A Factor Determining the Location of Pseudofractures in Osteomalacia

May, Marcus; Blunt, John W.

doi:10.1172/jci102099

Cited by 43 publications

(10 citation statements)

References 7 publications

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“…6 Lemay and Blunt suggested that Looser's zones were caused by continuous pulsation beating against a softened cortex. 10 Steinbach et al claimed to confirm this theory by arteriography, showing some of the pseudofractures to be in proximity to an abnormal obturatory artery in one case. 11 Jackson et al criticized this theory and concluded that the zones were not in close connection with pulsating blood vessels.…”

Section: Discussionmentioning

confidence: 90%

The importance of cone beam CT in the radiological detection of osteomalacia

Çakur¹,

Sümbüllü²,

Dağistan³

et al. 2012

Dentomaxillofacial Radiology

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Although osteomalacia is one of the most common osteometabolic diseases among the elderly, there is no case in the literature that presents the effects of osteomalacia in detail using cone beam CT (CBCT). While thin and porous bones are the most common radiographic sign of the disease, the radiological hallmarks are pseudofractures (Looser's zone). We coincidentally detected osteomalacia in a 23-year-old female and we showed the pseudofracture on CBCT images. In the present case, we aim to present the images of osteomalacia that were detected by CBCT in detail. CBCT has an important value in screening for osteomalacia.

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Section: Discussionmentioning

confidence: 90%

The importance of cone beam CT in the radiological detection of osteomalacia

Çakur¹,

Sümbüllü²,

Dağistan³

et al. 2012

Dentomaxillofacial Radiology

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“…The lamina dura may be especially thin in individuals with long-standing or severe osteomalacia. The teeth are not altered in this condition in as much as they are fully developed before the onset of osteomalacia[ 49 50 51 ] [ Figure 4 ].…”

Section: R Adiological M Anifestations Omentioning

confidence: 99%

Vitamin D deficiency in adolescents

Soliman¹,

Sanctis²,

Elalaily³

et al. 2014

Indian J Endocr Metab

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The prevalence of severe vitamin D deficiency (VDD) in adolescents is variable but considerably high in many countries, especially in Middle-east and Southeast Asia. Different factors attribute to this deficiency including lack of sunlight exposure due to cultural dress codes and veiling or due to pigmented skin, and less time spent outdoors, because of hot weather, and lower vitamin D intake. A potent adaptation process significantly modifies the clinical presentation and therefore clinical presentations may be subtle and go unnoticed, thus making true prevalence studies difficult. Adolescents with severe VDD may present with vague manifestations including pain in weight-bearing joints, back, thighs and/or calves, difficulty in walking and/or climbing stairs, or running and muscle cramps. Adaptation includes increased parathormone (PTH) and deceased insulin-like growth factor-I (IGF-I) secretion. PTH enhances the tubular reabsorption of Ca and stimulates the kidneys to produce 1, 25-(OH) 2D3 that increases intestinal calcium absorption and dissolves the mineralized collagen matrix in bone, causing osteopenia and osteoporosis to provide enough Ca to prevent hypocalcaemia. Decreased insulin like growth factor-I (IGF-I) delays bone growth to economize calcium consumption. Radiological changes are not uncommon and include osteoporosis/osteopenia affecting long bones as well as vertebrae and ribs, bone cysts, decalcification of the metaphysis of the long bones and pseudo fractures. In severe cases pathological fractures and deformities may occur. Vitamin D treatment of adolescents with VDD differs considerably in different studies and proved to be effective in treating all clinical, biochemical, and radiological manifestations. Different treatment regiments for VDD have been discussed and presented in this mini-review for practical use. Adequate vitamin D replacement after treating VDD, improving calcium intake (milk and dairy products), encouraging adequate exposure to the sun and possible enrichment of the stable food with vitamin D in areas with high prevalence of VDD are important measures to prevent the harmful consequences of VDD.

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“…Stresses exerted on such defectively mineralized bone result in little, linear fractures [49,39]. Clinical literature suggests two causative mechanisms for these defects; one concerning the pressure or pulsations of arteries on weakened bone tissue [35,61,39], and the second invoking a fracture response in weakened bone to muscle and soft tissue forces during normal motion [39,1,22,8]. The deficiency of the mineral matrix in osteomalacia can explain the localization of many of Looser's zones.…”

Section: Introductionmentioning

confidence: 99%

“…The concept that they start as easy fractures in bones which are pathologically weakened is acceptable, and their symmetry may be explained by the fact that many of the habitual stresses such as walking or breathing are likely to affect both sides of the body similarly. Pseudofractures may ultimately result in a full fracture [35]. In paleopathology, this type of fracture is a key means for suggesting the diagnosis of osteomalacia [12,28].…”

Section: Introductionmentioning

confidence: 99%

A case of osteomalacia in human skeletal remains from St Hripsime Church (Horom, Armenia)

Khudaverdyan¹,

Yengibaryan²,

Hovhanesyan³

et al. 2020

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In this study, we investigated the remains of an individual that were recovered during cleansing work of the Church of St Hripsime. Macroscopic and X-Ray inspections yielded pathological criteria which indicated osteomalacic origin. The findings of the study suggest that the individual who lived in the Late Medieval period may have gone through multiple episodes of vitamin D deficiency. Vitamin D deficiency as an effect of deficient exposure to sunlight (in particular, in rural individuals who lived in underground houses) and nourishment deficiency could be described as the main causes leading to osteomalacia in Armenia.

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A Factor Determining the Location of Pseudofractures in Osteomalacia

Cited by 43 publications

References 7 publications

The importance of cone beam CT in the radiological detection of osteomalacia

The importance of cone beam CT in the radiological detection of osteomalacia

Vitamin D deficiency in adolescents

A case of osteomalacia in human skeletal remains from St Hripsime Church (Horom, Armenia)

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