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药物性骨硬化症。

Drug-induced osteopetrosis.

机构信息

Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children-St Louis, St. Louis, MO 63110, USA.

Pediatric Radiology Section, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.

出版信息

Bone. 2023 Aug;173:116788. doi: 10.1016/j.bone.2023.116788. Epub 2023 May 10.

Abstract

Osteopetrosis (OPT) denotes the consequences from failure of osteoclasts to resorb bone and chondroclasts to remove calcified physeal cartilage throughout growth. Resulting impairment of skeletal modeling, remodeling, and growth compromises widening of medullary spaces, formation of the skull, and expansion of cranial foramina. Thus, myelophthisic anemia, raised intracranial pressure, and cranial nerve palsies complicate OPT when severe. Osteopetrotic bones fracture due to misshaping, failure of remodeling to weave the collagenous matrix of cortical osteons and trabeculae, persistence of mineralized growth plate cartilage, "hardening" of hydroxyapatite crystals, and delayed healing of skeletal microcracks. Teeth may fail to erupt. Now it is widely appreciated that OPT is caused by germline loss-of-function mutation(s) usually of genes involved in osteoclast function, but especially rarely of genes necessary for osteoclast formation. Additionally, however, in 2003 we published a case report demonstrating that prolonged excessive dosing during childhood of the antiresorptive aminobisphosphonate pamidronate can sufficiently block osteoclast and chondroclast activity to recapitulate the skeletal features of OPT. Herein, we include further evidence of drug-induced OPT by illustrating osteopetrotic skeletal changes from repeated administration of high doses of the aminobisphosphonate zoledronic acid (zoledronate) given to children with osteogenesis imperfecta.

摘要

骨硬化症(OPT)表示破骨细胞无法吸收骨骼和软骨细胞无法去除生长过程中钙化的骺软骨的后果。骨骼建模、重塑和生长受损会导致骨髓腔变宽、颅骨形成和颅腔扩大。因此,当 OPT 严重时,骨髓增生性贫血、颅内压升高和颅神经麻痹会使 OPT 复杂化。由于重塑未能编织皮质骨小柱和小梁的胶原基质、矿化生长板软骨的持续存在、羟磷灰石晶体的“硬化”以及骨骼微裂纹的延迟愈合,骨硬化症的骨骼会发生骨折。牙齿可能无法萌出。现在人们普遍认识到,OPT 是由种系失活功能突变(通常是参与破骨细胞功能的基因)引起的,但很少是由于形成破骨细胞所必需的基因引起的。然而,此外,我们在 2003 年发表了一篇病例报告,表明儿童时期长期过量使用抗吸收的氨基双膦酸盐帕米膦酸可以充分阻断破骨细胞和软骨细胞的活性,从而再现 OPT 的骨骼特征。在此,我们通过说明重复给予高剂量氨基双膦酸盐唑来膦酸(唑来膦酸盐)治疗成骨不全症儿童的骨硬化性骨骼变化,提供了药物诱导 OPT 的进一步证据。

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