Bones and Joints in Diabetes Mellitus

Transcription

1 Bones and Joints in Diabetes Mellitus

2 Series in Radiology Volume 4

3 Bones and Joints in Diabetes Mellitus by S. Forgacs Semmelweis University Medical School Budapest : ~. : 1982 Martinus Nijhoff Publishers The Hague / Boston / London

4 Distributors: for the United States and Canada Kluwer Boston, Inc. 160 Old Derby Street Hingham, MA USA for all other countries Kluwer Academic Publishers Group Distribution Center P.O. Box AH Dordrecht The Netherlands for Hungary, Albania, Bulgaria, China, Cuba, Czechoslovakia, German Democratic Republic, Democratic People's Republic of Korea, Mongolia, Poland, Roumania, Soviet Union, Vietnam, and Yugoslavia KULTURA Hungarian Foreign Trading Company H-1389 Budapest P.O.B. 149 Library of Congress Cataloging in Publication Data Forgacs, S. Bones and joints in diabetes mellitus. (Series in radiology; v. 4) Based on the author's thesis. Includes bibliographies and index. 1. Bones - Diseases. 2. Joints - Diseases. 3. Diabetes - Complications and sequelae. I. Title. II. Selies. (DNLM: 1. Bone and bones-radiography. 2. Joints-Radiography. 3. Bone diseases-etiology. 4. Joint diseases-etiology. 5. Diabetes mellitus-complications. WK835 F721b) RC930.F ISBN-13: e-isbn-13: DOl: / Joint edition published by MARTlNUS NIJHOFF PUBLISHERS P.O.B. 566, 2501 CN The Hague, The Netherlands and AKADEMIAI KIAD6 P.O.B. 24, H-1363, Budapest, Hungary Copyright Akademiai Kiad6, Budapest, 1982 All rights reserved. No part of this publication may be.eproduced, stored in a rettieval system, or transmitted in any form or by any mean" mecha. ical, photocopying, recording or otherwise, without the prior wlitten permission of the publisher, Martinus Nijhoff Publishers bv, P.O. flox 566, 2501 en The Hague. The Netherlands.

5 To Katalin

6 Contents Introduction Chapter 1 Pathophysiology of the diabetic bone (by Dr. Katalin Laszlo) Disorders of cell population dynamics The role of inorganic ions and hormones Summary Chapter 2 Osteoporosis and diabetes mellitus The author's data Evaluation of the author's data Summary Chapter 3 Hyperostosis and diabetes mellitus Hyperostosis of the spine Cranial hyperostosis Other manifestations of hyperostosis Relationship between hyperostosis and metabolism Pathogenesis of hyperostosis Summary Chapter 4 Diabetic osteoarthropathy 73 The occurrence of diabetic osteoarthropathy 73 Specific features of diabetic osteoarthropathy 75 Changes in the soft tissues and clinical findings in diabetic osteoarthropathy 82 Localization of diabetic osteoarthropathy 93 7

7 The stages and radiological symptoms of diabetic osteoarthropathy 93 Histological findings in diabetic osteoarthropathy 125 Rare localizations of diabetic osteoarthropathy 132 Differential diagnosis 139 Pathogenesis of diabetic osteoarthropathy 147 Prognosis of diabetic osteoarthropathy 150 Treatment and prevention of diabetic osteoarthropathy 151 Summary Chapter 5 Metabolic joint diseases and diabetes mellitus 165 Gout and diabetes mellitus 165 Chondrocalcinosis and diabetes mellitus Chapter 6 Congenital and hereditary bone disorders and diabetes mellitus 170 Fetal skeletal abnormality 170 Osteogenesis imperfecta and diabetes mellitus 170 Achondroplasia 171 Osteopoikilosis Chapter 7 Growth and bone development in diabetic children Chapter 8 Periarthritis of the shoulder and diabetes mellitus Chapter 9 The connection between other disorders of the skeletal system and diabetes mellitus 175 Rheumatoid arthritis 175 Paget's disease 175 Hyperparathyroidism 175 Osteomyelitis 176 Periodontal changes 176 Miscellaneous

8 Chapter 10 Bone changes in lipoatrophic diabetes Chapter 11 Bone fractures and diabetes mellitus Selected bibliography Subject Index

9 Introduction Complex disorders of the carbohydrate metabolism and associated complications cause many abnormalities detectable by radiography in the bones and joints. Mild clinical symptoms associated with very severe radiological changes were first recognized in relation to the gastroenterologic complications of diabetes. This phenomenon is more frequent in the skeletal system. For example, mild and painless swelling of the foot joints may often mask extremely severe bone destruction. Several other bone changes associated with diabetes are only detectable by radiography. Thus, the radiologist plays an important role in confirming these diabetic complications, furthermore he is involved in the therapeutic management of the patient. Although many details on this subject have been published, however no summarizing monograph has yet appeared. Manuals discussing diabetes include only short reviews on complications of the osseous system. The fact that the incidence of diabetes is very high, at present 1 %-2 % of the population is affected and their number is gradually increasing - displays the timeliness of this subject. Fifty years of experience with insulin therapy indicates that several important problems still remain to be solved. Insulin and modern oral antidiabetic drugs proved extremely efficient in the management of hyperglycemia and ketosis, but the incidence of other complications has not decreased. Moreover, as the number of diabetics and their life expectancy increase, late complications become likewise more frequent. Diabetic osteoarthropathy is one of these complications. Bone changes associated with diabetes may affect the whole skeletal system or may cause localized defects. Osteoporosis and hyperostosis belong to the former group, diabetic osteoarthropathy to the latter, and these will be discussed in detail in this volume. Besides the aforementioned changes, all other bone defects related to diabetes, according to the literature and to our observations, will also be included. This monograph is based on the examination of a large number of patients. Most of them were treated at Janos Hospital, Budapest (approximately 2000 beds), and at the Diabetic Outpatients Centre, which regularly follows up over 1000 diabetics. All the roentgenological examinations and diabetic control of these patients have been carried out by the author The studies were completed at the Semmelweis University Medical School. The help of all those who have contributed to this monograph is gratefully acknowledged. The remarks and advice of Professor I. Magyar and Professor F. Horvath, who revised my manuscript with great care and attention, were particularly useful. 11

10 Dr. Zsuzsa Csat6 and Professor J. Forrai made valuable remarks and suggestions about my Ph.D. Thesis, which served as a basis for this volume. Dr. J. Juhasz (Janos Hospital, Department of Orthopedics) was kind enough to undertake the histological examinations and to allow the use of the documentation on several patients, while Dr. Antonia Rosinger helped in the assay of osteoporosis. The majority of patients examined were outpatients at the Diabetic Clinic, led by Dr. T. Halmos, head physician, to whom I am also indebted. Dr. Katalin Laszlo (Semmelweis University Medical School, Institute of Physiology) has written the chapter "Pathophysiology of the diabetic bone." The photographic work was done by F. Ruzs-Molnar. Finally, I should like to express my gratitude to the team of Akademiai Kiad6 for their conscientious work. 12