Osteolysis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Luke Rusowicz-Orazem, B.S.

Overview

Osteolysis is the softening, absorption and destruction of bony tissue.

Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning Polyvinyl chloride
Dental No underlying causes
Dermatologic Haim-munk syndrome, Mycetoma, Psoriasis
Drug Side Effect No underlying causes
Ear Nose Throat Peridontal disease
Endocrine Hyperparathyroidism
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Bonnet-dechaume-blanc syndrome, Gaucher disease, Haim-munk syndrome, Hajdu-cheney syndrome, Hutchinson-gilford progeria syndrome, Idiopathic multicentric osteolysis, Interleukin 1 receptor antagonist deficiency, Majeed syndrome, Systemic hyalinosis, Torg-winchester syndrome, Van bogaert-hozay syndrome
Hematologic Gorham vanishing bone disease, Hairy cell leukaemia, Histiocytosis x, Sickle cell disease
Iatrogenic Prosthetics
Infectious Disease Cysts, Mycetoma, Peridontal disease, Secondary syphilis, Tertiary syphilis
Musculoskeletal/Orthopedic Acroosteolysis, Adamantinoma, Aging, Bone tumors, Chondroblastoma, Chondromyxoid fibroma, Chronic inflammation, Cleidocranial dysplasia, Craniomandibular dermatodysostosis, Desmoplastic fibroma, Enchondroma, Enchondromatosis, Epithelioid hemangioendothelioma, Ewing sarcoma, Gorham vanishing bone disease, Hajdu-cheney syndrome, Idiopathic multicentric osteolysis, Myeloma, Osteosarcoma, Polyostotic fibrous dysplasia, Polyostotic osteolytic expansile dysplasia, Pyknodysostosis, Reiter syndrome, Subchondral stress fracture, Torg-winchester syndrome, Van bogaert-hozay syndrome
Neurologic Bonnet-dechaume-blanc syndrome, Cleidocranial dysplasia, Craniomandibular dermatodysostosis, Hereditary sensory and autonomic neuropathy type 2, Neuroblastoma
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Adamantinoma, Bone tumors, Chondroblastoma, Chondromyxoid fibroma, Desmoplastic fibroma, Enchondroma, Enchondromatosis, Epithelioid hemangioendothelioma, Ewing sarcoma, Hairy cell leukaemia, Myeloma, Neuroblastoma, Osteosarcoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Arithritis, Polyostotic fibrous dysplasia, Polyostotic osteolytic expansile dysplasia, Psoriasis, Reiter syndrome, Sarcoidosis, Systemic hyalinosis, Systemic sclerosis
Sexual Secondary syphilis, Tertiary syphilis
Trauma Frostbite, Subchondral stress fracture
Urologic No underlying causes
Miscellaneous Aging, Chronic inflammation

Cause in Alphabetical Order

Differential Diagnosis

In alphabetical order. [1] [2]

osteolysis must be differentiated from other causes of hypercalcaemia

Differential diagnosis of hyperparathyroidism on the basis of hypercalcemia
Disorder Mechanism of hypercalcemia Clinical features Laboratory findings Imaging & diagnostic modalities
PTH Calcium Phosphate Other findings
Hyperparathyroidism Primary hyperparathyroidism Increase in secretion of parathyroid hormone (PTH) from a primary process in parathyroid gland. Parathyroid hormone causes increase in serum calcium.
  • Usually asymptomatic
  • Hypercalcemia detected on routine biochemical panel
↓/Normal Normal/↑ calcitriol Findings of bone resorption:

Preoperative localization of hyperfunctioning parathyroid gland:

Predicting post-operative success:

Secondary hyperparathyroidism Increase in secretion of parathyroid hormone (PTH) from a secondary process. Parathyroid hormone causes increase in serum calcium after long periods. ↓/Normal --
Tertiary hyperparathyroidism Continuous elevation of parathyroid hormone (PTH) even after successful treatment of the secondary cause of elevated parathyroid hormone. Parathyroid hormone causes increase in serum calcium. --
Familial hypocalciuric hypercalcemia This is a genetic disorder caused my mutation in calcium-sensing receptor gene.
  • A benign condition
  • Does not require treatment
Normal/↑ Normal/↑ -- --
  • Urinary calcium/creatinine clearance ratio
Malignancy[3] Humoral hypercalcemia of malignancy[4][5][6] Tumor cells secretes parathyroid hormone-related protein (PTHrP) which has similar action as parathyroid hormone. -- ↓/Normal PTHrP

Normal/↑ calcitriol

Osteolytic tumors Multiple myeloma produces osteolysis of bones causing hypercalcemia. Osteolytic metasteses can cause bone resorption causing hypercalcemia. -- --
Production of calcitirol Some tumors has ectopic activity of 1-alpha-hydroxylase leading to increased production of calcitriol. Calcitriol is active form of vitamin D and causes hypercalcemia. -- -- Calcitriol
Ectopic parathyroid hormone[7] Some tumors leads to ectopic production of parathyroid hormone. ↓/Normal Normal/↑ calcitriol
Medication induced Lithium[8] Lithium lowers urinary calcium and causes hypercalcemia. Lithium has been reported to cause an increase in parathyroid hormone and enlargement if parathyroid gland after weeks to months of therapy. -- --
Thiazide diuretics Thiazide diuretics lowers urinary calcium excretion and causes hypercalcemia. -- -- -- --
Nutritional Milk-alkali syndrome Hypercalcemia is be caused by high intake of calcium carbonate. -- -- --
Vitamin D toxicity Excess vitamin D causes increased absorption of calcium from intestine causing hypercalcemia. -- -- Vitamin D (calcidiol and/or calcitriol) --
Granulomatous disease Sarcoidosis[11] Hypercalcemia is causes by endogeous production of calcitriol by disease-activated macrophages. -- -- Calcitriol

ACE levels

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. Mirrakhimov AE (2015). "Hypercalcemia of Malignancy: An Update on Pathogenesis and Management". N Am J Med Sci. 7 (11): 483–93. PMC 4683803Freely accessible. PMID 26713296. doi:10.4103/1947-2714.170600. 
  4. Ratcliffe WA, Hutchesson AC, Bundred NJ, Ratcliffe JG (1992). "Role of assays for parathyroid-hormone-related protein in investigation of hypercalcaemia". Lancet. 339 (8786): 164–7. PMID 1346019. doi:10.1016/0140-6736(92)90220-W. 
  5. Ikeda K, Ohno H, Hane M, Yokoi H, Okada M, Honma T, Yamada A, Tatsumi Y, Tanaka T, Saitoh T (1994). "Development of a sensitive two-site immunoradiometric assay for parathyroid hormone-related peptide: evidence for elevated levels in plasma from patients with adult T-cell leukemia/lymphoma and B-cell lymphoma". J. Clin. Endocrinol. Metab. 79 (5): 1322–7. PMID 7962324. doi:10.1210/jcem.79.5.7962324. 
  6. Horwitz MJ, Tedesco MB, Sereika SM, Hollis BW, Garcia-Ocaña A, Stewart AF (2003). "Direct comparison of sustained infusion of human parathyroid hormone-related protein-(1-36) [hPTHrP-(1-36)] versus hPTH-(1-34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers". J. Clin. Endocrinol. Metab. 88 (4): 1603–9. PMID 12679445. doi:10.1210/jc.2002-020773. 
  7. VanHouten JN, Yu N, Rimm D, Dotto J, Arnold A, Wysolmerski JJ, Udelsman R (2006). "Hypercalcemia of malignancy due to ectopic transactivation of the parathyroid hormone gene". J. Clin. Endocrinol. Metab. 91 (2): 580–3. PMID 16263810. doi:10.1210/jc.2005-2095. 
  8. Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S (1989). "Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume". J. Clin. Endocrinol. Metab. 68 (3): 654–60. PMID 2918061. doi:10.1210/jcem-68-3-654. 
  9. Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, Fuleihan GE, Seely EW (1992). "Hypervitaminosis D associated with drinking milk". N. Engl. J. Med. 326 (18): 1173–7. PMID 1313547. doi:10.1056/NEJM199204303261801. 
  10. Hoeck HC, Laurberg G, Laurberg P (1994). "Hypercalcaemic crisis after excessive topical use of a vitamin D derivative". J. Intern. Med. 235 (3): 281–2. PMID 8120527. 
  11. Dusso AS, Kamimura S, Gallieni M, Zhong M, Negrea L, Shapiro S, Slatopolsky E (1997). "gamma-Interferon-induced resistance to 1,25-(OH)2 D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses". J. Clin. Endocrinol. Metab. 82 (7): 2222–32. PMID 9215298. doi:10.1210/jcem.82.7.4074. 

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