University of Southern Denmark Multiple Fractures and Impaired
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A Comparative Study of Pycnodysostosis, Cleidocranial Dysostosis, Osteopetrosis and Acro-Osteolysis
18 Mei 1974 S.-A. MEDIESE TYDSKRIF 1011 A Comparative Study of Pycnodysostosis, Cleidocranial Dysostosis, Osteopetrosis and Acro-osteolysis A. WOLPOWITZ, A. MATISONN SUMMARY thalmos, and blue sclerae have been noted. There may be a high, grooved palate. Platybasia may be found. There are A radiological study of cases of pycnodysostosis, osteo often poor dental formation and dental caries. Madelung's petrosis, cleidocranial dysostosis and acro-osteolysis type of deformity has been reported. revealed an interwoven relationship as regards the X-ray Laboratory findings are usually normal but reduced findings with numerous identical signs that these condi alkaline phosphatase values and slight hypercalcaemia tions had in common. Open fontanelles and sutures as have been reported. In recent reports cases with anaemia, well as metopic sutures were found in all 4 conditions; thrombocytopenia and splenomegaly were described."'· wormian bones, diminution or complete loss of mandibular angles, and hypoplastic paranasal sinuses and facial bones were noted in cleidocranial dysostosis, pycnodysostosis Radiological Findings and acro-osteolysis. Undertubulation of .Iong bones is seen in cleidocranial dysostosis and osteopetrosis. Osteo The most striking radiological finding is increased den petrosis and pycnodysostosis show sclerosis of bone, sity of bone. In spite of the bone sclerosis the medullary dense orbital margins, fractures after minimal trauma with canals are evident and the tubular bones are usually more abundant callus and rapid healing in common, while there delicate in calibre than normal, but normal in shape. is absorption of terminal phalanges and disturbance in There has, however, been a report of a case with splaying the development of the teeth in both pycnodysostosis and of the metaphyseal ends.' acro-osteolysis. -
Hypophosphatasia Could Explain Some Atypical Femur Fractures
Hypophosphatasia Could Explain Some Atypical Femur Fractures What we know Hypophosphatasia (HPP) is a rare genetic disease that affects the development of bones and teeth in children (Whyte 1985). HPP is caused by the absence or reduced amount of an enzyme called tissue-nonspecific alkaline phosphatase (TAP), also called bone-specific alkaline phosphatase (BSAP). The absence of TAP raises the level of inorganic pyrophosphate (Pi), which prevents calcium and phosphate from creating strong, mineralized bone. Without TAP, bones can become weak. In its severe form, HPP is fatal and happens in 1/100,000 births. Because HPP is genetic, it can appear in adults as well. A recent study has identified a milder, more common form of HPP that occurs in 4 of 1000 adults (Dahir 2018). This form of HPP is usually seen in early middle aged adults who have low bone density and sometimes have stress fractures in the feet or thigh bone. Sometimes these patients lose their baby teeth early, but not always. HPP is diagnosed by measuring blood levels of TAP and vitamin B6. An elevated vitamin B6 level [serum pyridoxal 5-phosphate (PLP)] (Whyte 1985) in a patient with a TAP level ≤40 or in the low end of normal can be diagnosed with HPP. Almost half of the adult patients with HPP in the large study had TAP >40, but in the lower end of the normal range (Dahir 2018). The connection between hypophosphatasia and osteoporosis Some people who have stress fractures get a bone density test and are treated with an osteoporosis medicine if their bone density results are low. -
Establishment of a Dental Effects of Hypophosphatasia Registry Thesis
Establishment of a Dental Effects of Hypophosphatasia Registry Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Jennifer Laura Winslow, DMD Graduate Program in Dentistry The Ohio State University 2018 Thesis Committee Ann Griffen, DDS, MS, Advisor Sasigarn Bowden, MD Brian Foster, PhD Copyrighted by Jennifer Laura Winslow, D.M.D. 2018 Abstract Purpose: Hypophosphatasia (HPP) is a metabolic disease that affects development of mineralized tissues including the dentition. Early loss of primary teeth is a nearly universal finding, and although problems in the permanent dentition have been reported, findings have not been described in detail. In addition, enzyme replacement therapy is now available, but very little is known about its effects on the dentition. HPP is rare and few dental providers see many cases, so a registry is needed to collect an adequate sample to represent the range of manifestations and the dental effects of enzyme replacement therapy. Devising a way to recruit patients nationally while still meeting the IRB requirements for human subjects research presented multiple challenges. Methods: A way to recruit patients nationally while still meeting the local IRB requirements for human subjects research was devised in collaboration with our Office of Human Research. The solution included pathways for obtaining consent and transferring protected information, and required that the clinician providing the clinical data refer the patient to the study and interact with study personnel only after the patient has given permission. Data forms and a custom database application were developed. Results: The registry is established and has been successfully piloted with 2 participants, and we are now initiating wider recruitment. -
Metabolic Bone Disease 5
g Metabolic Bone Disease 5 Introduction, 272 History and examination, 275 Osteoporosis, 283 STRUCTURE AND FUNCTION, 272 Investigation, 276 Paget’s disease of bone, 288 Structure of bone, 272 Management, 279 Hyperparathyroidism, 290 Function of bone, 272 DISEASES AND THEIR MANAGEMENT, 280 Hypercalcaemia of malignancy, 293 APPROACH TO THE PATIENT, 275 Rickets and osteomalacia, 280 Hypocalcaemia, 295 Introduction Calcium- and phosphate-containing crystals: set in a structure• similar to hydroxyapatite and deposited in holes Metabolic bone diseases are a heterogeneous group of between adjacent collagen fibrils, which provide rigidity. disorders characterized by abnormalities in calcium At least 11 non-collagenous matrix proteins (e.g. osteo- metabolism and/or bone cell physiology. They lead to an calcin,• osteonectin): these form the ground substance altered serum calcium concentration and/or skeletal fail- and include glycoproteins and proteoglycans. Their exact ure. The most common type of metabolic bone disease in function is not yet defined, but they are thought to be developed countries is osteoporosis. Because osteoporosis involved in calcification. is essentially a disease of the elderly, the prevalence of this condition is increasing as the average age of people Cellular constituents in developed countries rises. Osteoporotic fractures may lead to loss of independence in the elderly and is imposing Mesenchymal-derived osteoblast lineage: consist of an ever-increasing social and economic burden on society. osteoblasts,• osteocytes and bone-lining cells. Osteoblasts Other pathological processes that affect the skeleton, some synthesize organic matrix in the production of new bone. of which are also relatively common, are summarized in Osteoclasts: derived from haemopoietic precursors, Table 3.20 (see Chapter 4). -
Blueprint Genetics Comprehensive Skeletal Dysplasias and Disorders
Comprehensive Skeletal Dysplasias and Disorders Panel Test code: MA3301 Is a 251 gene panel that includes assessment of non-coding variants. Is ideal for patients with a clinical suspicion of disorders involving the skeletal system. About Comprehensive Skeletal Dysplasias and Disorders This panel covers a broad spectrum of skeletal disorders including common and rare skeletal dysplasias (eg. achondroplasia, COL2A1 related dysplasias, diastrophic dysplasia, various types of spondylo-metaphyseal dysplasias), various ciliopathies with skeletal involvement (eg. short rib-polydactylies, asphyxiating thoracic dysplasia dysplasias and Ellis-van Creveld syndrome), various subtypes of osteogenesis imperfecta, campomelic dysplasia, slender bone dysplasias, dysplasias with multiple joint dislocations, chondrodysplasia punctata group of disorders, neonatal osteosclerotic dysplasias, osteopetrosis and related disorders, abnormal mineralization group of disorders (eg hypopohosphatasia), osteolysis group of disorders, disorders with disorganized development of skeletal components, overgrowth syndromes with skeletal involvement, craniosynostosis syndromes, dysostoses with predominant craniofacial involvement, dysostoses with predominant vertebral involvement, patellar dysostoses, brachydactylies, some disorders with limb hypoplasia-reduction defects, ectrodactyly with and without other manifestations, polydactyly-syndactyly-triphalangism group of disorders, and disorders with defects in joint formation and synostoses. Availability 4 weeks Gene Set Description -
Crystal Deposition in Hypophosphatasia: a Reappraisal
Ann Rheum Dis: first published as 10.1136/ard.48.7.571 on 1 July 1989. Downloaded from Annals of the Rheumatic Diseases 1989; 48: 571-576 Crystal deposition in hypophosphatasia: a reappraisal ALEXIS J CHUCK,' MARTIN G PATTRICK,' EDITH HAMILTON,' ROBIN WILSON,2 AND MICHAEL DOHERTY' From the Departments of 'Rheumatology and 2Radiology, City Hospital, Nottingham SUMMARY Six subjects (three female, three male; age range 38-85 years) with adult onset hypophosphatasia are described. Three presented atypically with calcific periarthritis (due to apatite) in the absence of osteopenia; two had classical presentation with osteopenic fracture; and one was the asymptomatic father of one of the patients with calcific periarthritis. All three subjects over age 70 had isolated polyarticular chondrocalcinosis due to calcium pyrophosphate dihydrate crystal deposition; four of the six had spinal hyperostosis, extensive in two (Forestier's disease). The apparent paradoxical association of hypophosphatasia with calcific periarthritis and spinal hyperostosis is discussed in relation to the known effects of inorganic pyrophosphate on apatite crystal nucleation and growth. Hypophosphatasia is a rare inherited disorder char- PPi ionic product, predisposing to enhanced CPPD acterised by low serum levels of alkaline phos- crystal deposition in cartilage. copyright. phatase, raised urinary phosphoethanolamine Paradoxical presentation with calcific peri- excretion, and increased serum and urinary con- arthritis-that is, excess apatite, in three adults with centrations -
Two Cases with Pycnodysostosis in a Family: a Case Report
International Journal of Contemporary Pediatrics Reddy KV et al. Int J Contemp Pediatr. 2020 Jun;7(6):1441-1443 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 DOI: http://dx.doi.org/10.18203 /2349-3291.ijcp20202164 Case Report Two cases with pycnodysostosis in a family: a case report K. Venkataramana Reddy1*, Chapay Soren1, M. Geethika2, V. Malathi1 1Department of Pediatrics, 2Department of Radiodiagnosis, SVS Medical College, Mahabubnagar, Telangana, India Received: 06 February 2020 Revised: 28 April 2020 Accepted: 05 May 2020 *Correspondence: Dr. K. Venkataramana Reddy, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Pycnodysostosis (Greek, pycnos - density, dys - defect, ostosis - bone) is a rare inherited disorder of the bone, first described by Maroteaux and Lamy. Pycnodysostosis is an autosomal recessive disorder, with incidence estimated to be 1.7 per 1 million births. Clinical presentation of this disorder include short stature, dolichocephalic skull, frontal bossing, obtuse mandibular angle, dysplastic clavicles, and short hands and feet, diffuse osteosclerosis, acro- osteolysis along with the finger and nail abnormalities. The main oral aspects are midfacial hypoplasia, a grooved palate, and dental abnormalities include double row of teeth, delayed eruption of permanent dentition, multiple caries. Pathological fractures of the bones occur due to sclerosis. Radiologically, skull bones appear thickened with open fontanels which look like ‘lakes of bones’, hypoplasia of facial bones, generalized osteosclerosis, open fontanels and cranial sutures, non pneumotization of paranasal sinuses, and fractures commonly in lower limbs. -
Hypophosphatasia: Enzyme Replacement Therapy Brings New Opportunities and New Challenges
PERSPECTIVE JBMR Hypophosphatasia: Enzyme Replacement Therapy Brings New Opportunities and New Challenges Michael P Whyte Department of Internal Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, and Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA ABSTRACT Hypophosphatasia (HPP) is caused by loss-of-function mutation(s) of the gene that encodes the tissue-nonspecific isoenzyme of alkaline phosphatase (TNSALP). Autosomal inheritance (dominant or recessive) from among more than 300 predominantly missense defects of TNSALP (ALPL) explains HPP’s broad-ranging severity, the greatest of all skeletal diseases. In health, TNSALP is linked to cell surfaces and richly expressed in the skeleton and developing teeth. In HPP,TNSALP substrates accumulate extracellularly, including inorganic pyrophosphate (PPi), an inhibitor of mineralization. The PPi excess can cause tooth loss, rickets or osteomalacia, calcific arthropathies, and perhaps muscle weakness. Severely affected infants may seize from insufficient hydrolysis of pyridoxal 5‘- phosphate (PLP), the major extracellular vitamin B6. Now, significant successes are documented for newborns, infants, and children severely affected by HPP given asfotase alfa, a hydroxyapatite-targeted recombinant TNSALP. Since fall 2015, this biologic is approved by regulatory agencies multinationally typically for pediatric-onset HPP. Safe and effective treatment is now possible for this last rickets to have a medical therapy, -
Osteopetrosis Associated with Familial Paraplegia: Report of a Family
Paraplegia (1975), 13, 143-152 OSTEOPETROSIS ASSOCIATED WITH FAMILIAL PARAPLEGIA: REPORT OF A FAMILY By SKIP JACQUES*, M.D., JOHN T. GARNER, M. D., DAVID JOHNSON, M.D. and C. HUNTER SHELDEN, M. D. Departments of Neurosurgery and Radiology, Huntington Memorial Hospital, Pasadena, Ca., and the Huntington Institute of Applied Medical Research, Pasadena, Ca., U.S.A. Abstract. A clinical analysis of three members of a family with documented osteopetrosis and familial paraplegia is presented. All patients had a long history of increased bone density and slowly progressing paraparesis of both legs. A thorough review of the literature has revealed no other cases which presented with paraplegia without spinal cord com pression. Although the etiologic factor or factors remain unknown, our review supports the contention that this is a distinct clinical entity. IN 1904, a German radiologist, Heinrich Albers-Schonberg, described a 26-year old man with multiple fractures and generalised sclerosis of the skeleton. The disease has henceforth commonly been known as Albers-Schonberg disease or marble osteopetrosis, a term first introduced by Karshner in 1922. Other eponyms are bone disease, osteosclerosis fragilis generalisata, and osteopetrosis generalisata. Approximately 300 cases had been reported in the literature by 1968. It has been generally accepted that the disease presents in two distinct forms, an infantile progressive disease and a milder form in childhood and adolescence. The two forms differ clinically and genetically. A dominant pattern of inheritance is usually seen in the benign type whereas the severe infantile form is usually inherited as a Mendelian recessive. This important distinction has not been well emphasised. -
Biochemical, Clinical and Genetic Characteristics in Adults with Persistent Hypophosphatasaemia; Data from an Endocrinological Outpatient Clinic in Denmark
Bone Reports 15 (2021) 101101 Contents lists available at ScienceDirect Bone Reports journal homepage: www.elsevier.com/locate/bonr Biochemical, clinical and genetic characteristics in adults with persistent hypophosphatasaemia; Data from an endocrinological outpatient clinic in Denmark Nicola Hepp a,*, Anja Lisbeth Frederiksen b,c, Morten Duno d, Jakob Præst Holm e, Niklas Rye Jørgensen f,g, Jens-Erik Beck Jensen a,g a Dept. of Endocrinology, Hvidovre University Hospital Copenhagen, Kettegaard Alle 30, 2650 Hvidovre, Denmark b Dept. of Clinical Genetics, Aalborg University Hospital, Ladegaardsgade 5, 9000 Aalborg C, Denmark c Dept. of Clinical Research, Aalborg University, Fredrik Bajers Vej 7K, 9220 Aalborg Ø, Denmark d Dept. of Clinical Genetics, University Hospital Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark e Department of Endocrinology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark f Dept. of Clinical Biochemistry, Rigshospitalet, Valdemar Hansens Vej 13, 2600 Glostrup, Denmark g Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3 B, 2200 Copenhagen, Denmark ARTICLE INFO ABSTRACT Keywords: Background: Hypophosphatasia (HPP) is an inborn disease caused by pathogenic variants in ALPL. Low levels of Alkaline phosphatase alkaline phosphatase (ALP) are a biochemical hallmark of the disease. Scarce knowledge about the prevalence of ALPL HPP in Scandinavia exists, and the variable clinical presentations make diagnostics challenging. The aim of this Hypophosphatasia study was to investigate the prevalence of ALPL variants as well as the clinical and biochemical features among Osteoporosis adults with endocrinological diagnoses and persistent hypophosphatasaemia. Bisphosphonates Methods: A biochemical database containing ALP measurements of 26,121 individuals was reviewed to identify adults above 18 years of age with persistently low levels of ALP beneath range (≤ 35 ± 2.7 U/L). -
REVIEW ARTICLE Genetic Disorders of the Skeleton: a Developmental Approach
Am. J. Hum. Genet. 73:447–474, 2003 REVIEW ARTICLE Genetic Disorders of the Skeleton: A Developmental Approach Uwe Kornak and Stefan Mundlos Institute for Medical Genetics, Charite´ University Hospital, Campus Virchow, Berlin Although disorders of the skeleton are individually rare, they are of clinical relevance because of their overall frequency. Many attempts have been made in the past to identify disease groups in order to facilitate diagnosis and to draw conclusions about possible underlying pathomechanisms. Traditionally, skeletal disorders have been subdivided into dysostoses, defined as malformations of individual bones or groups of bones, and osteochondro- dysplasias, defined as developmental disorders of chondro-osseous tissue. In light of the recent advances in molecular genetics, however, many phenotypically similar skeletal diseases comprising the classical categories turned out not to be based on defects in common genes or physiological pathways. In this article, we present a classification based on a combination of molecular pathology and embryology, taking into account the importance of development for the understanding of bone diseases. Introduction grouping of conditions that have a common molecular origin but that have little in common clinically. For ex- Genetic disorders affecting the skeleton comprise a large ample, mutations in COL2A1 can result in such diverse group of clinically distinct and genetically heterogeneous conditions as lethal achondrogenesis type II and Stickler conditions. Clinical manifestations range from neonatal dysplasia, which is characterized by moderate growth lethality to only mild growth retardation. Although they retardation, arthropathy, and eye disease. It is now be- are individually rare, disorders of the skeleton are of coming increasingly clear that several distinct classifi- clinical relevance because of their overall frequency. -
Spectrum of Microarchitectural Bone Disease in Inborn Errors of Metabolism: a Cross-Sectional, Observational Study Karamjot Sidhu1,2, Bilal Ali1, Lauren A
Sidhu et al. Orphanet Journal of Rare Diseases (2020) 15:251 https://doi.org/10.1186/s13023-020-01521-6 RESEARCH Open Access Spectrum of microarchitectural bone disease in inborn errors of metabolism: a cross-sectional, observational study Karamjot Sidhu1,2, Bilal Ali1, Lauren A. Burt1, Steven K. Boyd1 and Aneal Khan2,3* Abstract Background: Patients diagnosed with inborn errors of metabolism (IBEM) often present with compromised bone health leading to low bone density, bone pain, fractures, and short stature. Dual-energy X-ray absorptiometry (DXA) is the current gold standard for clinical assessment of bone in the general population and has been adopted for monitoring bone density in IBEM patients. However, IBEM patients are at greater risk for scoliosis, short stature and often have orthopedic hardware at standard DXA scan sites, limiting its use in these patients. Furthermore, DXA is limited to measuring areal bone mineral density (BMD), and does not provide information on microarchitecture. Methods: In this study, microarchitecture was investigated in IBEM patients (n = 101) using a new three- dimensional imaging technology high-resolution peripheral quantitative computed tomography (HR-pQCT) which scans at the distal radius and distal tibia. Volumetric BMD and bone microarchitecture were computed and compared amongst the different IBEMs. For IBEM patients over 16 years-old (n = 67), HR-pQCT reference data was available and Z-scores were calculated. Results: Cortical bone density was significantly lower in IBEMs associated with decreased bone mass when compared to lysosomal storage disorders (LSD) with no primary skeletal pathology at both the radius and tibia. Cortical thickness was also significantly lower in these disorders when compared to LSD with no primary skeletal pathology at the radius.