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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 6: A 60 year-old man fell and broke his hip.
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1. Question
Week 243: Case 6
A 60 year-old man fell and broke his hip. There is a history of hypercalcemia and radiographs of his phalanges showed sub-periosteal resorption along the shafts of his phalanges. A bone was examined from the fractured femoral head.images/oct 24 2005 case 6 1.jpg
images/oct 24 2005 case 6 2.jpg
images/oct 24 2005 case 6 3.jpgCorrect
Answer: Hyperparathyroidism
Histology: The histologic section shows a bone with a very classic tunneling resorption. Teams of osteoclasts are eroding into the bone causing a tunnel, which diminishes the thickness of the bone. This histologic feature is consistent with osteoclasts activation secondary to increased levels of parathyroid hormone.
Discussion: The diagnosis is not simple osteoporosis. Osteoporosis is a clinical entity. Although hyperparathyroidism can cause osteoporosis, the histologic changes of tunneling resorption in this case point to a very specific cause.
The diagnosis is not Paget’s disease. Although early Paget’s disease is characterized by intense osteoclastic resorption, the characteristic giant osteoclasts of Paget’s disease are absent. In addition, even in the early stages of Paget’s disease, there is an evident increase in osteoblastic activity that is not present in this case.
Incorrect
Answer: Hyperparathyroidism
Histology: The histologic section shows a bone with a very classic tunneling resorption. Teams of osteoclasts are eroding into the bone causing a tunnel, which diminishes the thickness of the bone. This histologic feature is consistent with osteoclasts activation secondary to increased levels of parathyroid hormone.
Discussion: The diagnosis is not simple osteoporosis. Osteoporosis is a clinical entity. Although hyperparathyroidism can cause osteoporosis, the histologic changes of tunneling resorption in this case point to a very specific cause.
The diagnosis is not Paget’s disease. Although early Paget’s disease is characterized by intense osteoclastic resorption, the characteristic giant osteoclasts of Paget’s disease are absent. In addition, even in the early stages of Paget’s disease, there is an evident increase in osteoblastic activity that is not present in this case.
