Bone impairment in oxalosis: An ultrastructural bone analysis
Justine Bacchetta1, Delphine Farlay2, Kariman Abelin-Genevois3
1Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Bron, France; INSERM, UMR 1033, Lyon, France; Université de Lyon, Lyon France.
Systemic oxalosis causes calcium oxalate crystal deposition in bone, leading to fractures and pain. Bone analysis reveals crystals in marrow, not bone matrix, with increased bone hardness but unchanged mineralization.
Area of Science:
- Nephrology
- Orthopedics
- Pathology
Background:
- Systemic oxalosis is characterized by calcium oxalate crystal deposition in kidneys and bone.
- Bone involvement in oxalosis can lead to fractures, deformities, pain, and distinct radiographic findings (oxalate osteopathy).
Purpose of the Study:
- To investigate the characteristics of calcium oxalate deposition and its impact on bone quality in patients with oxalosis.
Main Methods:
- Iliac crest bone biopsies from 8 patients with oxalosis.
- Analysis using microradiography, microindentation, Fourier Transform InfraRed Microspectroscopy, transmission electron microscopy, and histomorphometry.
Main Results:
- Calcium oxalate deposits (whewellite) were found in bone marrow, surrounded by macrophages and giant cells, with some phagocytic activity.
- Deposits were not observed within the bone matrix, and bone mineralization remained unaffected.
- Bone quality analysis indicated increased bone hardness, potentially due to reduced carbonate content, suggesting increased bone fragility.
Conclusions:
- Calcium oxalate crystal formation in bone marrow appears independent of apatite and does not alter bone mineralization.
- Increased bone hardness may contribute to the brittle nature of bones in oxalosis patients.
- Further research is needed to elucidate the mechanisms of oxalate crystal nucleation and growth in bone.
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