BONE PATHOLOGY

Introduction
Normal Anatomy & Histology

Dr. Suraj Jain, M.D

Asst. Professor

Normal anatomy
Parts of a long bones:
diaphysis (shaft),
epiphysis (ends of bone, partially covered by
articular cartilage),
metaphysis (junction of diaphysis and epiphysis,
most common site of primary bone tumors)
Cross section:
periosteum
cortex (composed of cortical or compact bone)
medullary space (composed of cancellous or
spongy bone)

Normal histology
Lamellar Bone ( Mature)
layered bone with concentric parallel lamellae;
gradually replaces woven bone
Cortical
- 80%of skeleton
- 80-90% calcified
- relatively low metabolic activity
Cancellous or trabecular or spongy
- 20% of skeleton
- 5-20% calcified
- relatively high metabolic activity
Woven bone (immature bone)
irregular non-mineralized bone

Types of Bone Cells

Osteocytes : Mature bone cells
present in bone matrix

Osteoblasts : Bone-forming cells

located on surface of bone, involved in
mineralization. Receptors for PTH, vit D &
estrogen

Osteoclasts : Bone-destroying cells

Break down bone matrix for remodeling & release
of calcium, MNGC, derivate of GM- precursor

cell from bone marrow

Stages in the Healing of a Bone

Fracture

Bone remodeling is a process in which both

osteoblasts and osteoclasts participate

BONE PATHOLOGY
Classification

Infectious diseases
(Osteomyelitis)
Metabolic diseases
Tumours
Arthritis

BONE PATHOLOGY

Infective - Osteomyelitis

OSTEOMYELITIS
Inflammation of bone (osteo) &
marrow (myelo)

Bacterial osteomyelitis:
Acute suppurative osteomyelitis
Haematogenous / non-haematogenous

Chronic osteomyelitis:
non-specific / specific (TB & Syphilis)

Non- bacterial osteomyelitis:

Viral osteomyelitis / Sarcoidosis / Radiation
osteomyelitis

PYOGENIC OSTEOMYELITIS:
is almost always caused by bacteria.
Stapylococcus aureus (80-90%)
E.coli, Klebsiella and Pseudomonas in patients
with GU tract infections / IV drug abusers.
Mixed bacterial infections can be seen in the
setting of direct spread during surgery or open #
In neonatal period, H. influenzae and group B
streptococci are frequent pathogens
Salmonella infections - common in sickle cell
disease patients.
In 50% of the cases no organisms can be isolated.

Sites of involvement:
Influenced by the vascular
circulation, which varies with age.
Neonates: the metaphyseal vessels
penetrate the growth plate, resulting
in frequent infection of the
metaphysis, epiphysis or both.
Children: metaphyseal.
Adults: epiphyses and subchondral
regions.

Pathogenesis
1. Hematogenous spread.
2. Extension from a contiguous site.
3. Direct implantation

Pathogenesis:
Once localized in bone, the bacteria
proliferate and induce an acute
inflammatory reaction
Spread of bacteria and inflammation leads
to suppuration
Pus within bone reaches periosteum & forms
a subperiosteal abscess in 2-3 days.
Within medullary cavity it obstructs the
periosteal & endosteal blood supply causing
bone necrosis in approx. 7 days
Dead pieces of bone are known as the
sequestrum

 Rupture of the periosteumsoft tissue abscess

formationdraining sinuses
After 1st week, chronic inflammatory cells are
numerous with release of cytokines and
deposition of new bone at the periphery
This new bone formation from the stripped
surface of periosteum is known as the
Involucrum
In infants epiphyseal infection may spread to
the adjacent joint and causes septic or
suppurative arthritis.; may lead to permanent
disability.

Sequence of changes as follows :

Transient bacteraemia
Focus of acute inflammation in
metaphysis
Necrosis of bone forming
SEQUESTRUM
Reactive new bone formation
INVOLUCRUM

Microscopy

Inflammation of bone

Acute
osteomyelitis

Clinical Course:
Fever ,chills, malaise & throbbing pain
over the affected region.
Diagnosis:
Sign/symptoms.
X-ray
lytic focus of bone destruction
surrounded by zone of sclerosis

Blood / Pus culture

biopsy

Complications:
Pathologic fracture
Chronic suppurative osteomyelitis: including
sequestrum formation and skin sinus formation
Local Spread of infection: Arthritis / myositis /
neuritis
Systemic Spread of infection - toxaemia,
septicaemia or Endocarditis
Damage to the growth plate causing subsequent
growth deformity
Secondary amyloidosis
Squamous cell carcinoma in longstanding cases

 Brodies abscess:
Localised form of acute osteomyelitis
small intraosseus abscess that
frequently involves the cortex and is
walled off reactive bone.

Sclerosing osteomyelitis of Garre

Typically develops in the jaw.
a/w extensive new bone formation that
obscures much of the underlying
osseous structure.

TUBERCULOUS OSTEOMYELITIS
Routes of entry:
Usually blood borne and originate
from a focus of active visceral
disease.
Direct extension (e.g. from a
pulmonary focus into a rib)
spread via draining lymphatics.

 spine (40% of cases, especially thoracic &

lumbar vertebrae) followed by the knees
and hips are the most common sites
Pott disease - involvement of spine.
Infection breaks through the intervertebral
discs & extends into the soft tissues
forming abscesses.
Pain, Fever, weight loss
Tuberculous arthritis.
In patients with AIDS frequently multifocal.

Pott disease
presentation of extra-pulmonary tuberculosis that
affects the spine.
lower thoracic and upper lumbar vertebrae are
most often affected
Typically present with pain on motion, localized
tenderness, low-grade fevers, chills, and weight
loss
Paraspinal mass, sometimes a/w numbness,
paraesthesia or muscle weakness of the legs

Potts Disease

Diagnosis

Blood tests ESR

Tuberculin skin test
Radiographs of the spine
Bone scan
CT of the spine
Bone biopsy
MRI

Complications
Vertebral collapse resulting in
kyphosis / Scoliosis
neurologic deficits secondary to
Spinal cord or nerve compression
(Pott paraplegia)
Sinus tract formation
tuberculous arthritis
psoas abscess.