ENDOCRINE AND

METABOLIC DISORDERS
• Osteoporosis

• Hyperparathyroidism

• Rickets and osteomalacia

• Acromegaly
OSTEOPOROSIS :
• Definition : osteoporosis results either when the
bone loss is excessive or when the apposition of
bone is reduced.

• Risk factors :

• Post menopausal women

• In diseases such as cushing’s syndrome,
thyrotoxicosis, and primay hyperthyroidism
• Cigarette smoking and excessive alcohol
consumption
• Poor nutrition . lack of exercise and
calcium deficiency

• Low estrogen levels in females and low

testosterone levels in males.

• Clinical presentation:

• The jaw may be involved. Osteoporosis

occurring in edentulous patients may
result in the mandible being reduced to a
thin fragile strip of bone.
• Radiographic presentation:

• There is an increased radiolucency of bone, the

cortex is thinned, and there are marrow spaces
in the cancellous bone associated with thin
trabaculae.

• Histological findings:

• Histologic examination of osteoporotic bone

may reveal generalized thinning of trabeculae
and irregular perforation of trabeculae,
reflecting unbalanced osteoclast-mediated bone
resorption.
HYPERPARATHYROIDISM
• 1.Primary
• 2.secondary

• Primary hyperparathyroidism:

• Primary hyperparathyroidism is a disorder of the

parathyroid glands, also called parathyroids. “
• One or more enlarged, overactive parathyroid
glands secretes too much parathyroid hormone
(PTH).
• Etiology:

• 1. Parathyroid adenoma (85%)

• 2. Diffuse hyperplasia of all parathyroid glands.
(15%)
• 3. Parathyroid carcinoma (rarely)

• Radiographic presentation:

• No detectable changes or generalized

osteoporosis
• Partial loss of lamina dura around teeth
• Focal lesions may appear multilocular
• Histological presentation:

• Increased osteoclastic activity

• Formation of brown tumors
• Much hemosidrin present

• Secondary hyperparathyroidism:

• In secondary hyperparathyroidism, a
problem such as kidney failure causes the
parathyroids to be overactive.
• Etiology:

• Occurs in response to chronic hypocalcemia

• Chronic renal failure
• Also in association with rickets and
osteomalacia.

• Clinical presentation :

• Bone changes are complex and are a mixture of

those associated with osteomalacia and
hyperparathyroidism.
• Jaws are involved
• Treatment of hyperparathyroidism:

• Surgery to remove the enlarged

gland is the main treatment for the
disorder and cures it in 95% of the
cases.
RICKETS AND
OSTEOMALACIA:
• In rickets and osteomalacia there is softening
and weakening of the bones mainly due to the
deficiency of vitamin D. Osteomalacia is the
adult counterpart of rickets.

• Etiology:

• Lack of exposure to sunlight

• Dietry causes
• Diet high in cereal content
• Use of whole meal grains containing phytates
• Malabsorption
• Radiographic presentation:

• Almost similar as osteoporosis

• Failure of mineralization of osteoid and cartilage

• Dental abnormalities in rickets:

• Enamel hypoplasia
• Increased width of predentin
• Large amounts of interglobular dentine
• Treatment:

• Dietary changes
• Vitamin D supplements
• Hormonal supplements (post
menopausal women)
ACROMEGALY:
• This disease is caused by prolonged and
excessive secretion of growth hormone, usually
due to a secreting adenoma of the anterior lobe
of the pituitary developing after the epiphyses
have closed.

• Clinical presentation:

• Renewed growth of bones of jaws, hands, and

feet with overgrowth of some soft tissues.
• Activation of condylar growth
centre of mandible leads to :

• Enlarged jaw
• Protrusive jaw
• Spacing of teeth

• Soft tissues of face become

thickened and enlarged.
PAGET’S DISEASE:
• Paget's disease is a chronic bone condition
characterized by disorder of the normal bone
remodeling process.

• Etiology:

• Aetiology is unclear but may be due to a primary

dysfunction of the osteoclasts.
• Infection with paramyxoviruses
• Genetic predisposition
• Hereditary component on chromosome 18q has
been identified which predisposes to paget’s
disease.
• Clinical presentation:

• Varying degrees of bone deformity and

distortion of weight bearing portions of
skeleton, skull and facial bones.

• Incase of skull involvement there are sensory

and motor disturbances related to cranial nerve
compression.

• With progressive enlargement of maxilla,

alveolar ridge becomes thickened and widened,
the palate flattened and there is increasing facial
deformity.
• Incompetence of the lips
• In dentate patients there is:

• Derangement of occlusion
• Spacing of teeth
• Retroclination of incisors

• Striking palatoversion of posterior teeth

• In edentulous patients there may be difficulty in
wearing dentures.
• Root resorption may occur in osteolytic phase
• Involvement of teeth which often show
hypercementosis and may become ankylosed.
• Radiographic presentation:

• Radiographic features reflect different stages of

the disease.
• Osteoporosis is the earliest change, followed by
patchy osteosclerosis and the appearance of ill-
defined and irregular radiopaque areas
producing a characteristic cotton-wool
appearance
• In skull, thickening of the outer table of the vault
and loss of distinction between the tables and
diploe are also typical features
• In jaws, loss of lamina dura, hypercementosis,
and ankylosis may be noted.
• Histopathology:

• The lesions show a combination of osteoblastic

and osteoclastic activity.
• During the early osteoporotic phase,
osteoclastic resorption predominates.
• Bone trabaculae show numerous criss-crossing,
resting and scalloped reversal lines which stain
deeply with haematoxylin.
• As more and more bone is formed within the
lesion, the disjointed trabaculae fuse to form
dense sclerotic masses of mosaic bone.
• As the disease becomes less active so the
marrow becomes less vascular and
osteoclastic and osteoblastic activity is
decreased.

• New bone in jaw is in form of acellular

globular deposits which fuse to form
dense sclerotic masses

• Cementum may also undergo

disorganized remodelling
• Treatment:

• The treatment of Paget's disease is directed

toward controlling the disease activity and
managing its complications

• When Paget's disease causes no symptoms and

blood testing shows that the level of serum
alkaline phosphatase is normal or minimally
elevated, no treatment may be necessary

• Biphosphonates are the main stay of treatment