By Victor Parsons
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Extra resources for A Colour Atlas of Bone Disease (Wolfe Medical Atlases)
The anterior fontanelle may not close. The primary dentition may show enamel defects and caries and the permanent teeth hypoplasia. : a 41 b. Osteomalacia Osteomalacia is the adult counterpart of rickets and is characterised by failure of mineralisation and an excess of osteoid due to interference with calcification mechanisms (see 77). The osteoid is increased at the expense of mineralised bone (117,118). The diagnosis is established by bone biopsy and the examination of a mineralised section ground and stained by von Kossa's method which stains the mineral black/brown and leaves the osteoid unstained (119 x 200).
The trabeculae are arranged to withstand stress, for example in the femoral neck (95 and 96). Rapidly formed new bone in the foetus, at a fracture site or in Paget's disease is described as woven bone, a reference to the haphazard arrangement of the collagen fibres when viewed by polarised light (97). Woven bone eventually undergoes resorption and replacement by lamellar bone (98). 34 mean :t 2SD 92 Rone lamellae under polarised light 7O'SO 80+ 95 Fine structure of bone, tra beculae ---:-- 5. Bone formation Long bones are formed by endochondral ossification.
Bone loss occurs in all women after the menopause but with great individual variation in rate. Mineralised sections of iliac crest bone from females aged 20 years (137) and 80 years (138) show the diminution of bone with ageing (H&E x/50). Osteoporosis is difficult to diagnose. The serum calcium, phosphate and alkaline phosphatase are usually normal. The pathological condition correlates well with radiology, particularly of the second metacarpal and the femoral head and neck region where grades of osteoporosis vary according to the visible trabecular pattern (135, numbers refer to the Singh index grading, and 136).
A Colour Atlas of Bone Disease (Wolfe Medical Atlases) by Victor Parsons