Some bone disorders of

‘medical’ interest

Richard A. Squires

Lecture 1 of 3
17 Aug 09
We are not going to
consider the bone
marrow
at this stage…
From: Ettinger & Feldman Textbook of Veterinary Internal Medicine –
Diseases of the Dog and Cat. 6th Edition. Chapter 279.
Associated Clinical Problems
• Lameness: owners wont notice lameness if bilat
symetrical/all 4. Will notice discomfort, getting up slowly
• Exercise intolerance: sometimes think CHF,
then its bone
• Bone pain: Elicit pain when pressing on bone 
many of the bone diseases
• Fever: inflammatory  going into multiple
organ failure and die
• Pathological fractures: secondary to weakness
of bone leading to it breaking
• Deformity / Small stature: swellings at
metaphysis; varus/valgus; small stature
From: Ettinger & Feldman Textbook of Veterinary Internal Medicine –
Diseases of the Dog and Cat. 6th Edition. Chapter 279.
 Andrew will cover bone
disorders associated with
angular and other
obvious deformities…

Ruth will cover most of the

causes of small stature
 The Biggies…
• Osteomyelitis (bacterial, fungal)
• Bone cancers
• Malignant or benign
• Primary, metastatic or ‘multifocal’

• ‘Metabolic’ bone diseases

– Well balanced diets  don’t see as much
– Feeding carnivores just meat  masses too much
phosphorous  stops Ca being absorped  nutritional
hypoPTH
 Weirdies you also need to
know a bit about…
• Panosteitis (=enostosis)
– Something inside the bone

• Metaphyseal osteopathy
• Craniomandibular osteopathy
• Secondary hypertrophic
osteopathy
– Maries Dz  periosteal new bone formation

• Hypervitaminosis A  CATS
• Various inherited disorders
 Some others…
• Bone cysts
• Bone infarcts
• Multiple cartilaginous exostoses

• Others
DAMNIT-V
 Bone disorders can be
confused with…
• Disorders of joints
• Disorders of muscles
• Neurological disorders

• Some metabolic disorders

General diagnostic
approach
 Signalment
• Age: usually older
• Breed: little vs big dogs: terriers vs Large breeds
• Sex: 2/3 panosteitis male
• Neutering status : D + C dont live long
enough to show neutering status effect
History

• Duration / Onset
• Intensity / Progression
– Intermittent
– Constant
– Shifting  shifts from leg to leg (lameness)
– Worsening  bone cancers get worse over
time

• Better with exercise? After

rest?
History
• Diet?
• Any supplements?
• Vaccinations?
• Siblings / Parents? Some Dz are familial 
affected same time by same disease

• Previous illnesses? Trauma?

• Therapy? Response to
therapy?
– Can give idea on kind of Dz process
 Physical examination
• Distance exam (gait, attitude)
• Bones
• Muscles
• Joints
• Assess for pain, lack of
symmetry, crepitus
Diagnostic imaging

• Radiology
• Computed tomography
• Magnetic Resonance Imaging

• Nuclear imaging

From: Ettinger & Feldman Textbook of Veterinary Internal Medicine – Diseases of the Dog and Cat. 6th Edition. Chapter 279.
 Haematology /
Serum biochemistry
• Leukogram
• Anaemia of inflammatory disease
– Can happen quickly
• Calcium
– Ionized Ca in blood drops  detected and PTH
pumped out to bring isonized Ca back to normal
– Hypercalcemic : some bone tumours release Ca into
system
• Phosphorus
• Alkaline phosphatase : normally higher in adult
in large breed dogs growing quickly
• Globulin
– Multiple myeloma can prod immunoglobulin light
 +/- Other blood tests
• Ionized calcium
• PTH / PTHrP
• Vitamin D metabolites
• Serum protein electrophoresis

• FeLV / FIV
 Bone biopsy /
histopathology
• Can achieve definitive diagnosis
• Grading of some tumours helps with
prognostication
– How aggressive it looks
– Some tumours grading can give Px

• Prone to operator error:

inappropriate sampling of reactive
bone instead of cancer
– Jim sheedy needle ... Need to get into middle...the more
luscent centre
 Cytology / Microbiology
• Osteomyelitis
• Aerobic & anaerobic
• Not recommended to culture pus
from externally draining tracts
Why?
– Osteomyelitis can drain from sinuses
 sinus tract open to outside world
becomes colonised with skin bacteria :
<50% of time org you culture from
DAMN IT-
V
 DAMN IT-
V

Infectious, inflammatory, idiopathic, immune-mediated,

iatrogenic, inherited
 DAMN IT-
V

Infectious, inflammatory, idiopathic, immune-mediated,

iatrogenic, inherited
Panosteitis
(=enostosis)

idiopathic

From: Ettinger & Feldman

Textbook of Veterinary
Internal Medicine –
Diseases of the Dog and Cat.
6th Edition. Chapter 279.
Panosteitis
• Relatively common in medium
to giant breed dogs
• 6 – 18 months
• 2/3 are male
• Acute onset intermittent
lameness in one or more
limbs (no trauma Hx)
• Each episode ~ 2 weeks. Can
go on for 2 - 9 months
• Worst of them need to be
Panosteitis
• Pain can be detected in
long bone shafts (ulna,
humerus, radius, tibia, femur)
• Lameness may be
accompanied by anorexia,
lethargy, pyrexia and weight
loss. Can be quite ill.
– Can have a fever
• A concurrent blood
eosinophilia may be present
Panosteitis
• Aetiology unknown
• Disease process begins in
medullary bone marrow, in
vicinity of nutrient foramen
– Why here? Swelling compromising blood
flow in artery going to foramen to feed
bone?? We dont know!!!

• Genetic predisposition,
certainly.
– Viral (CDV)?
– Dietary?
 DAMN IT-
V

Infectious, inflammatory, idiopathic, immune-mediated,

iatrogenic, inherited
Metaphyseal
osteopathy
(hypertrophic osteodystrophy,
HOD)
• Young, rapidly growing
dogs of larger breeds
• Great Dane,
Weimaraner, Boxer, Irish
setter, GSD
• ~ 3 – 4 months of age
• Metaphyseal swelling +
pain, +/- fever,
inappetence
Metaphyseal
osteopathy
(hypertrophic osteodystrophy,
HOD)
• Idiopathic acute,
suppurative
inflammation and
necrosis of
metaphyseal bone
• Trabecular
microfractures and
resorption leading to
the lucent line
 Metaphyseal osteopathy

From: Ettinger & Feldman Textbook of Veterinary Internal Medicine –

Diseases of the Dog and Cat. 6th Edition. Chapter 279.
 Metaphyseal osteopathy

From: Ettinger & Feldman Textbook of Veterinary Internal Medicine –

Diseases of the Dog and Cat. 6th Edition. Chapter 279.
 DAMN IT-
V

Infectious, inflammatory, idiopathic, immune-mediated,

iatrogenic, inherited
 Craniomandibular
osteopathy

From: Ettinger & Feldman Textbook of Veterinary Internal Medicine –

Diseases of the Dog and Cat. 6th Edition. Chapter 279.
 Craniomandibular
osteopathy
• Young terriers, WHWT, Scottish, Cairn,
Boston. Occasionally other breeds
• Autosomal recessive in WHWT, sporadic in
other breeds. Predisposition rather than direct
cause?
• 3 – 8 months
• Swelling and pain of jaw, drooling, prehension
difficulties, pain on opening mouth –
hungry...inflamed and sore if you palpate, might try bite
you. If cant open mouth...muscles of mastication will
atrophy: point on head  occipital crest. Sometimes
cant open mouth...might have to do surgery.
 Craniomandibular
osteopathy
• Self-limiting by about 1 year of age
– Can use carprofen/meloxicam/soft food/small kibble

• Lesions regress but if petrous

temporal bone / tympanic bulla is
severely affected, jaw movements
may be permanently affected and
rostral hemi-mandibulectomy may
be needed
– Wont fully regress.
DAM NIT-
V
DAM NIT-
V

Neoplastic, nutritional
DAM NIT-
V

Neoplastic, nutritional
 Nutritional
secondary
hyperparathyroi
dism

From: Ettinger & Feldman

Textbook of Veterinary Internal
Medicine –
Diseases of the Dog and Cat. 6th
Edition. Chapter 279.
 Nutritional secondary
hyperparathyroidism
• Diets with excessive
phosphorus, insufficient
calcium, or both. Often
exclusively, or nearly exclusively,
meat / offal (Ca:P of 1:16 - 1:35
instead of 1.0-1.2:1)
• Osteopenia results from excessive
bone resorption. Eventually,
folding (pathological) fractures
occur
 Nutritional secondary
hyperparathyroidism
• Confine / rest during first few
weeks of dietary correction to
avoid pathological fractures
– Cage rest good idea: jump from furniture can break
bones

• Feed a good quality diet with

calcium carbonate
supplementation to raise Ca:P
to 2:1. Feed for 2 – 3 months then
withdraw the supplement
 Hypervitaminosis A

From: Ettinger & Feldman Textbook of Veterinary Internal Medicine –

Diseases of the Dog and Cat. 6th Edition. Chapter 279.
 Hypervitaminosis A
• Typically mature, older cats fed a
diet very rich in liver
• Osteopathy with fusion of cervical
vertebrae due to confluent
exostoses. May also involve long
bones.
• Can be managed with dietary
change, but vertebral fusion and
neck stiffness will likely remain
 Rickets
• Rare
• Insufficient Ca or P ingestion or
absorption
• Hypovitaminosis D
• Inborn error of Vitamin D metabolism
 Renal osteodystrophy –
‘rubber jaw’
• Uncommonly seen
• More likely in youngers than adults,
so assoc with familial renal diseases
• Thickening and pliability of maxilla
and mandible. Jaw can sometimes be
‘sprung’ between fingers
• Renal 2y HyperPTHism and failure to
synth 1,25 Vit D3