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Osteitis fibrosa
Definition
Osteitis fibrosa is a complication of hyperparathyroidism in which the bones turn soft and become deformed.
Alternative Names
Osteitis fibrosa cystica
Causes
The parathyroid glands are four glands in the neck that help control calcium use and removal by the body. They do this by producing parathyroid hormone, or PTH. PTH helps control calcium, phosphorus, and vitamin D levels within the blood and bone.
Too much parathyroid hormone (hyperparathyroidism) can lead to increased bone break down, which can cause bones to turn soft.
Rarely, parathyroid cancer may cause osteitis fibrosa.
Before 1950, about half of people diagnosed with hyperparathyroidism had osteitis fibrosa. Now it is uncommon, because patients with hyperparathyroidism are diagnosed earlier, before bone softening has occurred.
People with severe hyperparathyroidism have a higher risk for developing osteitis fibrosa.
Symptoms
Osteitis fibrosa may cause bone pain or tenderness. There may be fractures (breaks) in the arms, legs, or spine, or other bone problems.
Hyperparathyroidism may cause nausea, constipation, fatigue, and weakness.
Exams and Tests
Blood tests show a high level of calcium, parathyroid hormone, and alkaline phosphatase (a bone chemical). Phosphorus may be low.
X-rays may show thin bones, fractures, bowing, and cysts. Teeth x-rays may also be abnormal.
A bone x-ray may be done. People with hyperparathyroidism are more likely to have osteopenia (thin bones) or osteoporosis (very thin bones) than to have full-blown osteitis fibrosa.
Treatment
Most of the bone problems from osteitis fibrosa can be reversed with surgery to remove the abnormal parathyroid gland(s). However, some people may choose to not have surgery, and instead be followed with blood tests and bone measurements.
If surgery is not possible, drugs can sometimes be used to lower calcium levels.
Possible Complications
The complications of osteitis fibrosa include:
- Bone fractures
- Deformities
- Pain
- Problems due to hyperparathyroidism, such as kidney stones and kidney failure
When to Contact a Medical Professional
Call your health care provider if you have bone pain, tenderness, or symptoms of hyperparathyroidism.
Prevention
Today, routine blood tests done during a medical check-up or for another health problem usually detect high calcium levels before severe damage is done.
References
Wysolmerski JJ. Insogna KL. The Parathyroid Glands, Hypercalcemia, and Hypocalcemia. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 266.
Bringhurst FR, Demay MB, Kronenberg HM. Disorders of Mineral Metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 27.
Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 253.
Reviewed By: Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
