the immobilized right knee in a 48-year-old woman due to osteoarthritis shows porosis with coarsened trabeculae and pencil-line cortex. No radiographic arthritic change is seen. B Anterior pinhole scin-tigraph reveals coarse speckled tracer uptake of porosis and zonal uptake of early osteoarthritis (arrows)

Fig. 15.10A, B Normal return of tracer uptake in disuse osteoporosis. A Initial anterior pinhole scintigraph of the right shoulder in a 48-year-old woman with local porosis caused by months of immobilization following ipsilateral mastectomy shows intense tracer uptake in the glenohu-meral joint bones (arrowheads). B Follow-up scintigraph taken 3 years later reveals nearly normalized bone uptake (arrowhead) (c coracoid process)

Reflex Sympathetic Osteodystrophy

do not intensely accumulate tracer and, conversely, relatively acute and localized porosis observed in young and middle-aged patients shows prominent tracer uptake (Fig. 15.8B). The increased tracer uptake in regional or localized disuse porosis may slowly return to normal with active reuse (Fig. 15.10).

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