Amyloid Lesions of Bone

Pathologic Fractures Associated with Idiopathic Amyloidosis of Bone in Chronic Hemodialysis Patients

“…Amyloid bone involvement of four types has been described: (l)lytic or cystic areas, particularly near large joints; (2)diffuse bone marrow involvement with vertebral compression fractures; (3)expansile bone le sions, particularly of the ribs, and (4)avascular necrosis associated with amyloid involvement of nutrient arteries [7], Bony amyloid lesions have almost exclusively been seen in patients with primary amyloidosis or plasma cell dyscrasias [13]. Kyle and Greipp' s [5] review of 229 patients with AL amyloidosis showed that 80% of their patients had normal skeletal radiographs.…”

“…Current amyloid classification schemes rely on the type of protein deposited [1], The deposits are relatively resis tant to proteolysis, and their accumulation results in organ dysfunction. Amyloid bone lesions are a rare mani festation of systemic amyloidosis in the absence of overt myeloma [2][3][4][5][6][7]. Osseous amyloid is often associated with amyloid infiltration of joint spaces in patients with plasma cell dyscrasias.…”

Hemodialysis-associated amyloidosis of bone of beta-2 microglobulin origin

“…Congo red affinity and birefringence were remarkably decreased by pretreatment of the sections with potassium should be considered in any patient with nephrotic syndrome. Weinfeld et al [18] reported on amyloid lesions of bone and stated that bone lesions in amyloidosis presented in two different forms: amyloid deposited in and around joints, and amyloid within the marrow spaces. The second form may cause localized areas of bone destruction, as in their case; a third, the rarest form with "localized destructive lesions", has been described.…”

“…The second form may cause localized areas of bone destruction, as in their case; a third, the rarest form with "localized destructive lesions", has been described. Destructive arthropathies have been observed in some patients treated by maintenance hemodialysis for very long periods of time [2,11,18]. Regarding amyloidosis in patients undergoing hemodialysis, Bardin et al [1] reported on two patients with destructive arthropathies which required surgical replacement of the hip and concluded that amyloidosis appeared to be a prominent cause of bone cystic radiolucencies in dialysis patients.…”

“…We reconfirmed that cystic bone lesions associated with long-term hemodialysis are a manifestation of amyloidosis of beta-2 microglobulin origin. On the other hand, Weinfeld et al [18] also mentioned that in amyloidosis the joint space is not narrowed, as it is in rheumatoid arthritis, and may even be widened, and the bone erosions in amyloidosis are para-articular, sparing articular bone. Bywaters and Dorling [6] examined 20 patients with hyperparathyroidism, 14 of whom had bony erosions.…”