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Dear Colleagues
I am seeking advise or direction to support a patient of mine whom been labelled with Periostitis ossificans. I have been referred a 60 years old gentleman for Bisophosphonate Rx, who presented to his GP complaining of agony and discomfort of the left thigh, x-ray (attached) and CT Finding both revealed a perisoteal thickening of the left mid-shaft femur, site was biopsied and was compatible with osteosclorsis (X-ray referred to London for advise at the Orthopaedic centre and it was reported as Periostitis Ossificans and they recommended bisphosphonate), unfortunately no much in the literature in terms of evidence and management other than steroids and anti-inflammatory. Bone turnover markers came back very normal CTx (Resorption) and P1NP (Formation) I was very reluctant to commence on bisphosphonate in view of the very normal bone markers, however, taking into consideration the advise for expert centre London and patient desperation and willingness to take anything to alleviate the discomfort, I went ahead with 5mg IV Zolendronic acid, markers results below pre and post infusion, the patient remain with the same discomfort and agony and now 4 months post infusion, he have been rejected by the orthopaedic surgeon for shaving the bone. He is willing to travel anywhere in or outside the UK for advise/management and he doesn't mind research to alleviate his symptom.
CRP 3.7 mg/l, ESR 7 mm/hr. Hb, WBC were all satisfactory, organ profiles were very normal, no evidence of soft tissue inflammation and no Hx of Trauma. PSA very normal. ALP 64 iu/l. Advise would be greatly appreciated.
Date\ CTX
281013 0.21
160514 0.12
020115 0.06
Date P1NP
281013 30
160514 33
020115 12
Kind Regards
ALi
Dr Ali Al-bahrani MBCh.B MSc.Chem Path. EuClin.chem. CSci. FRCPath.
Lead Pathologist
RCPath Wessex Professionalism Lead
Consultant Chemical Pathologist and HOD of Chemical Pathology
St Mary's Hospital
Newport
Isle of Wight
PO30 5TG
United Kingdom
Te: 01983 534859/534917
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