Aguilera S, Cortés C, Martínez V
Departamento de Radiología, Hospital J J Aguirre, Santiago de Chile.
Rev Med Chil. 1994 Sep;122(9):1045-51.
We report two cases of regional migratory osteoporosis. One is a 41 years old male, with the classical form, presenting with successive episodes of painful osteoporosis lasting for 5 months at the hip, knee and distal epiphysis of the right metatarsophalangeal joints. The second case is a 40 years old female presenting with an unusual disseminated form, lasting for 30 months, with successive and simultaneous episodes of polyarticular and costal painful osteoporosis. An increased bone fraction of serum alkaline phosphatases and urine hydroxyproline/creatinine and calcium/creatinine ratios were detected. Imaging showed localized periarticular or costal osteoporosis. Bone biopsies disclosed a severe osteopenia with accelerated bone reabsorption. Bone scintigraphy precociously detected location, migration and evolution of lesions. Patients were treated with subcutaneous calcitonin, 100 U/day during 1 month and on alternative days posteriorly; this treatment alleviated pain but did not prevent the appearance of new crisis. Our observations suggest that regional migratory osteoporosis presentation may range from oligoarticular to disseminated forms and that calcitonin has a precocious and persistent analgesic effect.
我们报告两例局限性游走性骨质疏松症。一例为41岁男性,表现为典型形式,先后出现髋部、膝部及右跖趾关节远端骨骺疼痛性骨质疏松发作,持续5个月。第二例为40岁女性,表现为不寻常的播散形式,持续30个月,先后并同时出现多关节和肋骨疼痛性骨质疏松发作。检测到血清碱性磷酸酶、尿羟脯氨酸/肌酐及钙/肌酐比值的骨成分增加。影像学显示局部关节周围或肋骨骨质疏松。骨活检显示严重骨质减少伴骨吸收加速。骨闪烁显像能早期检测到病变的部位、游走及进展情况。患者接受皮下降钙素治疗,第1个月每天100 U,之后隔日一次;该治疗缓解了疼痛,但未能预防新的发作。我们的观察结果表明,局限性游走性骨质疏松症的表现形式可从少关节型到播散型不等,且降钙素具有早期和持续的镇痛作用。