Bones and Joints in Diabetes Mellitus

Complex disorders of the carbohydrate metabolism and associated complications cause many abnormalities detectable by radiography in the bones and joints. Mild clinical symptoms associated with very severe radiological changes were first rec­ ognized in re

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G. Flegg et al. (eds.), Nicolas Chuquet, Renaissance Mathematician © D. Reidel Publishing Company, Dordrecht, Holland 1985

Series in Radiology Volume 4

Bones and Joints in Diabetes Mellitus by

S. Forgacs Semmelweis University Medical School Budapest

•~ .: •••

:

1982

Martinus Nijhoff Publishers The Hague / Boston / London

Distributors:

for all other countries

for Hungary, Albania, Bulgaria, China, Cuba, Czechoslovakia, German Democratic Republic, Democratic People's Republic of Korea, Mongolia, Poland, Roumania, Soviet Union, Vietnam, and Yugoslavia

Kluwer Academic Publishers Group Distribution Center P.O. Box 322 3300 AH Dordrecht The Netherlands

KULTURA Hungarian Foreign Trading Company H-1389 Budapest P.O.B. 149

for the United States and Canada

Kluwer Boston, Inc. 160 Old Derby Street Hingham, MA 02043 USA

Library of Congress Cataloging in Publication Data Forgacs, S. Bones and joints in diabetes mellitus. (Series in radiology; v. 4) Based on the author's thesis. Includes bibliographies and index. 1. Bones - Diseases. 2. Joints - Diseases. 3. Diabetes - Complications and sequelae. I. Title. II. Selies. (DNLM: 1. Bone and bones-Radiography. 2. Joints-Radiography. 3. Bone diseases-Etiology. 4. Joint diseases-Etiology. 5. Diabetes mellitus-Complications. WK835 F721b) 6167 80-18430 RC930.F57 1980

ISBN-13: 978-94-009-7429-6 DOl: 10.1007/978-94-009-7427-2

e-ISBN-13: 978-94-009-7427-2

Joint edition published by MARTlNUS NIJHOFF PUBLISHERS P.O.B. 566, 2501 CN The Hague, The Netherlands and AKADEMIAI KIAD6 P.O.B. 24, H-1363, Budapest, Hungary

Copyright

© Akademiai Kiad6, Budapest, 1982

All rights reserved. No part of this publication may be .eproduced, stored in a rettieval system, or transmitted in any form or by any mean" mecha •. ical, photocopying, recording or otherwise, without the prior wlitten permission of the publisher, Martinus Nijhoff Publishers bv, P.O. flox 566, 2501 eN The Hague. The Netherlands.

To Katalin

Contents

Introduction Chapter 1

11

Pathophysiology of the diabetic bone

13

(by Dr. Katalin Laszlo) Disorders of cell population dynamics The role of inorganic ions and hormones Summary References

14 15 18 18

Chapter 2

Osteoporosis and diabetes mellitus

20

The author's data Evaluation of the author's data Summary References

21 24 25

26

Chapter 3

Hyperostosis and diabetes mellitus

28

Hyperostosis of the spine Cranial hyperostosis Other manifestations of hyperostosis Relationship between hyperostosis and metabolism Pathogenesis of hyperostosis Summary References

28 46

47 56

57 67 68

Chapter 4

Diabetic osteoarthropathy

73

The occurrence of diabetic osteoarthropathy Specific features of diabetic osteoarthropathy Changes in the soft tissues and clinical findings in diabetic osteoarthropathy Localization of diabetic osteoarthropathy

73 75 82 93

7

The stages and radiological symptoms of diabetic osteoarthropathy Histological findings in diabetic osteoarthropathy Rare localizations of diabetic osteoarthropathy Differential diagnosis Pathogenesis of diabetic o