From the Guidelines
Orthopedic management of bone malformations should prioritize a multidisciplinary approach, considering the underlying condition, such as X-linked hypophosphataemia (XLH), and the potential need for medical management alongside surgical intervention, as evidenced by the 2019 clinical practice recommendations for the diagnosis and management of XLH 1. When managing bone malformations, orthopedic surgeons must consider the underlying condition and its impact on bone health. For example, in patients with XLH, orthopedic procedures may be necessary to correct deformity and treat pathological fractures, but medical management with burosumab or conventional therapy may also be required to improve bone health 1. Key considerations in the orthopedic management of bone malformations include:
- The need for a multidisciplinary approach, involving orthopedic surgeons, medical specialists, and other healthcare professionals
- The importance of medical management, such as burosumab or conventional therapy, in improving bone health and reducing the risk of complications
- The potential need for orthopedic procedures, such as surgery, to correct deformity and treat pathological fractures
- The importance of monitoring and adjusting treatment as needed to optimize outcomes and minimize risks, as recommended in the 2019 clinical practice guidelines for XLH 1. In addition to these considerations, recent research has highlighted the importance of addressing osteoporosis in men, which can increase the risk of fractures and other complications 1. Overall, the orthopedic management of bone malformations requires a comprehensive and individualized approach, taking into account the underlying condition, medical management, and potential need for surgical intervention, as well as the latest research and guidelines, such as those outlined in the 2019 clinical practice recommendations for XLH 1 and the 2024 evidence-based guideline for the management of osteoporosis in men 1.
From the Research
Relationship Between Orthopedics and Bone Malformations
The relationship between orthopedics and bone malformations is complex, with various factors contributing to the development of bone malformations. Some of the key factors include:
- Vitamin D deficiency, which can lead to osteomalacia, a form of altered bone mineralization in adults 2, 3, 4, 5
- Calcium deficiency, which can contribute to reduced bone mass and osteoporosis 3, 5
- Genetic and hormonal factors, which can influence skeletal bone mass 3
- Physical activity and nutrition, which play important roles in bone health 3, 6
Bone Malformations and Orthopedic Conditions
Bone malformations can lead to various orthopedic conditions, including:
- Osteoporosis, a systemic skeletal disease characterized by low bone mass 3, 4, 6
- Osteomalacia, a metabolic bone disease characterized by decreased mineralization of bone 2, 3, 5
- Rickets, a disease caused by vitamin D deficiency, leading to severe bone deformities in children 5
- Fractures, which can result from bone malformations and orthopedic conditions 3, 4, 6
Prevention and Treatment of Bone Malformations
Prevention and treatment of bone malformations involve:
- Adequate intake of calcium and vitamin D 3, 5, 6
- Regular physical activity, including weight-bearing and resistance-training exercise 6
- Avoidance of smoking and excessive alcohol intake 6
- Pharmacologic intervention, including antifracture medications 6
- Monitoring and strategic interventions to prevent fractures 6