osteitis fibrosa

Osteitis Fibrosa: A Rare Complication of Hyperparathyroidism

Osteitis fibrosa, also known as osteitis fibrosa cystica (OFC), is a rare skeletal disorder that affects less than 5 percent of people with hyperparathyroidism. This condition is characterized by the replacement of bone mass with fibrous tissue, leading to a weakening of the bones and the formation of cyst-like brown tumors in and around the bone.

Causes and Symptoms

Osteitis fibrosa is caused by an overactive parathyroid gland, which leads to an excessive production of parathyroid hormone (PTH). This hormonal imbalance causes the bones to become abnormally weak and deformed. The symptoms of osteitis fibrosa may include:

• Bone pain or tenderness
• Fractures (breaks) in the arms, legs, or spine
• Other bone problems

Diagnosis

To diagnose osteitis fibrosa, routine blood tests will reveal elevated calcium and parathyroid hormone levels. The alkaline phosphatase level may come out to be lower than normal. X-rays may also reveal fragile and thin bones, fractures, or cysts.

Treatment

Most of the bone problems from osteitis fibrosa can be reversed with surgery to remove the abnormal parathyroid gland(s). Some people may choose not to have surgery, and instead be followed with blood tests and bone measurements. If surgery is not possible, medicines can sometimes be used to lower the blood calcium level.

Prevalence

Osteitis fibrosa is now very rare in people who have hyperparathyroidism and good access to medical care. It is more common in people who develop hyperparathyroidism at a young age, or have untreated hyperparathyroidism for a long time.

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Common Signs and Symptoms of Osteitis Fibrosa

Osteitis fibrosa, a rare complication of hyperparathyroidism, can cause various symptoms that affect the skeletal system. The primary signs and symptoms include:

• Bone pain: A deep-seated, vague pain in the bones, which can be a result of bone tenderness [4].
• Fractures: Fragility of the bones leading to fractures with minimal trauma, particularly in the long bones, ribs, and pelvis [5].
• Bone deformities: Softening of the bones resulting in deformities, such as bowing of the shoulders or collapse of lateral ribs [7].
• Fatigue and weakness: Early symptoms that can occur before bone pain and fractures become apparent [2].

Additionally, osteitis fibrosa may cause other complications, including:

• Paraplegia: Secondary to vertebral collapse [8].
• Elevated serum calcium: A laboratory finding that indicates hyperparathyroidism [8].
• Subperiosteal bone resorption: Radiographic evidence of bone loss and weakening [9].

It is essential to note that osteitis fibrosa can be a rare complication, especially in people with good access to medical care. However, it is more common in individuals who develop hyperparathyroidism at a young age or have untreated hyperparathyroidism for an extended period [15].

Diagnostic Tests for Osteitis Fibrosa

Osteitis fibrosa cystica, a rare complication of hyperparathyroidism, can be diagnosed through various diagnostic tests.

• Blood Tests: Blood tests are essential in diagnosing osteitis fibrosa. They show elevated levels of calcium, parathyroid hormone (PTH), and alkaline phosphatase (ALP) [7][8][9]. A high level of PTH is a key indicator of hyperparathyroidism, which can lead to osteitis fibrosa cystica.
• X-rays: X-rays or computed tomography (CT) scans may reveal lytic or multilobular cystic changes in the bones [6], indicating osteitis fibrosa. These imaging tests can also show fragile and thin bones, fractures, or cysts.
• Bone Density Tests: Osteopenia or osteoporosis may be indicated by x-rays, which can point to a higher risk of fractures [11].
• Imaging Studies: Imaging studies such as CT scans or MRI may be used to confirm the diagnosis and assess the extent of bone involvement.

Important Note: A correct diagnosis of osteitis fibrosa cystica requires a comprehensive evaluation, including medical history, physical examination, laboratory tests, and imaging studies. Consultation with an endocrinologist or a specialist in bone diseases is essential for accurate diagnosis and treatment planning.

References: [6] - The X-ray or computed tomography scan findings of osteitis fibrosa cystica include lytic or multilobular cystic changes. [7] - Laboratory testing is significant for an elevated serum calcium, alkaline phosphatase, and parathyroid hormone and decreased serum phosphate. [8] - Blood tests show a high level of calcium, parathyroid hormone, and alkaline phosphatase (a bone chemical). Phosphorus level in the blood may be low. [9] - Blood tests show a high level of calcium, parathyroid hormone, and alkaline phosphatase (a bone chemical). Phosphorus level in the blood may be low. [11] - Apart from this, x-rays may reveal fragile and thin bones, fractures, or cysts. An x-ray of the bone may reveal signs that may point to osteopenia or osteoporosis.

Differential Diagnosis of Osteitis Fibrosa Cystica

Osteitis fibrosa cystica, a rare complication of hyperparathyroidism, requires careful consideration of differential diagnoses to ensure accurate diagnosis and treatment. The following conditions should be considered in the differential diagnosis of osteitis fibrosa cystica:

• Metastatic carcinoma: Osteolytic lesions caused by metastatic cancer can mimic the appearance of osteitis fibrosa cystica on imaging studies.
• Non-Hodgkin's lymphoma: This type of cancer can also cause lytic bone lesions, which may be mistaken for osteitis fibrosa cystica.
• Myeloma: Multiple myeloma is a plasma cell malignancy that can cause osteolytic lesions, similar to those seen in osteitis fibrosa cystica.
• Brown tumors: These are benign lesions caused by hyperparathyroidism, which can be mistaken for osteitis fibrosa cystica due to their similar appearance on imaging studies.

Key Considerations

When considering the differential diagnosis of osteitis fibrosa cystica, it is essential to evaluate the patient's overall clinical presentation, including:

• Hypercalcemia: Elevated calcium levels are a hallmark of hyperparathyroidism and can be associated with osteitis fibrosa cystica.
• Bone pain: Patients with osteitis fibrosa cystica often present with bone pain, which can be localized or diffuse.
• Pathologic fractures: Osteitis fibrosa cystica can cause pathologic fractures due to the weakening of bones.

References

• [2] X-ray or computed tomography scan findings of osteitis fibrosa cystica include lytic or multilobular cystic changes.
• [4] Osteitis fibrosa cystica is a rare complication of hyperparathyroidism, affecting less than 5 percent of people with the hormone disorder.
• [12] Differential diagnoses for patients presenting with multiple bone lucencies include: metastatic carcinoma, non-Hodgkin's lymphoma, myeloma, ...
• [14] Osteitis fibrosa cystica (OFC) needs to be considered in the differential diagnosis when there are osteolytic lesions and hypercalcaemia.