Osteitis Fibrosa Cystica defined by Medcinenet is “a condition that is associated with excessive parathyroid production (hyperparathyroidism), in which bone tissue becomes soft and deformed. ” Several articles will be reviewed in order to form an in-depth understanding of the disease and specific cases studied. Osteitis Fibrosa Cystica(OFC), has existed centuries before it was first discovered in 1931 by a scientist who goes by the name Denninger (“The History of the Parathyroid Glands” 80).
Denninger’s studies conducted in Illinois, North America showed that certain bones had specific signs of wear and tear, common in Osteitis Fibrosa Cystica, which at that time did not have a name, and led him to the conclusion that OFC has existed for longer than originally believed (“The History of the Parathyroid Glands” 80). Throughout this essay, we will go over causes, symptoms, diagnosis, treatments, and other information pertaining to OFC. Types of Osteitis Fibrosa Cystica Osteitis Fibrosa Cystica has three forms in which it presents itself.
The first of the three forms is primary hyperparathyroidism. Hyperparathyroidism is a condition in which one or more parathyroid glands produce an excessive amount of parathyroid hormone or PTH (“Hyperparathyroidism”). This overproduction of PTH leads to the deformation and, sometimes, destruction of the affected bones in the human body. Primary hyperparathyroidism is the most common of the three forms of OFC (“Hyperparathyroidism”). The second type is secondary hyperparathyroidism; this is similar to above, with the exception of the difference in cause.
Secondary hyperparathyroidism is caused by low calcium levels due to kidney, liver, or bowel disease (“Hyperparathyroidism”). This second form of OFC is more severe than the primary form and is the rarest (“A Rare Form of Hyperparathyroidism”). Finally, the last form of OFC is called tertiary hyperparathyroidism, like the first two forms of Osteitis Fibrosa Cystica, it affects the bones in a very similar fashion, but to a much more severe degree. The effects of tertiary hyperparathyroidism become apparent after prolonged secondary hyperparathyroidism (“Hyperparathyroidism”).
The factor that differentiates tertiary hyperparathyroidism is that this form acts independently secreting PTH and is caused by chronic kidney disease (CKD) as secondary hyperparathyroidism is not (“Hyperparathyroidism”). Symptoms of Osteitis Fibrosa Cystica Along with the side effects of hyperparathyroidism, including primary, secondary, and tertiary, there are many symptoms of OFC. The most painful and evident of the symptoms are bone and stress fractures which causes tenderness of the bone(s) and pain to the patient (“Osteitis Fibrosa”).
Bone fractures are also the most common symptom seen in this disease (“Osteitis Fibrosa”). Skeletal deformities accompany the fractures; bowing of bones is also common. Nausea, vomiting, constipation, fatigue, and weakness are also found in patient with this disease (“Hyperparathyroidism”). Some other symptoms include weight loss, appetite loss, polyuria and polydipsia (“Hyperparathyroidism”). Diagnosis of Osteitis Fibrosa Cystica There are numerous methods used to diagnose OFC and to distinguish what form of the disease a patient has.
For most cases of OFC, diagnostic tests include checking blood calcium levels to see if the levels are normal. If blood calcium levels are abnormal, these tests will determine whether or not a patient has hypercalcemia (“Imaging in Primary Hyperparathyroidism”). If test results show to be positive, then medical professionals can factually diagnose the patient with one of the three forms of OFC and start treatment or therapy as soon as possible. Another diagnostic test most commonly used is simply taking x-rays on the suspected bone(s) to view the fractures and deformities and determine the severity of OFC (“Hyperparathyroidism”).
Quantitative computerized tomography is another way to test if a patient suffers from Osteitis Fibrosa Cystica (“Imaging in Primary Hyperparathyroidism”). This test is primarily done to see if a patient has osteoporosis (“Imaging in Primary Hyperparathyroidism”). In some cases, patients are able to self-diagnose themselves; many times muscles will appear bulked up or swollen, and muscle contraction and relaxation can be sluggish. These are telltale signs that a patient should be concerned and get a checkup.
Aside from muscle abnormalities, there can be intense and unusual bone pain that is also a telling sign of OFC and easy to notice. Treatments of Osteitis Fibrosa Cystica Because the disease can vary from patient to patient, there are many ways to treat OFC, the type of treatment a patient receives depends on the severity and type of hyperparathyroidism the patient has along with the other symptoms. For the primitive type of hyperparathyroidism, because it is the mildest form of OFC, medications to increase bone mass and regulate calcium levels are most commonly prescribed (“Hyperparathyroidism”).
Rest or refraining of use of the affected bone and surrounding muscles is also highly suggested and practiced to allow bones time to regain strength. Raloxifene is most commonly prescribed to postmenopausal women who are affected by OFC (“Hyperparathyroidism”). Bisphosphonates are prescribed for bone mass and cinacalcet is used for serum levels and PTH levels (“Hyperparathyroidism”). For the secondary type of hyperparathyroidism, the same medications may be prescribed to alleviate the same symptoms; dosage may be altered due to the difference in severity.
Due to the Chronic Kidney Disease that is part of this second form of OFC, phosphate restriction or phosphate binders are also prescribed along with calcium supplements (“Hyperparathyroidism”). Vitamin D treatment is also available for secondary hyperparathyroidism (“Hyperparathyroidism”). Treatment for the final form of OFC, tertiary hyperparathyroidism, is parathyroidectomy that is the removal of the parathyroid gland (“Hyperparathyroidism”). This procedure is done in order to stop the overproduction of the cells that breakdown and destroy the bones.
If necessary, although very rare, autotransplantation of parathyroid tissue is another method of treatment that can be done in order to allow the body to rebuild bones (“Hyperparathyroidism”). Case Study #1 One of the most interesting case studies was a patient who suffered from oral pains due to the deterioration of the bones. This went unnoticed until the patient noticed several chips on teeth and pains in certain parts of the chewing process. The issue was quickly resolved with proper follow-ups and a finalized prognosis of the disease.
The patient was suffering from a form of hyperparathyroidism. In the case study, it was unclear what form of hyperparathyroidism the patient had; it was leaning toward primary hyperparathyroidism, but there were some signs secondary hyperparathyroidism. Essentially, the doctor went over some ways to approach this disease, but the best treatment was to perform a surgical removal of the affected parathyroid glands. From the case study report, the recovery from the disease was amazing. The diagnosis was made possible due to the oral complaints the patient was having.
This case also showed that oral professionals played a vital role in the success of the patient. Without the help of the oral professionals, this case would have been unsuccessful. Case Study #2 On the second case study, a patient was seen with an increase of calcium in urine, as well as phosphorus concentrations. One interesting element in the case study was the parathyroid response to electrical shock. What was documented was that due to the overproduction of PTH, resuscitation is nearly impossible.
Basically, “PTH impairs cardiovascular response to resuscitation” (Jeffries, Ledgerwood, and Lucas). Since this form of hyperparathyroidism was affecting the cardiovascular system, the prognosis was said to be tertiary hyperparathyroidism. The treatments for this was therapy, as in, “watchful waiting for the PTH secretion to decrease” (Jeffries, Ledgerwood, and Lucas). Once it decreased the only way to approach this disease was to perform a parathyroidectomy. As seen with most cases of hyperparathyroidism, parathyroidectomy proved to be successful.
Parathyroidectomy is the most reasonable, full recovery treatment. Conclusion In conclusion, hyperparathyroidism is virtually impossible to attain; the most probable cases of hyperparathyroidism happen in people over the age of 40. Age seems to be the only factor in such a disease. Up until now, the procedures in order to eradicate this disease have proven to be successful. Most cases of hyperparathyroidism result in a parathyroidectomy. This procedure has a significant success rate, in most cases, but depending on the severity of the disease it can prove to be fatal.
