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Transient painful osteolysis -- a metabolic study

R F Jacox, C Waterhouse, D R Taves

    The Journal of Rheumatology
    |March 1, 1982
    PubMed
    Summary
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    Severe knee pain in a 45-year-old woman was linked to increased urinary calcium, hydroxyproline, and fluoride excretion. This suggests a potential role for circulating hydroxyapatite microcrystals in fluoride-induced renal clearance changes.

    Area of Science:

    • Nephrology
    • Metabolic Bone Disease
    • Rheumatology

    Background:

    • Subchondral osteolysis of femoral condyles can cause severe joint pain.
    • Metabolic investigations are crucial for diagnosing underlying bone conditions.

    Observation:

    • A 45-year-old woman presented with severe bilateral knee pain.
    • Elevated urinary calcium, hydroxyproline, and fluoride excretion were noted.
    • Increased erythrocyte sedimentation rate and peripheral eosinophilia were present.

    Findings:

    • Fluoride renal clearance was reduced during peak fluoride excretion.
    • Renal clearance values increased as fluoride excretion diminished.
    • These fluctuations suggest a dynamic process affecting kidney function.

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    Implications:

    • Circulating microcrystals of hydroxyapatite are hypothesized to explain altered renal clearance.
    • This case highlights a potential mechanism for fluoride-related bone and kidney issues.
    • Further research into hydroxyapatite crystal involvement in metabolic bone diseases is warranted.