[Osteopathy by renal disease, renal disease by osteopathy (disorders of the functional system: parathyroid glands, mineral balance, kidney)].
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Bone Diseases↗
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[Diabetic osteopathies and senile osteopathies].
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Aged↗
Andrew Taylor Still and the birth of osteopathy (Baldwin, Kansas, USA, 1855).
Osteopathy has gained ground in recent years and has been seeking recognition in France. Physicians often lack the information needed to answer patients who have derived from the media, advertisements, and other patients what they believe is a clear idea of osteopathy and its twin sister chiropractic. My academic activities led me to the heart of the United States, to Kansas, where settlers and Indians once stood face to face and where wagon trains left daily for the Western territories. There, in Baldwin, Andrew Taylor Still "discovered" osteopathy. I conducted an in-depth study of the birth of osteopathy and of the ideological and cultural influences that shaped this doctrine. The circumstances that surrounded the development of osteopathy deserve to be widely known because they explain how contemporary osteopaths work. Indeed, although the terms are different, the ideology that underlies osteopathy seems unchanged. The history of osteopathy emphasizes the importance of logical thinking in medicine, of the principle of pathophysiological foundation, of diagnostic hypotheses, and of careful treatment selection complying with the rules of deontology and ethics. Osteopathy is without doubt a product of society and perhaps also of vogue. It cannot leave physicians indifferent.
History, 19th Century↗
Bone scintigraphy and radiography in the early recognition of diabetic osteopathy.
Twenty-seven diabetic patients with clinical evidence of neuropathy were investigated by foot radiography, two-phase bone scintigraphy, biothesiometry and cardiovascular autonomic function testing. Typical signs of diabetic osteopathy on radiography were found in 10 subjects (37%), the degree of radiographic abnormality correlating with the severity of neurological impairment. Furthermore, all diabetics with evidence of severe neuropathy showed some evidence of osteopathy on foot radiographs. In all 10 cases of diabetic osteopathy diagnosed radiographically, abnormalities were shown on scintigraphy. In addition, five other patients showed scintigraphic abnormalities, without corresponding changes on radiography, and in this group the neurological impairment was less severe. Although confirmatory longitudinal studies are necessary, it seems likely that the earliest changes of diabetic neuropathic osteopathy may thus be recognized on bone scintigraphy, at a time when conventional radiographs are normal. This stage of diabetic osteopathy is associated with a lesser degree of neurological impairment.
Adult↗
Use of cisplatin for control of metastatic malignant mesenchymoma and hypertrophic osteopathy in a dog.
Cisplatin (cis-diammine-dichloroplatinum) treatment induced partial remission of pulmonary metastatic malignant mesenchymoma and nearly complete radiographic remission of hypertrophic osteopathy in a 14-year-old Beagle. Cisplatin was given once every 3 weeks. Clinical signs of hypertrophic osteopathy resolved one week after initiation of treatment. Partial remission of pulmonary metastases and partial radiographic remission of hypertrophic osteopathy was seen 6 weeks after initiation of treatment. Previous treatment of neoplasia-related hypertrophic osteopathy has consisted of removal of the initiating mass or vagotomy. In this case, appropriate chemotherapy was used to control clinical signs and progression of hypertrophic osteopathy.
Animals↗
[Dialysis osteopathy with spontaneous fractures, progressive demineralization and therapy resistance].
In 25 (33.8%) of 74 chronically haemodialysed patients a distinct osteopathy with bone pain, spontaneous fractures, arthralgias and weakness of the muscles due to dialysis was present. In comparison to a group without complaints the duration of the dialysis was longer by 6 months, the mineral contents of the bones was decreased in 38%, in the comparative group in 22%. A progressive demineralisation was found in 46%, in the comparative group in 20%. Hypercalcaemias under vitamin D2 caused a therapy resistance. In 1 exemplary case (type IIc, PTH 0.3 micrograms/l) in the 3rd year of dialysis a fracture of the neck of the femur took place and an endoprosthesis was implanted. There was a progressive demineralisation of about 16%. The suspicion of a typical combination with an encephalopathy due to dialysis did not confirm itself. A pseudocyst in the brain was found. The differential diagnosis to the hypercalcaemia-induced psychosis in the osteopathy due to dialysis is discussed. In a prophylactic application dihydrotachysterine proved favourable for avoidance of an osteopathy due to dialysis. Parallel to the clinical progressing of the osteopathy due to dialysis a progressive demineralisation could be demonstrated at the peripheral mineral contents of the bones. Extreme losses of minerals appeared from the 4th to the 59th month of dialysis from - 16% to - 37% and from the 22nd to the 87th month from plus 11% to minus 14% of the age-and-sex-specific normal values. Successful transplantations led to the stagnation of the progressive demineralisation, unsucessful transplantations increase them. The influence of the non-refined water for the production of dialysate by possible aluminium intoxications on the development of the osteopathy due to dialysis is discussed.
Aluminum Hydroxide↗
[Bone scan in the diagnosis of renal osteopathy (author's transl)].
Biochemical tests (serum calcium, inorganic phosphate and alkaline phosphatase), as well as clinical, radiological, scanning and histological investigations were undertaken in 24 patients in chronic renal failure. The frequency with which the diagnosis of renal osteopathy could be made depended in the method of investigation, the biochemical findings proving to be completely unreliable. There were positive radiological signs in ten patients and clinical signs in 12, predominantly in the progressive stages of osteopathy. A positive scan was obtained in 23 patients, typical histological bone changes in an equal number. Since it correlates so well with the histological findings, bone scan is suitable particularly in the early diagnosis of osteopathy. Since this test is easily performed and hardly stresses the patient, it should routinely be the initial one for the diagnosis of renal osteopathy.
Adolescent↗
[Involutional osteopathies: the clinical x-ray, biochemical and hormonal aspects of the diagnosis].
A study of patients with involution osteopathy has shown that the development of this disease is associated with osseous tissue dystrophic changes (osteoporosis) and, to a lesser extent, with osteomalacia. Involution osteopathy is not accompanied by severe changes in indices of phosphoric-calcium metabolism; it is characterized by a tendency to an increase in the levels of total and ionized calcium and a decrease in the level of serum phosphorus. A lowered level of calcitonin with a tendency to a decrease in the level of the somatotropic hormone and the unchanged content of parathormone was revealed in involution osteopathy. The blood level of sex steroids (both estradiol and testosterone) in women was decreased, a degree of a rise of gonadotropins in them was lower than that in healthy postmenopausal women. In men with involution osteopathy the mean level of serum testosterone was within low normal limits, the LH content remained normal, and a FSH level was raised. The level of prolactin in patients of both sexes was unchanged.
Aged↗
[Bone scans in the diagnosis of renal osteopathy].
Biochemical tests (serum calcium, inorganic phosphate and alkaline phosphatase), as well as clinical, radiological, scanning and histological investigations were undertaken in 24 patients in chronic renal failure. The frequency with which the diagnosis of renal osteopathy could be made depended in the method of investigation, the biochemical findings proving to be completely unreliable. There were positive radiological signs in ten patients and clinical signs in 12, predominantly in the progressive stages of osteopathy. A positive scan was obtained in 23 patients, typical histological bone changes in an equal number. Since it correlates so well with the histological findings, bone scan is suitable particularly in the early diagnosis of osteopathy. Since this test is easily performed and hardly stresses the patient, it should routinely be the initial one for the diagnosis of renal osteopathy.
Adult↗
[Alimentary osteopathies].
Alimentary osteopathies are classified into primary (with food deficient of Ca, vitamin "D", or of proteins) and secondary ones, that develop consequent to disturbed assimilation and absorption of these substances. Basic causes responsible for the development of alimentary osteopathies are listed and the pathogenesis of this malady is considered. The osteopathies are classified with respect to their causes, the prevalent form (osteoporosis, osteomalacia, or mixed forms) and according to the severity of the skeletal affection (latent stage, that of clinical manifestation and the stage with complications). A review of modern methods of diagnosis and therapy in dealing with alimentary osteopathies by using calcium, vitamin "D" and fluorine, as well as by applying other remedies (thyrocalcitonin, estrogens, androgens, anabolic hormones, diphosphonates) or measures (exercises, rehabilitation) is presented.
Age Factors↗
[Striated osteopathy].
Striated osteopathy, a roentgenological entity characterized by longitudinal striations, can occur concomitantly with a number of disorders which should be routinely looked for. There are three types of striated osteopathy. The pure form without severe bone disorders is the form originally reported by Voorhoeve. In the second form, there is a concomitant fibrous dysplasia, such as Jaffe-Lichtenstein-Uehlinger disease, Ollier enchondromatosis, sponastrism dysplasia, or osteopetrosis. This group also includes bone dysplasias with sclerosis such as melorheostosis, osteopecilia, and sclerosis of the base of the skull which is sometimes seen in patients with striated osteopathy. In the third form, striated osteopathy occurs concomitantly with a skin disease such as patchy dermal hypoplasia or hyperpigmented skin lesions.
Child↗
Studies on psoriatic osteopathy.
To demonstrate an as yet merely postulated generalized osteopathy in psoriatics, the serum calcium level, the alkaline phosphatase in the serum and the urinary excretion of hydroxyproline were evaluated in 24 patients with Ps and 24 patients with PA. Moreover, the bone bioptates from 25 patients with PA and 10 patients with Ps were examined histologically and measured morphometrically. The investigations provide evidence for the existence of a generalized "latent" osteopathy in terms of an elevated bone turnover rate without loss of bone volume (high turnover remodelling) in both patients with PA as well as those with Ps without arthritis. As a pathogenetically essential factor shared by dermatosis and "osteopathy", latent vitamin D deficiency and/or D hormone resistance is discussed.
Adult↗
Canine distemper virus transcripts detected in the bone cells of dogs with metaphyseal osteopathy.
Using the technique of in situ hybridisation, we have recently extended our observations that canine distemper virus (CDV) is present in the bone cells of patients with Paget's disease, and have shown that CDV is also detectable in the bone cells of dogs that are naturally infected with the virus. Since hybridisation was localised to bone cells within the metaphyses of the affected dogs, we investigated the possibility that CDV might be involved in the canine metaphyseal bone disorder, metaphyseal osteopathy. Bone samples from three cases of metaphyseal osteopathy were examined for the presence of the CDV nucleocapsid (CDV-N) gene and the measles virus nucleocapsid (MV-N) gene, using 35S-labelled sense and antisense riboprobes. As with our previous findings in Paget's disease of bone, only the antisense probe was found to hybridize to the osteoblasts and osteoclasts within the affected metaphyses. No hybridisation was seen with the CDV-N sense and MV-N probes in any of the samples tested. Bone samples were also taken from one of the cases to check for the presence of the CDV-N gene using the polymerase chain reaction (PCR). Our findings with in situ hybridisation were confirmed by PCR and subsequent Southern blotting and probing with a 32P-labelled cDNA probe. The detection of CDV RNA within the bone cells of dogs with metaphyseal osteopathy suggests that this virus may be a cause of the disease and provides further, indirect evidence that CDV might be responsible for the bony abnormalities seen in Paget's disease of bone.
Animals↗
[Treatment of renal osteopathy with 5,6-trans-25-hydroxycholecalciferol (author's transl)].
The influence of 5,6-trans-25-hydroxycholecalciferol on renal osteopathy was investigated in a total of 132 patients in 26 dialysis centres. Various doses were used, the average being 4000-6000 IU/day. In 32 patients a daily dose of 6000-9000 IU was used. The average individual duration of treatment was 276 days with a maximum of 910 days. Histologically there was an improvement in the renal osteopathy in 55.9% of evaluable cases (n = 34) and in 25.3% there was no deterioration. Radiographically these results were found in 21% and in 70.5% of evaluable cases (n = 105). Serum calcium increased in 46.6% of cases (n = 131), remained the same in 32.8% and decreased in 20.6%. The changes in alkaline phosphatase were similar : it dropped in 42.1% of patients, remained the same in 28.1% and rose in 29.8%. Immunoreactive parathormone which was invariably raised at the beginning of treatment (n = 36), fell in 25.0%, remained the same in 44.4% and rose further in 30.6%. The clinical symptoms of renal osteopathy which had been present in 57 patients improved in 51.0%, remained the same in 46.0% and deteriorated in 3.0%. Signs of intolerance and side effects were rare. Severe hypercalcaemia did not occur.
Adolescent↗
[Dialysis-associated amyloid osteopathy--the radiological aspects].
Amongst the complications of dialysis, amyloid osteopathy is getting increasingly significant. It is due to deposition of beta 2-microglobulin. To determine the incidence and time of development of this complication, the skeletal radiographs of 185 patients undergoing dialysis, some for up to ten years, were analysed retrospectively. In about 10% of patients, the presence of beta 2-microglobulin osteopathy may be expected. The radiological features, sites of predilection and differential diagnosis of amyloid osteopathy and of other skeletal changes due to dialysis are discussed.
Amyloidosis↗
Methotrexate osteopathy demonstrated by Technetium-99m HDP bone scintigraphy.
The authors report a case of methotrexate osteopathy as revealed by Tc-99m HDP bone scintigraphy in a patient with rheumatoid arthritis. Methotrexate is used widely in high doses as a chemotherapeutic agent. Lower doses are given in rheumatoid and psoriatric arthritis. Methotrexate affects bone metabolism, resulting in methotrexate osteopathy, characterized by osteoporosis, osseus pain, and even spontaneous (micro)fractures. Radiographic visualization of microfractures is difficult. Tc-99m HDP bone scans have been shown to be very sensitive in the visualization of changes in bone metabolism as a result of methotrexate osteopathy.
Antirheumatic Agents↗
Congenital megaesophagus with hypertrophic osteopathy in a 6-year-old dog.
Congenital megaesophagus is often sufficiently debilitating to a young puppy to result in an owner's request for euthanasia. If medically managed, some puppies may develop a functional esophagus and mature normally; in others, the dilation may persist, but nutritional support may be sufficient to allow skeletal maturation. Hypertrophic osteoarthropathy or hypertrophic osteopathy is well recognized in many animal species. Pulmonary neoplasia is most commonly associated with development of the secondary bone changes, but numerous other causes exist. The chronic changes of hypertrophic osteopathy were identified in a 6-year-old German Shepherd that was debilitated by persistent congenital megaesophagus. To the investigators' knowledge, a relationship between long-term esophageal dilatation and hypertrophic osteopathy has only been reported once in a human patient.
Animals↗
Methotrexate osteopathy in patients with osteosarcoma.
PURPOSE: To determine the frequency of osteopathy in patients treated with high-dose, short-term, intravenous methotrexate for osteosarcoma and whether this complication varies with patient age and methotrexate dose. MATERIALS AND METHODS: Radiographs and available scintigrams of 87 patients with osteosarcoma who received high-dose methotrexate were reviewed retrospectively for severe osteopenia, dense zones of provisional calcification, insufficiency fractures, and involvement of multiple bones. At least three of these radiographic abnormalities were required for the diagnosis of osteopathy. Patients with bone metastases were excluded. RESULTS: Eight patients (cumulative dose, 60-144 g/m2) exhibited adverse skeletal findings similar to those described in children with leukemia who received low-dose maintenance methotrexate. Images showed severe osteopenia (n = 8), dense zones of provisional calcification (n = 8), multiple bone involvement (n = 6), and insufficiency fractures (n = 6). Most commonly affected sites were the distal tibia (n = 7), distal radius and proximal humerus (n = 3), and calcaneus and public ramus (n = 2). The affected patients were significantly younger (mean age, 9.2 years; P < .001) than the 79 unaffected patients (mean age, 14.9 years). CONCLUSION: Osteopathy occurs in approximately 9% of children who receive high-dose methotrexate for osteosarcoma and is substantially more likely to occur in younger patients. The complication rate was not directly dose dependent.
Adolescent↗