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The clinical features, investigation, treatment and outcome of two adults with fibrogenesis imperfecta ossium are described. In this rare acquired disorder of bone, normal lamellar collagen is replaced by structurally unsound collagen-deficient tissue, which leads to extreme bone fragility and ununited fractures. Transmission microscopy and SEM showed striking ultrastructural changes in bone structure and mineralisation. Both patients had monoclonal IgG paraproteins in the plasma and one excreted monoclonal lambda light chains in the urine. No abnormal plasma cells were found in the bone marrow and there was no evidence of amyloid deposition in the tissues. In both patients initial treatment with 1 alpha-hydroxycholecalciferol appeared to be ineffective, but in one, repeated courses of melphalan and corticosteroids over three years together with 1 alpha-hydroxycholecalciferol produced striking clinical and histological improvement. The findings in these and other patients strongly suggest that paraproteinaemia is an integral feature of fibrogenesis imperfecta ossium, and this needs further investigation.

Type

Journal article

Journal

The Journal of bone and joint surgery. British volume

Publication Date

09/1995

Volume

77

Pages

820 - 829

Addresses

Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford, UK.

Keywords

Bone and Bones, Tendons, Humans, Bone Diseases, Paraproteinemias, Collagen Diseases, Melphalan, Hydroxycholecalciferols, Collagen, Adrenal Cortex Hormones, Microscopy, Electron, Adult, Aged, Middle Aged, Child, Female, Male, Fractures, Bone