Osteitis fibrosa cystica

Osteitis fibrosa cystica, also known as Von Recklinghausen's disease of bone, is characterized by increased osteoclastic resorption of calcified bone with replacement by fibrous tissue. It may be caused by primary hyperparathyroidism or other causes of the rapid mobilization of mineral salts.

The bone problems associated with the disorder osteitis fibrosa are usually reversible with surgery, except in the case of fluid filled cysts, which require non-surgical attention.

Symptoms
Osteitis fibrosa cystica can lead to bone pain or tenderness, pathological fractures in the arms, legs, or spine, and deformities (bowing of the bones). Being a precursor to the disorder, hyperparathyroidism itself may cause kidney stones, nausea, constipation, fatigue and weakness. Blood tests show a high level of serum calcium and alkaline phosphatase, and low serum phosphorus. X-rays may indicate thin bones, fractures, bowing, and cysts. The cysts may be lined by osteoclasts, filled with fibrous stroma and sometimes blood ("brown tumors"). The skull may look like "ground glass" or "salt and pepper." The outer part of bones may be eroded; the most sensitive area to check is the fingers. Teeth X-rays may also be abnormal.

Treatment
The main treatment for hyperparathyroidism is surgery to remove the abnormal parathyroid gland(s). Newer techniques use radioactive tracers and rapid parathyroid hormone blood tests to make the surgery quicker and easier. If surgery is not possible, drugs can sometimes be used to lower calcium levels.

Osteítis fibrosa