Dear Ali,
The patient has a periosteal sclerotic reaction of the mid femur of unknown aetiology that is still causing him pain and discomfort so I would suggest referral to an orthopaedic surgeon to deal with its diagnosis and management as it is not a metabolic bone disease so outside our area of expertise.
Best regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath
Consultant Chemical Pathologist
--------------------------------------------
On Fri, 16/1/15, Al-Bahrani Ali <[log in to unmask]> wrote:
Subject: Periostitis Ossificans
To: [log in to unmask]
Date: Friday, 16 January, 2015, 12:54
Periostitis Ossificans
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
<<LEG_20150116_121515.jpeg>>
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