Osteitis Fibrosa Cystica

• • End-stage skeletal manifestation of severe hyperparathyroidism

  • Rarely seen now in industrialized societies

  • Consists of bone cysts, osteoporosis, and brown tumors (result of excessive osteoclastic bone resorption)

Epidemiology

• • Historically, 15% of hyperparathyroid patients presented with bone disease

Symptoms and Signs

• • Pain

  • Pathologic fractures

  • Paraplegia (secondary to vertebral collapse)

Laboratory Findings

• • Elevated serum calcium

  • Elevated intact parathyroid hormone level

Imaging Findings

• • Bone radiographs demonstrate osteoporosis, fractures, cysts

  • Subperiosteal resorption of the radial aspect of the index and long fingers

  • Increased uptake on bone scan

Rule Out

• • Parathyroid carcinoma

• • Bone scan

• • Only effective treatment is the localization and excision of all abnormal parathyroid tissue

Surgery

Indications

• • All patients with osteitis fibrosa cystica should have parathyroidectomy

Medications

• • Calcium and vitamin D supplementation postoperatively to aid in bone remineralization

Treatment Monitoring

• • Monitor serum calcium and intact parathyroid hormone level

Prognosis

• • Reversal of bone loss is common after parathyroidectomy, but recovery of bone mass to normal is rare

References