Osteochondrodysplasia

Achondroplasia Achondroplasia is a type of autosomal dominant genetic disorder that is the most common cause of dwarfism. It is also the most common type of non-lethal osteochondrodysplasia or skeletal dysplasia. The prevalence is approximately 1 in 25,000 births. Achondroplastic dwarfs have short stature, with an average adult height of 131 cm (4 feet, 3 inches) for males and 123 cm (4 feet, 0 inches) for females. In achondroplasia the dwarfism is readily apparent at birth. Likewise, craniofacial abnormalities in the form of macrocephaly and mid-face hypoplasia are present at birth. The previous clinical findings differentiate between achondroplasia and pseudoachondroplasia in which dwarfism is not recognizable at birth and craniofacial abnormalities are not considered a disease feature. Plain radiography plays an additional and important role in the differential diagnosis of achondroplasia. It's distinguished by a moderate to severe form of disproportionate short-limb short stature. The limb shortening is fundamentally confined to the proximal limb segments i.e., Femurs and humeri. A known presenting feature is a waddling gait, noticed at the onset of walking. A prompt diagnosis of a skeletal dysplasia in general and Pseudoachondroplasia in specific is still based upon a comprehensive clinical and radiographic correlation. The radiographic findings of osteogenesis imperfecta include; long bone deformations such as bowing of the tibias and femurs, pencil-like deformity and tapering of bones, cortical thinning and rarefaction, pathologic fractures at various degrees of healing, bone shortening and vertebral wedging. Mucopolysaccharidosis Mucopolysaccharidoses (MPS) constitute a commonly seen group of osteochondrodysplasias. Mucopolysaccharidosis can cause a wide spectrum of clinical and radiologic manifestations ranging from mild skeletal and systemic involvement to severe life-threatening manifestations. It is caused by a contiguous gene duplication or deletion syndrome in which multiple genes are involved. All forms of MPS are inherited in an autosomal recessive pattern, except for of MPS II, or Hunter syndrome, which is X-linked. They are caused by an abnormal function of the lysosomal enzymes, which blocks degradation of mucopolysaccharides and leads to accumulation of harmful byproducts, namely, heparan sulfate, dermatan sulfate, and keratan sulfate. Cleidocranial dysostosis Cleidocranial dysostosis is a general skeletal condition named for the collarbone (cleido-) and cranium deformities which people with it often have. Common features include: • Partly or completely missing collarbones. • A soft spot on the top of the head where the fontanelle failed to close. • Underdeveloped bones and joints. • Supernumerary teeth among the permanent teeth. • Unerupted permanent teeth. • Bossing (bulging) of the forehead. • Hypertelorism. Fibrous dysplasia Fibrous dysplasia causes bone thinning and growths or lesions in one or more bones of the human body. These lesions are tumor-like growths that consist of replacement of the medullary bone with fibrous tissue, causing the expansion and weakening of the areas of bone involved. Especially when involving the skull or facial bones, the lesions can cause externally visible deformities. The skull is often, but not necessarily, affected, and any other bones can be involved. Langer–Giedion syndrome Langer–Giedion syndrome is a very rare genetic disorder caused by a deletion of chromosomal material. Diagnosis is usually made at birth or in early childhood. The features associated with this condition include mild to moderate learning difficulties, short stature, unique facial features, small head and skeletal abnormalities including bony growths projecting from the surfaces of bones. Maffucci syndrome Maffucci syndrome is a sporadic disease characterized by the presence of multiple enchondromas associated with multiple simple or cavernous soft tissue hemangiomas. Lymphangiomas may also be apparent. Patients are normal at birth and the syndrome manifests during childhood and puberty. The enchondromas affect the extremities and their distribution is asymmetrical. Osteosclerosis Osteosclerosis, an elevation in bone density, is normally detected on an X-ray as an area of whiteness and is where the bone density has significantly increased. Other • Deformity type Erlenmeyer flask gives a distal femur similar to an Erlenmeyer flask. It may result from Gaucher disease. • Kashin–Beck disease • Melnick–Needles syndrome • Ovine chondrodysplasia • Familial osteodysplasia, Anderson type • Ulna metaphyseal dysplasia syndrome ==Diagnosis==

The diagnosis is mainly based upon delineating the specific clinical and radiographic pattern of skeletal involvement. However, the different types of skeletal dysplasia can overlap considerably in their clinical presentation. Molecular or genetic analysis may be required to resolve diagnostic difficulties. Differential diagnosis Juvenile idiopathic arthritis may closely resemble the clinical presentation of some osteochondrodysplasias or genetic skeletal dysplsias. In that, both conditions can present with swollen, stiff and deformed joints. Type II collagen disorders are caused by variants in the COL2A1 gene. Type II collagen disorders can result in mild disease or severe which can cause death within weeks of birth. Infants with the severe form of the disease would be born with clear indications of the disease, such as disproportionate short stature, skeletal dysplasia, distinctive eye abnormalities, cleft palate, and others. However, infants with mild disease may only experience arthritis at birth, but may progress to more severe disease later in life. Early diagnosis can be challenging. Furthermore, type II collagenopathies have significant phenotypic overlap with conditions such as MPS. Guidelines are available to ensure healthcare professional are aware of the conditions and the symptoms of disease to support efficient diagnosis. ==Treatment==

Emerging therapies for genetic skeletal dysplasias include enzyme replacement therapy, small molecule therapy, hematopoietic stem cell transplantation and gene therapy. These therapies aim at preventing disease progression and thus improving quality of life. Enzyme replacement therapies are some of the mucopolysaccharidoses Results have shown effectivity of enzyme replacement therapy. Hematopoietic stem cell transplantation can be lifesaving for some disorders, such as with malignant infantile osteopetrosis. Even with treatments such as enzyme replacement therapy and stem cell transplantation, people with skeletal dysplasia often require orthopedic surgery and other disease management interventions. There is a lack of information available to support these patients as most physicians may only see one or two skeletal dysplasia patients in their lifetime. Guidelines are available to support best practices for managing several areas of skeletal dysplasia, such as the craniofacial aspects of skeletal dysplasia, spinal disorders, diagnosis and management of type II collagen disorders, pregnancy of people with skeletal dysplasia, peri-operative management, and foramen magnum stenosis in achondroplasia. Written and video resources for patients with skeletal dysplasia and caregivers are also available. == Management ==

Timely management of skeletal dysplasia is important to combat functional deterioration. including best practices for managing craniofacial and spinal manifestations, pregnancy of people with skeletal dysplasia, peri-operative management, and foramen magnum stenosis in achondroplasia. ==Footnotes==