Pathological Fractures

Disseminated disease can cause neurologic deficits from CNS metastases, bone pain or pathologic fractures secondary to bone metastases, or liver dysfunction from hepatic involvement. 

Bisphosphonates such as pamidronate and zoledronic acid may prevent skeletal morbidity, such as pathologic fractures and spinal code compression, when used for hormone-refractory prostate cancer in patients with clinically significant bone loss. Usual dosages are pamidronate, 90 mg every month, and zoledronic acid, 4 mg every 3 to 4 weeks. 

Arthralgias, including skeletal changes such as hyperostoses, tendinous calcifications, premature epiphysial closure, and pathological fractures. 

Muscle weakness, steroid myopathy, loss of muscle mass, severe arthralgia, vertebral compression fractures, aseptic necrosis of humeral and femoral heads, pathologic fracture of long bones, osteoporosis... 

There was kyphosis of the thoracic spine from T7 to T9, with pathological fractures. An MRI scan showed massive epidural fat extending from T1 to T9. She recovered 3 months after surgical removal of the epidural fat. 

Pathological fractures of several bones, and destructive lesions seen radiologically in other bones, have been reported in patients who had received repeated intravenous injections of polyvidone for many years (28,29). Biopsies of the fracture sites showed both intracellular deposits of polyvidone and mucoid changes in the affected cells. If of sufficient severity, this may cause a virtual melt down of osseous tissue. 

Kepes JJ, Chen WY, Jim YF. Mucoid dissolution of bones and multiple pathologic fractures in a patient with past history of intravenous administration of polyvinylpyrrolidone (PVP). A case report. Bone Miner 1993 22(1) 33-41. 

The major population at risk for aluminum loading and toxicity consists of individuals with renal failure. In a study by Alfrey (1980), 82% of nondialyzed uremic patients and 100% of dialyzed uremic patients had an increased body burden of aluminum. The decreased renal function and loss of the ability to excrete aluminum, ingestion of aluminum compounds to lessen gastrointestinal absorption of phosphate, the aluminum present in the water used for dialysate, and the possible increase in gastrointestinal absorption of aluminum in uremic patients can result in elevated aluminum body burdens. The increased body burdens in uremic patients has been associated with dialysis encephalopathy (also referred to as dialysis dementia), skeletal toxicity (osteomalacia, bone pain, pathological fractures, and proximal myopathy), and hematopoietic toxicity (microcytic, hypochromic anemia). Pre-term infants may also be particularly sensitive to the toxicity of aluminum due to reduced renal capacity (Tsou et al. 1991)... 

After persistent hypercalciuria, osteopenia can develop, causing metabolic bone disease, pathological fractures, and immobilization. Hypercalciuria can also lead to nephrolithiasis and nephrocalcinosis, factors that can impair renal function. Intravenous chlorothiazide has been successfully used for its hypocalciuric effect, with remarkable effect over a period of 6 months in a 13-year-old child who had received parenteral nutrition for 6 years. Calcium excretion and tubular reabsorption of phosphate returned to normal (48). What is not clear from this study is whether the drug actually has a positive long-term beneficial effect on metabolic bone disease. 

Bone pain and/or pathologic fractures Liver dysfunction Neurologic deficits Spinal cord compression... 

Most commonly, patients with advanced disease present with back pain and stiffness due to osseous metastases. Eventually, spinal cord lesions may lead to cord compression if not treated properly. Rarely, pathologic fractures can occur. Lower extremity edema can occur as a result of lymphatic obstruction. Anemia and weight loss are nonspecific signs of advanced disease. 

Taylor GN, Christensen WR, Jee WSS, et al. 1966. Intercomparison of pathological fractures in beagles injected with 226Ra, 228Ra, 239Pu or 90Sr. Health Phys 12 361-367. 

As a result of decreased bone density, a cKent with osteoporosis is at risk for pathological fractures. If the client does not experience these types of fractures, it indicates that the medication therapy is effective. 

Charcot neuroarthropathy (CN) is a progressive condition that affects the bones and joints of the foot. It is characterised by joint dislocation, subluxation and pathological fractures of the foot in neuropathic patients resulting in debihtating deformity [42]. The incidence of CN is reported to be around 0.1-0.5. Although diabetes is the most common cause in the Western World CN can occur in other diseases associated with peripheral neuropathy. There is no sex predilection and it can occur at any age but is more commonly seen in the fourth or fifth decades of fife and in patients with a long duration of diabetes [42]. 

---