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[Fluorine osteosis caused by a very long-term niflumic acid treatment in 2 cases of rheumatoid arthritis].

An osteosclerosis opacifying the axial skeleton and affecting in particular all of the spine, was observed in two women aged 75 and 42 years who had been suffering from a rheumatoid arthritis developing between 15 and 26 years. It was traced to a chronic fluorine intoxication, stemming from the regular taking, for 10 years and 8 1/2 years, of a non cortisone, anti-inflammatory niflumic acid. This fluorine product has 3 atoms of fluor in its molecule (50.0 mg for a tablet of 250 mg). Its administration to control subjects proved the production of ionized fluor by way of the metabolism, and the accumulation of fluor in the organism. Rheumatoid polyarthritis and the prolonged corticotherapy (10 mg of prednisone per day for 21 years) cannot be dismissed as the origin of the severe demineralization of the limbs observed in the second patient, but the role of fluorine seems marked in the occurrence of this peripheral involvement with problems of mineralization and secondary hyperparathyroidisms. On the other hand, the absence of an intervertebral narrowing in the 2 patients, despite the very prolonged taking of cortisone (5 mg of prednisone per day for 15 years, for the 75-year-old patient) is perhaps a result of the fluorine.

Adult↗

[Brick-tea type adult bone fluorosis].

To investigate health impact of brick-tea type fluorosis in adults, the total daily fluorine intake, environment fluorine level were determined, the average urinary fluorine content assay and bone X-ray examination were conducted, the clinical manifestations were observed in the brick-tea type bone fluorosis epidemiological study conducted in Naqu County, Tibet at September, 2001. One hundred and eleven adults aged at 30-78 year-old were enrolled. It was found that the fluorine level of drinking water in Naqu County was 0.10 +/- 0.03 mg/L, but the brick-tea water processed foods-zamba and buttered tea had fluorine content of 4.52 +/- 0.74 mg/kg and 3.21 +/- 0.65 mg/kg respectively. The adult daily fluorine intake reached 11.99 mg, among which 99% is originated from the brick-tea containing foods. Positive detection rate of fluorosis osteopathy was 89% and the X-ray film confirmed that the diagnosis rate was 83%. Degenerative arthropathy and ossification of the interosteal membrane, calcification of the tendon were the characteristics that indicated by both the positive signs and reogenological examination. The prevalence of osteosclerosis type (bone matrix increased) was 74%. It is suggested that there were even more severe health impact compared with those in the water type and coal combustion type fluorosis.

Adult↗

[Schnitzler's syndrome. A new case].

A new case of Schnitzler's syndrome is reported in a 72-year old man hospitalized for severe deterioration of his general condition associated with recurrent ancient urticaria. Paraclinical examinations, which showed inflammatory syndrome, bone condensation and IgM monoclonal gammapathy, led to the diagnosis of Schnitzler's syndrome, first described in 1972. Twenty-two cases have now been published, characterized by vasculitic urticaria, osteosclerosis and IgM macroglobulinaemia. There is also severe inflammatory syndrome and the other immunological examinations are normal. Recent studies suggest the possibility of uncontrolled activity of interleukin-1 alpha. The condition is chronic and usually benign, but the fear of malignant transformation in the long term makes the therapeutic choice difficult.

Aged↗

[A new method of age determination by age-related changes in the hand bone].

An anthropological method designed for determining the age is under discussion; it is based on the point-evaluation of age-related changes observed in the hand bones by X-Ray, i.e. osteophytes, osteoporosis, osteosclerosis and joint deformations. The method was made use of to elaborate a new modified point-based assessment of the above changes in the hand bones with respect to their severity.

Adolescent↗

Dental and facial bone abnormalities in pyknodysostosis: CT findings.

Pyknodysostosis is an autosomal-recessive disorder of osteoclast dysfunction causing osteosclerosis, with associated maxillofacial anomalies. Multidetector CT with multiplanar and 3D reconstruction illustrated the pathologic findings in this case. Abnormalities included multiple retained deciduous teeth, unerupted teeth with associated follicles, an irregularly expanded alveolus and body of the mandible, and an obtuse mandibular angle. Volume-rendered imaging better delineated the irregular dentition, with crowding and retention of deciduous teeth.

Adult↗

[The bone manifestations in 94 cases of sarcoidosis].

94 patients diagnosed as having sarcoidosis were studied in Galicia in order to evaluate the frequency of bone manifestations, as well as to analyse the clinical and radiological features. Bone lesions were found in 10 patients (10.6%) with a median age of 47.4 years, the predominant sex being female in this group (70%). The lesions were of two types: a) osteolytic on metacarpal (4 cases), nasal bones (1 case), sacrum (1 case), femur (1 case); b) osteosclerosis on femur and fibula (1 case), acrosclerosis (3 cases), metacarpal (1 case). The first lesions were associated to chronic types of sarcoidosis with skin and lung involvements. The second lesions were associated to a sub-acute type of Löfgren. We highlight the behaviour of both types of bone lesions and comment on the physiopathology of the sclerotic lesions.

Age Factors↗

[A study using nondecalcified bone biopsy of the incidence and presentation forms of renal osteodystrophy].

BACKGROUND: Renal osteodystrophy (ROD) is a common complication of chronic renal failure. Fibrous osteitis and, to a lesser extent, osteomalacia are the predominant lesions. The aim of the present study was to evaluate the prevalence of the different forms of ROD. METHODS: Nondecalcified bone biopsies were evaluated in 100 patients with end-stage renal disease (57 in pre-dialysis and 43 on hemodialysis) in whom biochemical (calcium, phosphorus, alkaline phosphatase, parathyroid hormone) and histomorphometric studies were carried out. Bone biopsies were classified in four histological groups: mild, fibrous osteitis (FO), osteomalacia (OM) and mixed type (FO + OM). RESULTS: 96% of patients had histological findings of ROD with the following distribution: 41% mild; 30% FO; 14% OM; and 11% mixed. The most advanced types of ROD were seen in interstitial renal diseases. Pre-dialysis OM was associated with metabolic acidosis, a low phosphocalcic product and relative hypophosphoremia. Chronic aluminium poisoning was uncommon (7%) and was basically associated with OM. No instance of aluminium poisoning with osteodystrophy and bone fractures was seen. CONCLUSIONS: The most severe histological forms of OM were found in hemodialysis patients with persistent hypophosphoremia and associated with osteosclerosis.

Adolescent↗

Condensing osteitis of the clavicle. Report of two cases and review of the literature.

Condensing osteitis of the clavicle, better defined as aseptic enlarging osteosclerosis of the clavicle, is a rare and benign idiopathic lesion. It is probably of degenerative or mechanical origin, and is most commonly seen in middle-aged women as a tender swelling over the medial one-third of the clavicle. Although the clinical features may be confusing and nonspecific, the typical radiographic and histopathological findings will mostly lead to a correct diagnosis of this disorder. The differential diagnosis is quite extensive. Most difficult to differentiate are: avascular necrosis of the medial clavicular epiphysis, sternoclavicular orsteoarthritis, low-grade chronic osteomyelitis, sternocostoclavicular hyperostosis and Tietze's syndrome. The authors recommend a thorough physical examination and technical tests, not only in subjects with pain of the clavicle but also in those with shoulder pain only, especially in women who are in their fourth decade. Treatment with analgesic and anti-inflammatory medications may be variably effective. In refractory cases excisions of the medial one-third of the clavicle may be indicated to offer better relief of symptoms as well as to exclude malignancy.

Adult↗

[Differential diagnosis in osteoporosis].

Osteoporosis is a so called metabolic osteopathy. Under this term alterations are included concerning primary the bone tissue, but in consequence disable bone organs. Into this group of affections belong also the osteomalacia, the parathyreogenic osteodystrophy, the osteosclerosis caused by systemic changes of the bone tissue turn-over and furthermore different combinations of such alterations. For their principal diagnosis in every single case the histological findings are most important for their pathogenetic differentiation and for the (therapeutically and diagnostically important) individual specification anamnesis, X-ray findings and several biochemical parameters are important.

Bone Diseases, Metabolic↗

Endocrine function in sclerosteosis.

Sclerosteosis is a rare autosomal recessive condition which is characterized by excessive skeletal overgrowth, distortion of the facies, cranial nerve abnormalities and raised intracranial pressure. Syndactyly and digital malformation are associated features. Radiological examination reveals thickened sclerotic bone maximally involving the skull, including the pituitary fossa. Sclerosis and hyperostosis are present throughout the skeleton. Biochemical and endocrine tests were carred out on 3 patients with sclerosteosis in an attempt to detect any dysfunction of calcium regulation of the pituitary. Results revealed no abnormality of basal parathyroid or calcitonin secretion. Histological examination revealed quantitatively increased bone resorption in comparison with normal subjects, although the pattern resembled osteosclerosis. Regulation of growth hormone, adrenocorticotrophin, gonadotrophin and thyrotrophin function were intact. We conclude that pituitary function and calcium 'homeostasis' are normal in this disorder.

Adult↗

Osteopathia striata with cranial sclerosis.

We report a case of osteopathia striata, which is an osseous dysplasia with linear striations of the metaphyses of long bones. Our case is very unusual as there are no associated abnormalities of the bones. Osteopathia striata should not be mistaken for osteopoikilosis. Osteopathia striata is not only a peculiar roentgenologic feature: when it is diagnosed other abnormalities should be looked for, especially cranial osteosclerosis, which may result in complications.

Adult↗

[Regression of skeletal fluorosis following termination of non-occupationally-induced exposure].

It is reported on a female patient with skeletal fluorosis stage II. The osteosclerosis seen on X-rays of the skeleton has decisively diminished within 12 years after termination of fluoride exposure. The fluoride content of the bone ash correlates to the roentgenological picture. Consequences concerning a therapy of osteoporosis with sodium fluoride are discussed.

Air Pollutants, Occupational↗

Endemic fluorosis with spinal cord compression. A case report and review.

We report a case of spinal cord compression in a Mexican immigrant due to vertebral osteosclerosis from chronic fluoride intoxication. Endemic fluorosis is acquired through drinking water. Groundwater sources with high fluoride content occur worldwide. The epidemiology, metabolism, and clinical features of fluorosis are reviewed. Greater physician awareness of this entity is important to identify correctly patients with this unusual and potentially devastating clinical disorder.

Aged↗

Plasma cell sclerosis of bone: a spectrum of disease.

We describe the clinical, radiographic, and pathologic manifestations of a group of disorders characterized by osteosclerosis in association with plasmacytic infiltration of bone marrow. These conditions include multiple myeloma, plasma cell granuloma, sternocostoclavicular hyperostosis, the POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes), and chronic symmetric plasma cell osteomyelitis of childhood. Although clinically unrelated in many respects, features shared by these diseases support the existence of a specific factor linking the plasma cell to local osteogenesis.

Adolescent↗

Renal osteodystrophy--a radiological review.

Renal osteodystrophy is an amalgam of a number of distinct pathological conditions, in particular, hyperparathyroidism and osteomalacia. In addition, there may be a change in the guantity of bone, i.e., osteopenia (osteoporosis) or osteosclerosis. While bone biopsy may be the most reliable method for detecting these lesions, it is not yet a routine procedure in many centers. Radiological assessment of the bones, therefore, is the most widely used method for assessing the type and severity of the bone lesions in patients with chronic renal failure. This article reviews the world literature and pays attention to conventional radiological techniques as well as macroradiography. In addition, studies in which radiological appearances are correlated with histological appearances are described. Mention is also made of the effects on radiological bone disease of dialysis and transplantation. Consideration is also given to the manifestations of soft-tissue calcification, both of the vascular and subcutaneous type, and to the effects of treatment.

Alveolar Process↗

[Study on prognostic factors in bone metastases of breast cancer].

UNLABELLED: In order to assess the prognosis of breast cancer patients with bone metastases, a comprehensive imaging of the skeleton was studied. A total of 256 positive bone scans from 94 patients was analyzed to institute a new staging system of bone metastases and to identify characteristic presentations of their prognosis. The correlation between the image characteristics and the survival was examined. RESULTS: 1) The extent of tumor spread on the bone scan was classified into the following three stages: stage 1 (confined to lumbar spine, thoracic spine or ribs), stage 2 (expanded into pelvis, skull, cervical spine or sternum) and stage 3 (expanded further into other areas). 2) Presence of vital system metastases, extent of tumor spread as reflected in the stage, progression of tumor spread on the serial bone scans and radiographic evidence of osteosclerosis were proved to determine prognosis. An appropriate management of orthopedic complications taking these factors into consideration is required.

Bone Neoplasms↗

[Etiopathogenetic significance of bone changes in spontaneous gonarthritis in the mouse].

In the C57 Black, STR/IN and MAGf strains of mice, which are prone to develop spontaneous osteo-arthritis of the knee, histomorphological examinations were made of the osseous parts of the joint. It was found that the number of animals with osteo-arthritis and with degenerative changes in the epiphyseal growth zone increases with age. There is nevertheless evidently no interrelation between the two phenomena. The same applies to the occurrence of osteoporosis and degenerative joint disease, since male C57 Black mice, for example, develop osteo-arthritis of the knee relatively often, but develop osteoporosis much more rarely, while the opposite is observed in the females. Moreover, among the juvenile joint degenerations in the STR/IN and MAGf strains, a high percentage of osteo-arthritis of the knee is found, but only a few instances of osteoporosis. The majority of the (relatively rare) idiopathic condylar necroses coincide with osteo-arthritis of the knee, but not vice versa. The development of osteosclerosis and degenerative cartilaginous defects is mostly (possibly always) a sequela and not the cause of osteo-arthritis of the knee. Malpositions are often associated with the development of osteo-arthritis of the knee. The C57 Black strain exhibits a certain tendency to develop genu valgum, and the STR/IN strain almost regularly shows genu varum; no distinct tendency is detectable in MAGf mice. Like the osteophytes, the enlarged menisci with obligatory ossification centres invariably seen in conjunction with osteoarthritis apparently help to compensate for the condylar incongruence caused by the degenerative process, prevent partial dislocations, and hence improve the stability of the joint.

Animals↗