New bone-like tissue formation in calcific tendinopathy: A case report

Area of Science:

• Orthopedics
• Nephrology
• Pathology

Background:

• Nontraumatic heterotopic ossification (HO) pathogenesis is poorly understood, particularly in patients undergoing hemodialysis.
• This case involves a 75-year-old woman on hemodialysis presenting with forearm pain and swelling.

Observation:

• Radiographs revealed radiopaque material in the right wrist and shoulder.
• Biopsy confirmed heterotopic ossification with marrow and calcified material.
• Histomorphometry showed severe osteitis fibrosa and a predominance of woven bone-like tissue.

Findings:

• Elevated intact parathyroid hormone levels (203 pg/mL) were noted, but iliac crest bone biopsy showed normal structure.
• Frequent, continuous shredding of cabbage using the right hand was identified as a potential contributing factor.
• The localized HO on the dorsal aspect of the right wrist correlated with the repetitive occupational task.

Implications:

• Suggests repetitive mechanical stress from occupational activities can induce nontraumatic HO.
• Highlights the importance of considering occupational history in diagnosing and managing HO in dialysis patients.
• Further research is needed to elucidate the mechanisms linking mechanical stress, secondary hyperparathyroidism, and HO development.