Combination of osteogenesis imperfecta and hypophosphatasia in three children with multiple fractures, low bone mass and severe osteomalacia, a challenge for therapeutic management

被引:3
作者
Fratzl-Zelman, Nadja [1 ,2 ,3 ,8 ]
Linglart, Agnes [4 ]
Bin, Kim [5 ]
Rauch, Frank [6 ]
Blouin, Stephane [1 ,2 ,3 ]
Coutant, Regis [4 ,7 ]
Donzeau, Aurelie [7 ]
机构
[1] Ludwig Boltzmann Inst, Osteol Hanusch Hosp OEGK, Vienna, Austria
[2] 1st Med Dept Hanusch Hosp, AUVA Trauma Ctr Meidling, Vienna, Austria
[3] Vienna Bone & Growth Ctr, Vienna, Austria
[4] Paris Saclay Univ, AP HP, Reference Ctr Rare Dis Calcium & Phosphate Metab,P, EndoERN & BOND ERN Ctr,Endocrinol & Diabet Childre, Paris, France
[5] Pediat Orthoped Surg Angers Univ Hosp, Angers, France
[6] Shriners Hosp Children, Montreal, PQ, Canada
[7] Angers Univ Hosp, Competence Ctr Rare Dis Calcium & Phosphate Metab, Dept Pediat Endocrinol & Diabetol, Angers, France
[8] Ludwig Boltzmann Inst Osteol AUVA Trauma Ctr Meid, Kundrat str 37, A-1120 Vienna, Austria
关键词
Rare bone disorders; Therapy; Bone biopsy samples; Bone histomorphometry; Mineralization; Quantitative backscattered electron; microscopy; MINERALIZATION DENSITY DISTRIBUTION; MESENCHYMAL STEM-CELLS; BISPHOSPHONATE THERAPY; MARROW FIBROSIS; YOUNG-CHILDREN; NORMATIVE DATA; HISTOMORPHOMETRY; INFANTILE; MUTATIONS; DIAGNOSIS;
D O I
10.1016/j.ejmg.2023.104856
中图分类号
Q3 [遗传学];
学科分类号
071007 ; 090102 ;
摘要
Osteogenesis imperfecta (OI) and hypophosphatasia (HPP) are rare skeletal disorders caused by mutations in the genes encoding collagen type I (COL1A, COL1A2) and tissue-non-specific isoenzyme of alkaline phosphatase (ALPL), respectively. Both conditions result in skeletal deformities and bone fragility although bone tissue abnormalities differ considerably. Children with OI have low bone mass and hypermineralized matrix, whereas HPP children develop rickets and osteomalacia.We report a family, father and three children, affected with growth retardation, low bone mass and recurrent fractures. None of them had rickets, blue sclera or dentinogenesis imperfecta. ALP serum levels were low and genetics revealed in the four probands heterozygous pathogenic mutations in COL1A2 c.838G > A (p.Gly280Ser) and in ALPL c.1333T > C (p.Ser445Pro). After multidisciplinary meeting, a diagnostic transiliac bone biopsy was indicated for each sibling for therapeutic decision.Bone histology and histomorphometry, as compared to reference values of children with OI type I as well as, to a control pediatric patient harboring the same COL1A2 mutation, revealed similarly decreased trabecular bone volume, increased osteocyte lacunae, but additionally severe osteomalacia. Quantitative backscattered electron imaging demonstrated that bone matrix mineralization was not as decreased as expected for osteomalacia.In summary, we observed within each biopsy samples classical features of OI and classical features of HPP. The apparent nearly normal bone mineralization density distribution results presumably from divergent effects of OI and HPP on matrix mineralization. A combination therapy was initiated with ALP enzyme-replacement and one month later with bisphosphonates. The ongoing treatment led to improved skeletal growth, increased BMD and markedly reduced fracture incidence.
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页数:14
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