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Skeletal X ray .pdf

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Title: Skeletal X-ray
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Skeletal X-ray
Dr. Md. Zahid Alam
FCPS (Medicine)

Associate professor, Cardiology


What we see in skeletal X-ray?
• As a whole: Normal anatomy

• All spines: Curvatures, osteopenia, bony lesion, disc space
• Vertebral body: Shape & size (compare with surroundings),
osteophytes, syndesmophytes, sliding
• Joint spaces: Reduction, widening, any deposition
• Any bone: Osteolysis, osteosclerosis, bony erosion

• Soft tissue shadow: Paravertebral, associated with/ near
the lesion

• Bones, muscles, joints, tendons are attached with each others & work together
• Many important structures (not a part of skeletal system) are in close proximity
• If one part is affected, it will affects others


• Reduced bone density
(= brittle bone)
Remember! No problem in

• Increased risk of fracture
(= low trauma fracture)
• Due to defect in attaining
peak bone mass and/or
accelerated bone loss

Normal bone

• Osteoporosis are always
asymptomatic until a

fracture occurs
• Common sites of fracture
- Forearm (Colles fracture)
- Spine (vertebral fracture)

- Hip (most serious)
• Symptoms of osteoporotic
fracture depends on the

site & nature of fracture

Normal bone density
(Normal trabecular structures)

(Reduced bone density/trabecular bone)

(Normal bone density, but defective mineralization)

• Causes
– Older age (= age related
– Menopause (= due to
– Hypogonadism in male
– Genetic
– Corticosteroids, alcoholism,
smoking, immobilization
– Systemic diseases:
Cushing’s, RA, IBD, CLD,
myeloma, etc

• Osteopenia is an X-ray finding
• Osteoporosis is diagnosed by
Dual Energy X-ray Absorptiometry

(DEXA) at the lumbar spine and hip
• Treatment
– Non pharmacological (reduction of risk

factors, eg. quit smoking)
– Pharmacological (Calcium & Vit-D,
Bisphosphonates, Denosumab, PTH,
Hormone replacement therapy for
menopausal osteoporosis)
– Surgical (Vertebroplasty & kyphoplasty)

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