Presentation
Presents at preschool age (tarda). [orthobullets.com]
Diverticulosis is more likely to present in patients with OI type I, since these patients are more likely to survive to adulthood, due to the milder presentation of the disease. [jscimedcentral.com]
On the contrary, mild forms (type 1) may present with no fractures. [japi.org]
All the patients diagnosed in childhood presented with fractures during this period and 7 of them also presented with new fractures as adults (3 received biphosphonates). The 4 patients diagnosed as adults have had fractures. [reumatologiaclinica.org]
Infants with OI type IV, V and VI, with normal sclerae and normal length, may present only with fracture. [nature.com]
Entire Body System
- Weakness
Characteristics frequently seen in children who have OI include: Short stature Weak tissues, fragile skin, muscle weakness, and loose joints Bleeding, easy bruising and frequent nosebleeds Hearing loss Breathing problems Curvature of the spine Characteristics [specialeducationalneeds.co.uk]
Weakness in tendons and muscles. [hypermobility.org]
Equipment - ranging from simple pillows to specialized wheelchairs, can help children and adults achieve motor and personal care goals even if they have weakness or are recovering from a fracture. 5. [physio-pedia.com]
Type 1 OI is the most common form and individuals with this condition tend to have some broken bones although not as many as other types, muscle weakness, blue/gray tint to the whites of the eyes, and hearing loss. [pedsendo.org]
Alterations in collagen, elastin and proteoglycans, either congenital or acquired, could lead to weakness of the bowel wall thus predisposing to the development of diverticula [6]. [jscimedcentral.com]
- Surgical Procedure
The surgical procedure was performed when the patient began pulling to stand. The goal of the surgical procedure was to improve alignment and stability, reduce the fracture rate, and increase mobility. [journals.lww.com]
Clinical features include: large hypertrophic calluses at the fracture or surgical procedure sites calcification of the interosseous membrane between the radius and ulna restricts forearm rotation and may cause dislocation of the radial head Types VI [radiopaedia.org]
Care of fractures, extensive surgical and dental procedures, and physical therapy are often recommended for people with OI. [checkorphan.org]
Once healing of the nonunion site occurs, the locking plate should be removed; however, Cho et al reported that plate removal was generally delayed until another surgical procedure was performed. [healio.com]
Surgical and dental procedures may be used - a surgical procedure called “rodding” involves inserting metal rods down the length of long bones to provide strength and correct or prevent deformities. [alliedmedtraining.com]
- Asymptomatic
Echocardio-Doppler was used in children with asymptomatic abnormal heart sounds. [journals.lww.com]
In addition, complications can include transient asymptomatic hypocalcemia and symptomatic hypocalcemia. [1][2] Surgical treatment Fractures in OI patients should be treated similarly to children and adults without OI. [eyewiki.aao.org]
EudraCT Number: 2009-016217-23 Sponsor Protocol Number: CA184-095 Start Date*: 2010-10-29 Sponsor Name:Bristol-Myers Squibb International Corporation Full Title: Randomized, Double-Blind, Phase 3 Trial to Compare the Efficacy of Ipilimumab vs Placebo in Asymptomatic [clinicaltrialsregister.eu]
It has been estimated that the incidence of OI is approximately 1:10-20.000 [1-4] and the clinical manifestations can vary from almost asymptomatic forms to very severe cases. [revistadeosteoporosisymetabolismomineral.com]
Asymptomatic hypocalcemia was noted in case 2 even with calcium and vitamin D supplementation (data not shown). Delayed bone healing was reported only after intramedullary rodding procedure, but not after fracture. [raredisorders.imedpub.com]
Gastrointestinal
- Failure to Thrive
Hadju-Cheney syndrome (OMIM 102500 ) is characterized by short stature, failure to thrive, conductive hearing loss, dysmorphic features, early tooth loss, genitourinary anomalies, osteopenia, pathologic fractures, wormian bones, failure of suture ossification [ncbi.nlm.nih.gov]
Cardiovascular
- Hypotension
Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty. J Vasc Interv Radiol. 2001; 12(8):1001–1002. doi:10.1016/S1051-0443(07)61584-X [CrossRef] Abdul-Jalil Y, Bartels J, Alberti O, Becker R. [healio.com]
Musculoskeletal
- Fracture
The average pre-operative fracture rate was 0.87 fractures/year (SD 0.47), and the average post-operative fracture rate was 0.10 fractures/year (SD 0.16) ( Table 2 ). [online.boneandjoint.org.uk]
An x-ray reveals a fractured femur, as well as several healed rib fractures. ...Parents bring their one-year-old daughter to the emergency room. [oif.org]
Total number of fractures experienced by participants defined as the combination validated clinical fractures and vertebral fractures and fractures reported by participants, where imaging was not performed, not feasible or where the results were inconclusive [isrctn.com]
Type II osteogenesis imperfecta is lethal in the perinatal period, owing to severe fractures and deformity. Patients with type III or type IV osteogenesis imperfecta survive fractures in infancy and childhood but have progressive deformity. [nejm.org]
The degree of bone fragility and fracture rate vary widely. Type III is characterised by frequent fractures of the long bones and a markedly short stature. Spine curvatures, compression fractures, Scoliosis and chest deformities occur frequently. [specialeducationalneeds.co.uk]
- Joint Dislocation
He also reported of multiple fractures and frequent joint dislocations secondary to minor trauma. The dental findings were identical to that of the younger sibling, but there was no evidence of delayed eruption (Figure 5). [hindawi.com]
[…] the Osteogenesis Imperfecta Panel and their clinical significance Gene Associated phenotypes Inheritance ClinVar HGMD ALPL Odontohypophosphatasia, Hypophosphatasia perinatal lethal, infantile, juvenile and adult forms AD/AR 78 291 B3GAT3 * Multiple joint [blueprintgenetics.com]
Additional symptoms associated with OI type I include loose (hyper extensible) joints and low muscle tone (hypotonia). This may result in a predisposition to joint dislocations and ligament sprains. Some patients have skin that bruises easily. [rarediseases.org]
- Decrease in Height
In our cohort, we found that children with type I OI have birth lengths within the normal range, but the height percentiles gradually decrease to the subnormal range in childhood with final adult heights ending up slightly below the normal height range [nature.com]
Ears
- Hearing Impairment
impairment Hearing impairment Growth abnormality Short stature Small for gestational age IMPORTANT NOTE: NIH does not independently verify information submitted to the GTR; it relies on submitters to provide information that is accurate and not misleading [ncbi.nlm.nih.gov]
Affiliated tissues include bone and skin, and related phenotypes are hearing impairment and beaded ribs Disease Ontology : 12 An osteogenesis imperfecta that has material basis in contiguous gene deletion on chromosome 11p11. [malacards.org]
In general, four major clinical features characterize osteogenesis imperfecta 5 : osteoporosis with abnormal bone fragility blue sclera dentinogenesis imperfecta hearing impairment Other features include ligamentous laxity and hypermobility of joints, [radiopaedia.org]
Of the patients with normal hearing on audiometry, 17.1% reported subjective hearing loss, and 19.1% of the patients with impaired hearing did not recognize it. [journals.sagepub.com]
She did not have visual and hearing impairment, moreover, limitation of joint movement, and bony deformity were absent. Based on these findings, the patient was diagnosed as OI type I. [raredisorders.imedpub.com]
- Hearing Problem
Problems with children’s teeth (dentinogenesis) are common in OI. Children with OI may tire easier than other children. Hearing problems are known to affect people with OI usually after puberty. [gosh.nhs.uk]
The diversity of the clinical phenotypes of discolored teeth, blueness of the sclera, back and joint pain, cardiovascular disease, Diabetes type II, hearing problems and a long list of orthopedic problems are have to be considered. [journals.lww.com]
None of the patients presented with blue sclerae or hearing problems, and only one girl (F7II1) was noted to have dentinogenesis imperfecta (Figure 3E). [frontiersin.org]
Psychiatrical
- Suggestibility
Suggested Listings for Evaluation: DETERMINATION LISTING REMARKS Meets 110.08 A Catastrophic congenital disorder Equals * Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. [secure.ssa.gov]
Second-harmonic-generation circular dichroism successfully differentiated normal human and OI skin tissues, whereas other SHG polarization schemes did not provide discrimination, suggesting this approach has high sensitivity for studying the difference [osapublishing.org]
A study of several families has suggested that the defect may reside in Type I collagen. [thefetus.net]
These results, in conjunction with previous results obtained on collagens from type II osteogenesis imperfecta tissues, suggest that aberrant fibril formation in this syndrome allows increased lysyl oxidase activity. Images [jci.org]
- Fear
Water is a great place to start getting past the fear of movement. 4. [physio-pedia.com]
After suffering a horrific burnout at the end of 2009, he set a goal to become a virtual ...… Do you ever find that you are held back by your fears or self-limiting beliefs? If so, then today’s episode is for you. [player.fm]
The inexperienced clinicians may (partly through fear of litigation) engage mechanically and defensively with decision support technologies, stifling the development of a more nuanced clinical expertise that embraces accumulated practical experience, [journals.lww.com]
Cleopatra even put an end to her own sister, Arsinoë, because she feared Arsinoë was plotting to take over the throne. Cleopatra had Arsinoë executed on the steps of a temple in Rome. [lilodunrema.linkpc.net]
Workup
Only thorough preoperative workup and prompt management can improve the outcome in these patients. 1. Karabiyik L, Parpucu M,Kurtipek O. [ijaweb.org]
X-Ray
- Nephrolithiasis
[…] craniofacial dysmorphism, and congenital heart defects AR 6 13 B4GALT7 Ehlers-Danlos syndrome, progeroid form AR 8 9 BMP1 Osteogenesis imperfecta AR 7 21 CLCN5 Proteinuria, low molecular weight, with hypercalciuric nephrocalcinosis, Hypophosphatemic rickets,, Nephrolithiasis [blueprintgenetics.com]
Treatment
Those in the second group receive standard care, which may involve no treatment or treatment with bisphosphonates. Participants in both groups are reviewed at 12 months, 24 months and again at the end of study (between 36-60 months). [isrctn.com]
Treatment Currently, there is no known cure for osteogenesis imperfecta. The primary focus of treatment is on preventing injuries and maintaining healthy bones. [verywell.com]
Nonsurgical Treatment In most cases, treatment is nonsurgical. Medication. Medical bisphosphonates, given to the child either by mouth or intravenously, slow down bone resorption. [orthoinfo.aaos.org]
No fractures occurred over the 2 years of denosumab treatment. Her L-BMD and H-BMD respectively improved from 1.07 and 0.945 before treatment to 1.166 (9.0% increase) and 0.994 (5.1% increase) at 2 years of treatment. [jstage.jst.go.jp]
Prognosis
Prognosis is very variable depending on type ranging from being uniformly lethal from type II to a slight reduction in life expectancy for type I. [radiopaedia.org]
The parents opted to interrupt the pregnancy, based on the diagnosis of a lethal skeletal dysplasia and the associated poor prognosis. The fetus was delivered at 25 weeks’ gestation. [sajr.org.za]
Prognosis - Osteogenesis imperfecta- type 3 The prognosis for an individual with OI varies greatly depending on the number and severity of symptoms. [checkorphan.org]
It is clear that the prognosis of Types I and IV is much better than for types II and III. The radiological appearance of the neonate predicts the prognosis in that better bone mineralization and morphology suggest a more favorable outcome. [thefetus.net]
Etiology
Depending on the etiology of the deformity, these children are often cared for by multiple specialists including pediatricians, pediatric orthopaedists or orthopaedic spine surgeons, neurologists, pediatric surgeons, pediatric neurosurgeons, oncologists [books.google.ro]
Etiology OI type IV can be autosomal dominant and caused by mutations in the COL1A1 and COL1A2 genes (17q21.31-q22 and 7q22.1 respectively) or it can be autosomal recessive and caused by mutations of the PPIB gene (15q21-q22) (sometimes described as OI [orpha.net]
Osteogenesis imperfecta type 2 (OI type 2) Osteogenesis imperfecta type 3 Osteogenesis imperfecta type 4 (MIM.166220) Osteogenesis imperfecta with opalescent teeth (MIM.166240) Etiology mutations in COL1s genes mutations in COL1A1 gene (MIM.120150) mutations [humpath.com]
The sequence of diverse pathological events recorded within each family would be almost incomprehensible without a proper etiological understanding of the natural history of each child/family deformity that led to their occurrences. [journals.lww.com]
Epidemiology
Summary Epidemiology The overall prevalence of OI is estimated at between 1/10,000 and 1/20,000 but the prevalence of type IV is unknown. [orpha.net]
Free Abstract An epidemiological and genetical study of osteogenesis imperfecta (OI) in Victoria, Australia confirmed that there are at least four distinct syndromes at present called OI. [jmg.bmj.com]
(b) The genetic epidemiology of OI in Sweden. Flow chart picturing the pediatric cohort (142 individuals), divided by OI and mutation type to illustrate the genetic epidemiology of this disorder in an entire population. [nature.com]
Osteogenesis imperfecta in Sweden: Clinical, genetic, epidemiological and sociomedical aspects [Thesis]. Stockholm, Sweden : Svenska bokförlaget, 1961. Google Scholar 21. Stewart, EJ, O'Reilly, BF. [journals.sagepub.com]
Pathophysiology
Streamline the decision-making process with integrated protocols, classic signs, and ACR guidelines, as well as a design that structures every chapter consistently to include pathophysiology, imaging techniques, imaging findings, differential diagnosis [books.google.ro]
Mutations can also be caused by CRTAP or PH3H1(LEPRE1) in an autosomal recessive pattern. [14] Pathophysiology The pathophysiology of osteogenesis imperfecta is primarily due to a dysfunction in collagen and is classified under connective tissue diseases [eyewiki.aao.org]
However, in the past 10 years discoveries of further (mainly recessive) causative genes have lent support to a predominantly collagen-related pathophysiology [ 1 ]. [patient.info]
The basic pathophysiology for OI is the mutation in the gene coding for type I collagen [3]. The most widely accepted classification was proposed by Sillence et al. in 1979 [4]. [hindawi.com]
Genetic_DisordersOriginal Editors - Barrett Mattingly from Bellarmine University's Pathophysiology of Complex Patient Problems project. [physio-pedia.com]
Prevention
Broken bones in children with osteogenesis imperfecta are often treated with surgery in order to stabilize the bones and prevent deformities. [verywell.com]
This should include: Exercise—swimming is often an ideal and safe activity Good nutrition Not smoking Avoiding excessive amounts of alcohol Prevention OI is caused by a genetic defect. There is no known way to prevent it. [cancercarewny.com]
These are used to prevent deformity and promote support or protection. [chop.edu]
The good news is that many of these injuries may be preventable by following some simple tips and learning how to avoid accidents and injuries. To learn more, read our tips on playground, swimming, boating, lawn mower and fire safety. [shrinershospitalsforchildren.org]
People with OI are encouraged to exercise as much as possible to promote muscle and bone strength, which can help prevent fractures. [checkorphan.org]