1/21. 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 = fracture (Clic here for more details about this article) |
2/21. Pentavalent technetium-99m DMSA uptake in pseudofractures of osteomalacia.Tc-99m MDP and Tc-99m (V) DMSA images are described from a 49-year-old woman with chronic renal insufficiency complicated by osteomalacia. Clinical, biochemical, and radiologic bone profiles were compatible with osteomalacia. osteomalacia is a condition associated with disorders in which mineralization of the organic matrix is defective. All bone lesions visualized with Tc-99m MDP also showed increased uptake of Tc-99m (V) DMSA. Tc-99m (V) DMSA accumulation has been reported in many malignant and some benign conditions. Pseudofractures in osteomalacia could be included in the spectrum of benign lesions that accumulate Tc-99m (V) DMSA.- - - - - - - - - - ranking = 1.6666666666667keywords = fracture (Clic here for more details about this article) |
3/21. immobilization hypercalcaemia in patients on regular haemodialysis.immobilization of normal people causes reabsorption of calcium from bone, a small rise in serum ionized calcium, and, rarely, frank hypercalcaemia. The hazard is increased when patients with renal osteodystrophy are immobilized because of pathological fractures.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
4/21. Compressive optic neuropathy caused by renal osteodystrophy. Case report.Compressive optic neuropathy with acute or chronic vision loss has been associated with various skull base tumors, aneurysms, graves disease, trauma, and, less commonly, fibrous dysplasia and osteopetrosis. The authors present a case of acute visual deterioration in a 25-year-old woman who had massive calvarial hypertrophy with optic canal stenosis secondary to renal osteodystrophy (uremic leontiasis ossea [ULO]: bighead disease). Significant visual field restoration was achieved with high-dose corticosteroids followed by optic nerve decompression. This is the first case report of cranial neuropathy associated with ULO.- - - - - - - - - - ranking = 0.033047347604123keywords = compression (Clic here for more details about this article) |
5/21. Neglected bilateral femoral neck fractures in a patient with end-stage renal disease before chronic dialysis.Bilateral femoral neck fractures are rarely reported in patients with end-stage renal disease before chronic dialysis. We report on a 39-year-old woman with neglected bilateral femoral neck fractures, who presented with severe uremic complications prior to chronic dialysis. Three years before admission, she had injured herself in a trivial slip with subsequent bilateral hip pain. She had progressively waddled since then. Pelvic X-ray taken after admission revealed bilateral femoral neck fractures. Bilateral hip hemiarthroplasties were subsequently performed. Displaced femoral neck fractures were found intraoperatively. Pathologic findings and results of examinations supported the coexistence of osteoporosis and high turnover renal osteodystrophy, rendering this woman at high risk of bilateral femoral neck fractures. Therefore, preventing a simple fall or trivial accident and treating renal osteodystrophy and osteoporosis are paramount in patients with chronic renal failure even before the start of dialysis therapy. We also emphasize the need to seek any possible underlying metabolic bone disease once a patient presents with unusual fractures.- - - - - - - - - - ranking = 3.3333333333333keywords = fracture (Clic here for more details about this article) |
6/21. Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure.Pathologic femoral neck fracture due to renal osteodystrophy is rare. We report the case of a young adult patient with chronic renal failure who presented with bilateral spontaneous femoral neck fractures due to renal osteodystrophy. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure is discussed.- - - - - - - - - - ranking = 2.3333333333333keywords = fracture (Clic here for more details about this article) |
7/21. Prominent Tc-99m MIBI skeletal uptake in renal osteodystrophy: a possible role for whole-body scanning.renal osteodystrophy is a process whereby renal failure causes profound bone disease. Effects on bone include osteosclerosis, osteomalacia, osteoporosis, pathologic fractures, aseptic necrosis of the hips, and bone pain. The authors present a case of renal osteodystrophy with intense Tc-99m 2-methoxy isobutyl isonitrile (MIBI) radiotracer uptake in the mandible and propose that Tc-99m MIBI may have a potential role in diagnosing renal osteodystrophy.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
8/21. Vertebral localization of a brown tumor: description of a case and review of the literature.The authors report a case of a female aged 45 years submitted to a long period of hemodialysis, affected with brown tumor of the lumbar spine. Brown tumor must be taken into consideration in the differential diagnosis of osteolytic lesions of the skeleton, particularly in young, nephropathic women undergoing hemodialysis. Brown tumor has a more favorable prognosis as compared to other lesions that have similar clinical and radiographic findings, such as metastatic lesions and giant cell tumors. In the case of brown tumor, in addition to treating lesion of the spine, treatment varying depending on neurological findings and biomechanical complications (structural collapse, segmental kyphosis, pathologic fracture, etc.), removal of the parathyroids and correction of the metabolic alterations is indispensable.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
9/21. Multiple bone fractures following an epileptic seizure in renal osteodystrophy.Seizure induced bone fractures in patients with renal osteodystrophy are uncommon. A case is described where multiple bone fractures occurred following convulsions which appeared shortly after haemodialysis.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
10/21. cauda equina compression revealing brown tumor of the spine in a long-term hemodialysis patient.Brown tumors, or osteoclastomas, are erosive bony lesions arising as a complication of hyperparathyroidism (HPT). In patients with end-stage renal disease (ESRD), brown tumors are classic skeletal manifestations usually seen in severe forms of secondary HPT. However, involvement of the spine is considered extremely rare. We report a long-term hemodialysis case, in which cauda equina compression developed due to a sacral brown tumor. A decompressive surgery and subtotal parathyroidectomy were indicated to preserve neurologic function, and to ensure remineralization of the lesion. This case illustrates that, though rare, brown tumors should be considered in uremic patients with neurological symptoms. Emergent decompressive surgery is required to remove pressure on neurological structures and to stabilize the spine.- - - - - - - - - - ranking = 0.16523673802062keywords = compression (Clic here for more details about this article) |
| | Next -> |