By Victor Parsons

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Additional info for A Colour Atlas of Bone Disease (Wolfe Medical Atlases)

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5 per cent. 9 percent), are found in elderly women in the seventh to ninth decades (91 ). 1 per cent of the areas measured. Using these techniques a composite picture of normal and diseased bone can be built up. Bone is seen both as a skeletal structure undergoing constant renewal and as a metabolic store of ions such as calcium and phosphate which can be mobilised for healing fractures, foetal growth, lactation, muscle contraction and in times of mineral deprivation. 90 Rone density 91 Rone density 900 variations in males variations in females 900 one one ineral ontent g/cm2 forearm (SO% of forearm (SO% of forearm length from styloid) 500 400 300 300 mean :t 2SD 200 200 100 100 age cohorts o 20"30 4.

Hyperparathyroidism is the most common cause of nephrocalcinosis which is visible radiologically in about 15 per cent of cases (177). Bone changes are the second most common presentation. The earliest change is demineralisa- 176 Hyperparathyroidism tion which is difficult to detect radiologically. The phalanges may show subperiosteal erosions (178) and even distal fracture. Loss of bone density in the skull is seen as a characteristic punctate loss of density, 'pepper pot skull'. After long continued parathyroid activity, the bone changes of osteitis fibrosa cystica (von Recklinghausen's disease of bone) may be seen as 'brown tumours' expanding the ribs (179) and jaw (180).

Neoplasms complicating Paget's disease are more 161 Osteosarcoma complicating Paget's disease 163 Osteosarcoma 52 complicating malignant than those occurring in its absence and the patient seldom survives long. Biochemical values in Paget's disease of bone include normocalcaemia, hypercalcaemia (when complicated by fracture and bed rest or hyperparathyroidism) and rarely, hypocalcaemia when complicated by osteomalacia in the very old. The alkaline phosphatase is often grossly increased, occasionally forty-fold, and acid phosphatase is also raised (but carcinoma of the prostate, which would also raise acid phosphatase, can coexist in the elderly male).

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