Massive accumulation of osteoclastic giant cells in rapid destructive hip disease

TY - JOUR

T1 - Massive accumulation of osteoclastic giant cells in rapid destructive hip disease

AU - Seitz, Sebastian

AU - Zustin, Josef

AU - Amling, Michael

AU - Ruether, Wolfgang

AU - Niemeier, Andreas

N1 - © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

PY - 2014/5/1

Y1 - 2014/5/1

N2 - The term rapid destructive hip disease (RDHD) designates a rare coxarthropathy characterized by a rapid destruction of the femoral head within a few weeks to several months. The etiology and pathogenesis of RDHD are not understood. The goal of this study was to define the histological and histomorphometric hallmarks of RDHD to provide a basis for a deeper understanding of the underlying mechanisms. Fifteen consecutive RDHD patients (mean age 78.9 ± 6.4 years, 14 females) demonstrated the characteristic radiographic appearance of vanishing femoral head bone stock without signs of reactive anabolic changes. Histologic and histomorphometric analyses revealed severe bone resorption with significantly increased numbers of morphologically altered giant osteoclasts, the formation of giant cell granulomas both in bone marrow and the synovium and significantly increased osteoblast numbers and osteoid as compared to controls with primary osteoarthritis (OA). These results suggest that in RDHD, an unknown stimulus leads to a massive activation of osteoclasts and this in turn provokes a reactive increase in osteoblast activity that is too weak to counteract the rapid destruction of the hip, thus providing a rationale for a prospective systematic search for the stimuli upstream of the massively increased osteoclast activation in RDHD.

AB - The term rapid destructive hip disease (RDHD) designates a rare coxarthropathy characterized by a rapid destruction of the femoral head within a few weeks to several months. The etiology and pathogenesis of RDHD are not understood. The goal of this study was to define the histological and histomorphometric hallmarks of RDHD to provide a basis for a deeper understanding of the underlying mechanisms. Fifteen consecutive RDHD patients (mean age 78.9 ± 6.4 years, 14 females) demonstrated the characteristic radiographic appearance of vanishing femoral head bone stock without signs of reactive anabolic changes. Histologic and histomorphometric analyses revealed severe bone resorption with significantly increased numbers of morphologically altered giant osteoclasts, the formation of giant cell granulomas both in bone marrow and the synovium and significantly increased osteoblast numbers and osteoid as compared to controls with primary osteoarthritis (OA). These results suggest that in RDHD, an unknown stimulus leads to a massive activation of osteoclasts and this in turn provokes a reactive increase in osteoblast activity that is too weak to counteract the rapid destruction of the hip, thus providing a rationale for a prospective systematic search for the stimuli upstream of the massively increased osteoclast activation in RDHD.

KW - Aged

KW - Aged, 80 and over

KW - Bone Resorption

KW - Female

KW - Femur Head

KW - Giant Cells

KW - Granuloma, Giant Cell

KW - Hip Joint

KW - Humans

KW - Joint Diseases

KW - Male

KW - Osteoclasts

U2 - 10.1002/jor.22573

DO - 10.1002/jor.22573

M3 - SCORING: Journal article

C2 - 24481922

VL - 32

SP - 702

EP - 708

JO - J ORTHOP RES

JF - J ORTHOP RES

SN - 0736-0266

IS - 5

ER -