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Hypertrophic osteodystrophy
Synonym(s): Hypertrophic osteopathy, Marie's disease, hypertrophic pulmonary osteoarthropathy, HPOA, HO
Introduction
- Cause: unknown etiology. Has been associated with a variety of diseases; usually associated with primary intrathoracic disease; no articular involvement.
- Signs: bilaterally symmetrical proliferation of connective tissue and subperiosteal bone along the diaphyses of the lower limb bones.
- Diagnosis: radiography.
- Treatment: primary cause and symptomatic therapy.
- Prognosis: guarded to poor.
Presenting signs
- Bilaterally symmetrical edema and bony swellings of the metacarpal and metatarsal bones, which may or may not be painful.
- Weight loss.
- Lethargy.
- Depression.
- Reduced flexion or resentment to flexion of affected areas.
- Synovial distension.
- Pyrexia.
- Ventral edema.
- Tachypnea or dyspnea.
- Cough.
- Involvement of other bones, eg radius, carpus, phalanges, tibia, tarsal, skull, mandible, maxilla and nasal bones.
Age predisposition
- ~6 years.
Breed/Species predisposition
- Larger breeds.
- Donkeys.
Special risks
- Usually due to primary problem.
Pathogenesis
Etiology
- Unknown.
- Theories include:
- Hormonal disturbances.
- Hypoxia.
- Arteriovenous shunts and neural mechanisms via afferent sympathetics.
- The disorder is usually associated with intrathoracic disease, especially primary or metastatic neoplasia Respiratory: neoplasia .
- Intrathoracic abscess, ovarian granulosa cell tumor Ovary: neoplasia - granulosa / theca cell with metastasis and a dysgerminoma Ovary: neoplasia - overview with metastasis, for example, have been described too.
Predisposing factors
General- Intrathoracic disease: neoplasia Respiratory: neoplasia , tuberculosis, granulomatous inflammatory lesions, pneumonia Lung: pneumonia - bacterial or abscess, pleural inflammation, mediastinal disease Pneumothorax , pulmonary infarction.
- Pregnancy.
Specific
- Increased intact PTH concentration Endocrine: parathyroid hormone assay could not be demonstrated in association with equine hypertrophic osteodystrophy.
- The exact pathophysiology is unknown.
Pathophysiology
- Proposed mechanisms include hypoxia, hormonal dysfunction, pulmonary vascular shunting, and neural mechanisms via afferent parasympathetic pathways.
- Increased blood flow -> fluid retention -> vascular tissue and periosteal proliferation -> new bone formation.
Timecourse
- Progressive.
- The onset of the disorder varies from one week to seven months
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Packer M & McKane S (2012) Granulosa thecal cell tumour in a mare causing hypertrophic osteopathy. Equine Vet Educ 24 (7), 351-356 VetMedResource.
- Lewis N L et al (2011) Resolution of hypertrophic osteopathy in a 2-year-old filly. Equine Vet Educ 23 (5), 217-223 VetMedResource.
- Enright K, Tobin E & Katz L M (2011) A review of 14 cases of hypertrophic osteopathy (Marie's disease) in horses in the Republic of Ireland. Equine Vet Educ 23 (5), 224-230 VetMedResource.
- Schleining J A & Voss E D (2004) Hypertrophic osteopathy secondary to gastric squamous cell carcinoma. Equine Vet Educ 16 (6), 304-307 VetMedResource.
- Mair T S & Tucker R L (2004) Hypertrophic osteopathy (Marie's disease) in horses. Equine Vet Educ 16 (6), 308-311 VetMedResource.
- Van der Kolk J H, Geelen S N J, Jonker F H, Pycock J F & Koeman J P (1998) Hypertrophic osteopathy associated with ovarian carcinoma in a mare. Vet Rec 143, 172-173 PubMed.
- Leach M W & Pool R R (1997) Hypertrophic osteopathy in a Shetland pony attributable to pulmonary squamous cell carcinoma metastases. Equine Vet J 24, 247-249 PubMed.
- Mair T S, Dyson S J, Fraser J A et al (1996) Hypertrophic osteopathy (Marie's disease) in Equidae - a review of twenty-four cases. Equine Vet J 28, 256-262 PubMed.
- Lavoie J P, Carlson G P & George L (1992) Hypertrophic osteopathy in three horses and a pony. JAVMA 201, 1900-1904 PubMed.
- Chaffin M K, Ruoff W W, Schmitz D G et al (1990) Regression of hypertrophic osteopathy in a filly following successful management of an intrathoracic abscess. Equine Vet J 22 (1), 62-65 PubMed.
- Sweeney C R, Stebbins K E, Schelling C G, Beech J & Schilling D A (1989) Hypertrophic osteopathy in a pony with a pituitary adenoma. JAVMA 195, 103-105 VetMedResource.