Mario Andrés Quintana Duque

Osteonecrosis and Antiphospholipid Syndrome

Osteonecrosis (ON), or avascular necrosis of bone, has been related to decreased blood flow to the bone. Many local and systemic factors have been implicated in the pathogenesis of ON, involving corticosteroid therapy, systemic lupus erythematosus (SLE), hemoglobinopathies, alcohol abuse, Caisson disease, Gaucher disease, and hypercoagulability states. We describe the case of a previously healthy young male with no history of corticosteroid therapy, who developed ON initially on the femoral head, and later on the humeral head with high levels of anticardiolipin antibodies (aCL), beta-2-glycoprotein 1 antibodies and positive lupus anticoagulant. The association between primary antiphospholipid syndrome (PAPS) and ON is controversial and few cases without other risk factors have been described. A review of ON pathogenesis and its relation with thrombotic microangiopathy because of PAPS is presented.

Enfermedades osteocondensantes con compromiso de huesos largos: presentación de dos casos y revisión de la literatura*

Summary Sclerosing bone disorders are a rare group of diseases characterized by increased bone mass in both long and flat bones. Traditionally, plain radiography has allowed the diagnosis of these diseases identifying characteristic patterns of bone involvement. At present, the molecular and genetic characterization of these diseases has provided a better understand of their pathophysiology and phenotypic expression, however plain radiography continues to have an important role in the recognition of sclerosing bone disorders.

Osteomalacia inducida por tumor

Resumen La osteomalacia inducida por tumor es un sindrome paraneoplasico secundario en la mayoria de los casos a tumores de origen mesenquimal. Se caracteriza por perdida aumentada de fosfato a nivel urinario por el efecto inhibidor que ejerce el factor de crecimiento fibroblastico 23 sobre el transporte de fosforo en el tubulo renal proximal. Debe sospecharse en un paciente con debilidad y dolor osteomuscular generalizado que se presente con hipofosfatemia, normocalcemia, fosfatasa alcalina elevada y niveles de 25 hidroxivitamina D y PTH normales. El tratamiento definitivo de la enfermedad es la reseccion quirurgica del tumor. Cuando se desconozca la neoplasia primaria o no sea posible el tratamiento quirurgico debe iniciarse reposicion de fosforo y calcitriol. En este articulo se presenta el primer caso de una paciente con osteomalacia inducida por tumor asociada a un carcinoma lobulillar infiltrante de seno.