1/35. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia.We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity.- - - - - - - - - - ranking = 1keywords = vitamin (Clic here for more details about this article) |
2/35. Musculoskeletal manifestations of osteomalacia: report of 26 cases and literature review.OBJECTIVE: This study was undertaken to describe the musculoskeletal manifestations in a selected population of 26 patients with biopsy-proven osteomalacia (OM) and provide a literature update. methods: The 26 patients with biopsy-proven OM were selected from a total number of 79 patients who underwent anterior iliac crest biopsy. The diagnosis of OM was confirmed by the presence of an osteoid volume greater than 10%, osteoid width greater than 15 microm, and delayed mineralization assessed by double-tetracycline labeling. RESULTS: OM was caused by intestinal malabsorption in 13 patients, whereas six other patients presented with hypophosphatemia of different causes. Five elderly patients presented with hypovitaminosis D, and in two patients the OM was part of renal osteodystrophy. Twenty-three patients presented with bone pain and diffuse demineralization, whereas three other patients had normal or increased bone density. Characteristic pseudofractures were seen in only seven patients. Six of the 23 patients with diffuse demineralization had an "osteoporotic-like pattern" without pseudofractures. Prominent articular manifestations were seen in seven patients, including a rheumatoid arthritis-like picture in three, osteogenic synovitis in three, and ankylosing spondylitis-like in one. Two other patients were referred to us with the diagnosis of possible metastatic bone disease attributable to polyostotic areas of increased radio nuclide uptake caused by pseudofractures. Six patients also had proximal myopathy, two elderly patients were diagnosed as having polymalgia rheumatica, and two young patients were diagnosed as having fibromyalgia. One of the patients who presented with increased bone density was misdiagnosed as possible fluorosis. CONCLUSION: OM is usually neglected when compared with other metabolic bone diseases and may present with a variety of clinical and radiographic manifestations mimicking other musculoskeletal disorders.- - - - - - - - - - ranking = 1keywords = vitamin (Clic here for more details about this article) |
3/35. osteoporosis: a factor in mortality following cardiac surgery.osteoporosis may be a significant factor in unfavorable results following open cardiac surgery. This brief case report describes the fatal outcome of mitral valve replacement in an elderly woman with congestive heart failure complicated by severe osteoporosis. Profound collapse of the thoracic spine resulted in pulmonary insufficiency. The discussion includes substantiation that this phenomenon is not unusual but rather can be expected to occur in postmenopausal women who are inactive, not receiving calcium and vitamin d supplements, and are suffering from congestive heart failure for which loop diuretics are administered. Bone mineral density testing is essential to determine and track the efficacy of treatment.- - - - - - - - - - ranking = 1keywords = vitamin (Clic here for more details about this article) |
4/35. Congenital bilateral short femur complicated by stress fracture. A case report.Congenital malformation of the femur is an uncommon but complex problem. Short femur with proximal deficiency (Kalamchi type III) is part of this congenital anomaly. If the precautions associated with progressive coxa vara and bowing in the femoral shaft are not taken, stress fractures may occur in the femoral neck and the femoral shaft. We report on a 38-year-old female with type III-A congenital malformation of both femurs who presented the complications mentioned and had not been treated before. This case is instructive because it illustrates the complications developed in patients who have not been treated.- - - - - - - - - - ranking = 0.019989935333642keywords = deficiency (Clic here for more details about this article) |
5/35. Mitochondrial respiratory chain deficiency revealed by hypothermia.We observed a 17-month-old girl with profound and initially isolated episodes of hypothermia. Thereafter, she developed growth delay, repetitive corneal and bone lesions. Persistent hyperlactataemia in plasma and in CSF prompted us to investigate respiratory chain enzymes. A deficit in respiratory chain complexes III and IV was demonstrated in isolated skeletal muscle mitochondria, circulating lymphocytes and fibroblasts by spectrophotometric and polarographic studies. Moreover, UCP3 mRNA expression in muscle was decreased.- - - - - - - - - - ranking = 0.079959741334568keywords = deficiency (Clic here for more details about this article) |
6/35. A case of osteomalacia mimicking ankylosing spondylitis.A 39-year-old woman presented with symptoms of pain in the lumbar region and lower extremities. Physical findings included restricted movement of the lumbar spine, sacroiliac joint tenderness, positive Schober's test (10-12.5 cm), and bilaterally positive Mennel and Fabere tests. Although these symptoms and findings were suggestive of ankylosing spondylitis, osteomalacia was diagnosed with the appearance of multiple pseudofractures in her pelvic X-ray and laboratory abnormalities. All her symptoms and signs resolved in 6 months with vitamin d and calcium treatment.- - - - - - - - - - ranking = 1keywords = vitamin (Clic here for more details about this article) |
7/35. Niemann-Pick disease type B: an unusual clinical presentation with multiple vertebral fractures.We report here a unique case of a 55-year-old woman presenting with a clinical picture of parkinson disease, severe back pain, splenomegaly, and pronounced dyspnea. Radiographic examination of the spine showed multiple vertebral fractures. Niemann-Pick disease type B was diagnosed by findings of lipid-loaded histiocytes and a strongly reduced sphingomyelinase enzyme activity. She was homozygous for the deletion of codon 608 (delR608), which encodes an arginine residue in the Acid Sphingomyelinase gene. To investigate the cause of the unusual vertebral fractures, we screened for polymorphisms previously described as possibly associated with increased risk for osteoporosis and fractures. Our patient was heterozygous for the polymorphisms of the vitamin d receptor gene, the estrogen receptor gene, and the collagen 1A1gene. Increased physical activity after Parkinson treatment, a genetic predisposition, together with worsening disease due to interfering medications could explain the dramatic presentation of this patient. She was treated with cholesterol lowering drugs such as statins to decrease sphingomyelin synthesis, avoidance of drugs that inhibit sphingomyelinase, and bisphosphonates. No new fractures have occurred, but the interstitial lung disease has progressed.- - - - - - - - - - ranking = 1keywords = vitamin (Clic here for more details about this article) |
8/35. Decreased cutaneous vitamin d-synthesis in heavily melanized individuals: a rare cause for pathologic fractures of the hip.Painful pathological fractures of the femoral neck and the subtrochanteric region of the femur are reported in two women originating from india. After exclusion of renal or intestinal causes, laboratory data on bone metabolism, scintigraphic and radiographic examinations were characteristic for the presence of secondary hyperparathyroidism. Based on vitamin deficiency and low calcium absorption, disturbed mineralization of bone and increased osteoclastic resorption have apparently led to osteomalacia and subsequent fracturing. Fracture localization necessitated surgical fixation in one patient; conservative treatment including protected weightbearing was effective in the other women. After supplementation of calcium and vitamin D3, levels of parathyroid hormone and scintigraphic alterations returned to normal in both patients. In these two cases, pathological fractures of the hip could be attributed to the presence of secondary hyperparathyroidism based on decreased cutaneous vitamin d synthesis.- - - - - - - - - - ranking = 7.0199899353336keywords = vitamin, deficiency (Clic here for more details about this article) |
9/35. Bilateral simultaneous combined intra- and extracapsular femoral neck fracture secondary to nutritional osteomalacia: a case report.A case of bilateral simultaneous combined extra- and intracapsular femoral neck fractures is presented in an adult Asian male patient suffering from nutritional osteomalacia. The radiological and biochemical findings were classical for osteomalacia with Looser's zones affecting the shoulder and the pelvic girdle. Treatment consisted of bed rest and calcium and vitamin-D replacement. The fractures healed without surgery. A high index of suspicion for nutritional osteomalacia among Asian immigrants especially among the low socio-economic classes is required in the Western community. early diagnosis and treatment prevents chronic disability and skeletal deformity.- - - - - - - - - - ranking = 1keywords = vitamin (Clic here for more details about this article) |
10/35. Atypical Pott's disease: localized infection of the thoracic spine due to mycobacterium avium-intracellulare in a patient without human immunodeficiency virus infection.mycobacterium avium-intracellulare (MAI) rarely causes disease of the spine in healthy individuals. We describe an elderly woman who had isolated skeletal involvement with MAI, mimicking Pott's disease. She responded well to surgical excision of the inflamed tissue and antibiotic therapy. osteomyelitis due to MAI must be differentiated from that due to mycobacterium tuberculosis because the treatment regimens are different.- - - - - - - - - - ranking = 0.079959741334568keywords = deficiency (Clic here for more details about this article) |
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