Osteitis fibrosa is a complication of hyperparathyroidism in which the bones turn soft and become deformed.
Osteitis fibrosa cystica
Causes, incidence, and risk factors
The parathyroid glands are four glands in the neck that help control calcium use and removal by the body. They do this by producing parathyroid hormone, or PTH. PTH helps control calcium, phosphorus, and vitamin D levels within the blood and bone.
Too much parathyroid hormone (hyperparathyroidism) can lead to increased bone break down, which can cause bones to turn soft.
Rarely, parathyroid cancer may cause osteitis fibrosa.
Before 1950, about half of people diagnosed with hyperparathyroidism had osteitis fibrosa. Now it is uncommon, because patients with hyperparathyroidism are diagnosed earlier, before bone softening has occurred.
People with severe hyperparathyroidism have a higher risk for developing osteitis fibrosa.
Osteitis fibrosa may cause bone pain or tenderness. There may be fractures (breaks) in the arms, legs, or spine, or other bone problems.
Hyperparathyroidism may cause kidney stones, kidney problems, nausea, constipation, fatigue, and weakness.
Signs and tests
Blood tests show a high level of calcium, parathyroid hormone, and alkaline phosphatase (a bone chemical). Phosphorus may be low.
A bone x-ray may be done. People with hyperparathyroidism are more likely to have osteopenia (thin bones) or osteoporosis (very thin bones) than to have full-blown osteitis fibrosa.
Most of the bone problems of osteitis fibrosa are usually reversible with surgery.
Most patients with hyperparathyroidism have no symptoms, and many can be followed with blood tests and bone measurements. Others may need surgery to remove the abnormal parathyroid gland(s).
If surgery is not possible, drugs can sometimes be used to lower calcium levels.
The complications of osteitis fibrosa include bone fractures, pain, and deformities. There may be other problems due to hyperparathyroidism such as kidney stones and kidney failure.
Calling your health care provider
Call your health care provider if you have bone pain, tenderness, or symptoms of hyperparathyroidism.
Today, routine blood tests performed during a medical check up or for another health problem usually detect high calcium levels before severe damage is done.
Wysolmerski JJ. Insogna KL. The Parathyroid Glands, Hypercalcemia, and Hypocalcemia. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 266.
Bringhurst FR, Demay MB, Kronenberg HM. Disorders of Mineral Metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 27.
Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.