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Whyte MP, Madson KL, Mumm S, McAlister WH, Novack DV, Blair JC, Helliwell TR, Stolina M, Abernethy LJ, Shaw NJ. Rapid skeletal turnover in a radiographic mimic of osteopetrosis. J Bone Miner Res 2014; 29:2601-9. [PMID: 24919763 PMCID: PMC4391634 DOI: 10.1002/jbmr.2289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 12/13/2022]
Abstract
Among the high bone mass disorders, the osteopetroses reflect osteoclast failure that prevents skeletal resorption and turnover, leading to reduced bone growth and modeling and characteristic histopathological and radiographic findings. We report an 11-year-old boy with a new syndrome that radiographically mimics osteopetrosis (OPT), but features rapid skeletal turnover. He presented at age 21 months with a parasellar, osteoclast-rich giant cell granuloma. Radiographs showed a dense skull, generalized osteosclerosis and cortical thickening, medullary cavity narrowing, and diminished modeling of tubular bones. His serum alkaline phosphatase was >5000 IU/L (normal <850 IU/L). After partial resection, the granuloma re-grew but then regressed and stabilized during 3 years of uncomplicated pamidronate treatment. His hyperphosphatasemia transiently diminished, but all bone turnover markers, especially those of apposition, remained elevated. Two years after pamidronate therapy stopped, bone mineral density (BMD) Z-scores reached +9.1 and +5.8 in the lumbar spine and hip, respectively, and iliac crest histopathology confirmed rapid bone remodeling. Serum multiplex biomarker profiling was striking for low sclerostin. Mutation analysis was negative for activation of lipoprotein receptor-related protein 4 (LRP4), LRP5, or TGFβ1, and for defective sclerostin (SOST), osteoprotegerin (OPG), RANKL, RANK, SQSTM1, or sFRP1. Microarray showed no notable copy number variation. Studies of his nonconsanguineous parents were unremarkable. The etiology and pathogenesis of this unique syndrome are unknown.
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Affiliation(s)
- Michael P. Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - Katherine L. Madson
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - William H. McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children’s Hospital, Washington University School of Medicine; St. Louis, MO, USA, 63110
| | - Deborah V. Novack
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
- Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - Jo C. Blair
- Department of Endocrinology, Alder Hey Children’s National Health Service Foundation Trust; Liverpool, UK, L12 2AP
| | - Timothy R. Helliwell
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool; Liverpool, UK, L69 3GA
| | | | - Laurence J. Abernethy
- Department of Radiology, Alder Hey Children’s National Health Service Foundation Trust; Liverpool, UK, L12 2AP
| | - Nicholas J. Shaw
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital; Birmingham, UK, B4 6NH
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Shaker JL. Paget's Disease of Bone: A Review of Epidemiology, Pathophysiology and Management. Ther Adv Musculoskelet Dis 2012; 1:107-25. [PMID: 22870432 DOI: 10.1177/1759720x09351779] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Paget's disease of bone is a common disorder which may affect one or many bones. Although many patients are asymptomatic, a variety of symptoms and complications may occur. Fortunately, effective pharmacologic therapy, primarily with potent bisphosphonates, is now available to treat patients with complications or symptoms. This review of Paget's disease of bone will include epidemiology and pathophysiology, complications and clinical findings, indications for treatment, and the drugs currently available to treat this condition.
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Abstract
Giant cell tumor (GCT) of the bone, also called osteoclastoma, is a rare complication of Paget's bone disease. We report a patient from Southern Italy who developed a GCT infiltrating the neighboring tissues. The natural history and the therapeutic outcomes of this unique complication of Paget's bone disease are presented.
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