By Victor Parsons

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

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Arthropathy is another recognised feature. One of the joint lesions, calcium pyrophosphate deposition in and around joints. is shown in 184. Chondrocalcinosis, calcification of joint cartilages, is also a fairly common radiological finding in patients with long-standing hyperparathyroidism. \82 Peptic ulcer in hyperparathyroidism ~ \83 Acute pancreatitis \84 Chondrocalcinosis in hyperparathyroidism 2. Secondary hyperparathyroidism Conditions which produce a fall in the level of the plasma calcium and a compensatory parathyroid response are included under the heading of secondary hyperparathyroidism.

The classic case of the rare severe generalised Paget's disease is that of a deaf old man with a bent back, bowed legs, curved tibia, a large skull and wobbling gait. The arms appear relatively long and the patient ape-like (147 and 148). Some patients with severe Paget's disease may have few complaints whereas others with a lesser degree of involvement suffer severe persistent pain. 147 Paget's disease affecting lower limbs 148 Paget's An isolated lesion affecting a single bone is not uncommon.

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. Cortical 30"40 40"5050"60 and cancellous age cohorts 60"70 70"80 SO+ o 20"30 30"40 40"5050"60 60'70 bone Cortical and cancellous bone is seen to consist of lamellae of bone when examined under polarised light (92).

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