Osteopoikilosis, also called osteopathy, disseminated condensed or stained bones, is a bone change that usually does not presents symptoms and, therefore, is commonly diagnosed accidentally, through radiographs related to other pathologies. It occurs mainly in patients aged between 15 and 30 years and is a little more frequent in males - probably because, statistically, they undergo more X-rays. Most of the time the lesions appear in childhood, persisting until the end of life, but there are some cases of reduction and even complete disappearance of these spots.
In a review of 210,000 radiographs from the Vienna Hospital, only 12 cases were observed, generating an approximate ratio of 1:50,000. Thus, because the disease is quite rare and, in most cases, it is accidentally diagnosed, information about it is relatively scarce.
It is known, however, that in this pathology, first reported in 1905, there is an alteration in bone maturation which, seen under a microscope, reflects compaction of compact bone in the cancellous region. On radiographs, they appear as thick, rounded or oval dots, with dimensions ranging from one to ten millimeters in diameter. Lesions are, most of the time, symmetrical and present in the bony ends. Of these, those on the hands and feet are more vulnerable and more frequent. However, ribs, vertebrae, collarbone, jaw, pelvis, skull and scapula may also be affected, to a lesser degree.
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It is believed that the disease has family and hereditary influences, since there are many reports in the literature of patients from the same family, in several generations, being carriers. Furthermore, there is an argument that osteopoikilosis is more present in regions where the frequency of consanguineous marriages is higher. In these cases, the lesions follow similar distribution patterns among family members.
In most cases, no treatment is necessary, as the disease is asymptomatic for most patients (joint pain is present in 15% to 20% of cases). However, regular visits to the specialist ensure better follow-up in order to monitor its benignity and verify the appearance or not of associated diseases – if they occur, drugs will be prescribed (usually non-steroidal anti-inflammatory drugs).
Oteosarcoma, chondrosarcoma, giant cell tumors, rheumatoid arthritis, scleroderma, diabetes mellitus, palmoplantar keratosis, tumor development of giant cells, osteosarcomas and short stature were described as present in some patients, but the definitive association between the pathologies is not confirmed. In approximately 10% of cases, there are skin lesions, forming the Buschke-Ollendorff syndrome, with an increase in elastic fibers and, sometimes, in collagen.
Despite this significant list, it is worth remembering that these cases of disease evolution are rare and it is mainly because of them that medical guidance and follow-up are necessary.
By Mariana Araguaia
Graduated in Biology