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  • Osteitis deformans

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  • 731.0 Osteitis deformans without mention of bone tumor

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  • M88.9 Osteitis deformans of unspecified bone

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Description

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  • Osteometabolic bone disease
  • Excessive reabsorption of bone by osteoclasts, followed by vascular and fibrous tissue filling in the bone marrow
  • Weakening of the bones
  • Slow progressive enlargement of the bones
  • Accelerated bone remodeling

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Essentials of Diagnosis

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General Considerations

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  • Can be asymptomatic
  • Managed with surgery or medicine
  • Pathologic fractures
  • Can cause paraplegia or stenosis
  • Paget’s disease of the nipple
    • Chronic rash on the nipple

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Demographics

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  • More common with elderly, aging population
  • Individuals with absorption issues in the intestines
  • Men > women
  • Anglo-Saxon descent

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Signs and Symptoms

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  • Bone growth
  • Bone pain
  • Bone deformity
  • Enlarged head
  • Hearing loss
  • Headaches
  • Joint pain
  • Tingling
  • Muscle weakness
  • Nerve compression
  • Joint stiffness
  • Genu varus
  • Neck pain
  • Pathologic fractures
  • Osteoarthritis
  • Heart failure
  • Bone cancer

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Functional Implications

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  • Delayed fracture union
  • Hearing problems
  • Gait dysfunction

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Possible Contributing Causes

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  • Age (>/= 50 years)
  • Gender (female>male)
  • No specific cause
  • Several genes maybe related
  • Hereditary
  • Insufficient calcium and vitamin D

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Differential Diagnoses

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  • Trauma
  • Pathologic fracture from neoplasm
  • Osteogenesis imperfecta
  • Inadequate mineralization of existing bone matrix (osteoid) or poor bone quality
  • Osteoporosis
  • Infections, such as tuberculosis
  • Fibrous dysplasia
  • Peripheral neuropathy
  • Repetitive stress fractures
  • Multiple myeloma, lymphoma, or metastatic cancer
  • Leukemia
  • Renal osteodystrophy
  • Hormone deficiency (estrogen in women; androgen in men)
  • Cushing’s syndrome or glucocorticoid administration
  • Hyperthyroidism
  • Hyperparathyroidism
  • History of drug abuse or misuse (alcohol, tobacco)
  • Excessive vitamin D and A
  • Juvenile osteoporosis occurs in children or young adults of both genders with normal gonadal function; onset typically occurs around age 8 to 14 years and hallmarks include rapid onset of bone pain and/or fracture secondary to trauma
  • Type I (Postmenopausal osteoporosis) typically occurs in women 50 to 65 years of age and is characterized by accelerated bone loss (trabecular bone)
  • Type II (Age-associated or senile osteoporosis) presents in women and men older than 70 years of age as a result of bone loss associated with the aging process; fractures occur in both cortical and trabecular bone

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Laboratory Tests

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  • Serum calcium
  • Alkaline phosphatase (ALP)
  • Blood calcium levels
  • 24-hour urine calcium measurement
  • Thyroid function test
  • Parathyroid hormone levels
  • Testosterone level (men)
  • 25-hydroxyvitamin D test
  • Biochemical markers
  • Urine test

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