Osteopetrosis And Related Disorders

Osteopetrosis, also known as marble bone disease, is a descriptive term that refers to a group of rare, heritable disorders of the skeleton characterized by increased bone density on radiographs.

Epidemiology

The overall prevalence and incidence of these conditions is difficult to estimate but autosomal recessive malignant osteopetrosis (ARO; see this term) has an incidence of 1/ 250,000 births, and autosomal dominant osteopetrosis (ADO or Albers-Schönberg osteopetrosis; see this term) has an incidence of 1 in 20,000 births.

Clinical description

Osteopetrotic conditions vary greatly in their presentation and severity, ranging from neonatal onset with life-threatening complications such as bone marrow failure (e.g. classic or ''malignant'' ARO; see this term), to the incidental finding of osteopetrosis on radiographs (e.g. osteopoikilosis; see this term). Classic ARO is characterized by fractures, short stature, compressive neuropathies, hypocalcemia with attendant tetanic seizures, and life-threatening pancytopenia. The presence of primary neurodegeneration, intellectual deficit, skin and immune system involvement, or renal tubular acidosis may point to rarer osteopetrosis variants, whereas onset of primarily skeletal manifestations such as fractures and osteomyelitis in late childhood or adolescence is typical of ADO.

Etiology

Osteopetrosis is caused by failure of osteoclast development or function, and mutations in at least ten genes have been identified as causative in humans, accounting for 70% of all cases.

Diagnostic methods

Diagnosis is largely based on clinical and radiographic evaluation and should be confirmed by gene testing where applicable. Once the diagnosis of a primary osteopetrotic condition is made, it is important to distinguish between different subtypes. Correct diagnosis is essential for predicting and understanding the natural history of the disease, providing specific treatments where available, and offering adapted counseling regarding recurrence risks and prenatal diagnosis for severe forms.

Differential diagnosis

Alternative diagnoses include fluorosis; beryllium, lead and bismuth poisoning; myelofibrosis; Paget's disease (sclerosing form); and malignancies (lymphoma, osteoblastic cancer metastases) (see these terms).

Antenatal diagnosis

Antenatal diagnosis is possible if the mutations causing the condition in the family are known.

Genetic counseling

These conditions can be inherited as autosomal recessive, dominant or X-linked traits with the most severe forms being autosomal recessive.

Management and treatment

Treatment of osteopetrotic conditions is largely symptomatic, although hematopoietic stem cell transplantation is employed for the most severe forms associated with bone marrow failure, and currently offers the best chance of longer-term survival for patients in this group.

Prognosis

The severe infantile forms of osteopetrosis are associated with diminished life expectancy, with most untreated children dying in the first decade as a consequence of bone marrow suppression. Life expectancy in the adult-onset forms is normal.