Osteogenesis Imperfecta (OI) is a congenital, non-sex-linked, hereditary disorder involving connective tissues.
The hallmark feature of osteogenesis imperfecta is fragile bones that fracture easily. Osteogenesis imperfecta affects both bone quality and quantity (i.e. bone mass) 6.
The estimated incidence is a approximately 1 in every 12,000-15,000 births 2. Osteogenesis imperfecta occurs with equal frequency among males and females and across races and ethnic groups. The life span varies with the type (see osteogenesis imperfecta classification).
The clinical presentation of osteogenesis imperfecta is highly variable, ranging from a mild form with no deformity, normal stature, and few fractures to a form that is lethal during the perinatal period.
A fundamental pathology in osteogenesis imperfecta (OI) is a disturbance in the synthesis of type I collagen, which is the predominant protein of the extracellular matrix of most tissues. In bone, this defect results in osteoporosis, thus increasing the tendency to fracture. Besides bone, type I collagen is also a major constituent of dentin, sclerae, ligaments, blood vessels, and skin 4.
Osteogenesis Imperfecta is the result of a mutation in one of the two genes that carry instructions for making type 1 collagen. Mutations in the COL1A1 and COL1A2 genes are responsible for more than 90 percent of all cases.
Depending on the type, the inheritance of the disorder can be autosomal-dominant, autosomal-dominant with new mutations, or autosomal-recessive 2,6.
The first classification of osteogenesis imperfecta was by Looser, in 1906 who divided the condition into two forms, osteogenesis imperfecta congenita (also known as Vrolik disease) and osteogenesis imperfecta tarda (also known as Ekman-Lobstein disease).
Since then newer classification systems were based on work by Sillence and colleagues in 1979, have taken into account the phenotypic features and the mode of inheritance. This has since been revised and up to eight forms of osteogenesis imperfecta have been identified.
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, short stature, and easy bruising.
Three main types are easily distinguished :
- mild - type I
- perinatal lethal - type II
- progressive deforming - type III
Types IV to VIII are variable in severity and uncommon (see osteogenesis imperfecta classification for further detail).
This is the preferred initial examination.
- head, neck & spine :
- chest :
- pelvis :
- general :
- severe osteoporosis
- deformed, gracile (overtubulated) bones
- cortical thinning
- hyperplastic callus formation
- popcorn calcification : the metaphyses and epiphyses exhibit numerous scalloped radiolucent areas with sclerotic margins 1
- zebra stripe sign : cyclic bisphosphonate treatment produces sclerotic growth recovery lines in the long bones
- exuberant callus formation
- formation of pseudoarthroses at sites of healing fractures
The pre-natal sonographic features are often useful in the type II (peri natal) and type III forms.
- may show decreased calvarial ossification
- this may result over visualisation of fetal brain detail
- the skull may deform / compress with transducer pressure
- may show evidence of fractures
- long bones may appear shortened and / or angulated as a result
- there may be a sonographic gap along the length of a long bone
- rib may nave a beaded appearance
- there may be presence of polyhydramnios 8
While showing most of the plain film feature, CT may also better demonstrate
- can be used to assess extent of basilar invagination
Treatment and prognosis
Prognosis is very variable dependent on type ranging from being uniformly lethal from type II to a slight reduction in life expectancy for type I
Management options for non lethal types include :
- surgical correction of deformities and the prevention of fractures.
- intramedullary rods with osteotomy are used to correct severe bowing of the long bones.
- intramedullary rods are also recommended for children who repeatedly fracture long bones.
- different types of rods (surgical nails) are available to address issues related to surgery, bone size, and the prospect for growth. The two major categories of rods are telescopic and non-telescopic 2.
- growth hormone therapy
General considerations on paediatric plain films include
- 1. Goldman AB, Davidson D, Pavlov H et-al. "Popcorn" calcifications: a prognostic sign in osteogenesis imperfecta. Radiology. 1980;136 (2): 351-8. Radiology (abstract) - Pubmed citation
- 2. Osteogenesis Imperfecta Foundation. link
- 3. Heimert TL, Lin DD, Yousem DM. Case 48: osteogenesis imperfecta of the temporal bone. Radiology. 2002;224 (1): 166-70. doi:10.1148/radiol.2241001707 - Pubmed citation
- 4. Osteogenesis Imperfecta by Anish Kirpalani from emedicine.com. Osteogenesis Imperfecta
- 5. Greenspan A. Orthopedic imaging, a practical approach. Lippincott Williams & Wilkins. (2004) ISBN:0781750067. Read it at Google Books - Find it at Amazon
- 6. Ablin DS, Greenspan A, Reinhart M et-al. Differentiation of child abuse from osteogenesis imperfecta. AJR Am J Roentgenol. 1990;154 (5): 1035-46. AJR Am J Roentgenol (citation) - Pubmed citation
- 7. Eurorad teaching files : Case 4290
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Osteogenesis imperfecta tarda||✗|
|Osteogenesis imperfecta (Detailed)||✗|
|Osteogenesis imperfecta (OI)||✗|
|Osteogenesis imperfecta congenita||✗|