melphalan and Bone-Diseases--Metabolic

Fibrogenesis imperfecta ossium (FIO) is an extremely uncommon fatal bone disorder of poorly understood etiology. The pathogenesis of FIO is not well known. The fundamental skeletal defect appears to be an abnormality in organic matrix of bone characterized by defective mineralization of the abnormal collagen. FIO clinically manifests in middle-aged adults presenting with fracture and bone pain. Elevated serum alkaline phosphatase is the only and the most consistent biochemical abnormality. Although paraproteinemia is observed in one-third of cases, the pathogenic link to the disease process is unclear. Limited information on FIO and its close resemblance to many metabolic bone disorders leads to delayed or missed diagnoses and management. Prednisolone, bisphosphonates, melphalan and steroids have been tried previously with variable success. Recently, a trial of recombinant growth hormone therapy was found to be effective. Further research focused on the pathogenetic mechanisms of FIO is needed to identify and develop targeted therapeutic options.

Topics: Alkaline Phosphatase; Biopsy; Bone and Bones; Bone Diseases, Metabolic; Collagen; Diphosphonates; Disease Progression; Fractures, Bone; Humans; Melphalan; Mutation; Osteogenesis Imperfecta; Paraproteinemias; Prednisolone; Prognosis; Radionuclide Imaging; Steroids

Topics: Amyloidosis; Bone Diseases, Metabolic; Bone Marrow; Colchicine; Drug Therapy, Combination; Female; Humans; Liver Diseases; Melphalan; Middle Aged; Prednisone; Remission Induction