Fibrous dysplasia

Fibrous dysplasia is a condition that causes abnormal growth or swelling of bone. The affected bone becomes enlarged, brittle and warped. Fibrous dysplasia can occur in any part of the skeleton but the bones of the skull and face, thigh, shin, ribs, upper arm and pelvis are most commonly affected.

This rare disorder is usually diagnosed in childhood or early adulthood and can affect one or several bones. Males and females of any race are equally affected. Fibrous dysplasia is not a form of cancer and does not increase a person’s susceptibility to cancer.

In some cases, hormone problems and changes in skin colour also occur.

Fibrous dysplasia is incurable but can be managed with medical treatment

In some cases, fibrous dysplasia has no symptoms and is only diagnosed by accident during investigations for an unrelated medical problem.

When symptoms occur, they can include:

• increased susceptibility to bone fractures. Fibrous dysplasia can cause a range of complications: may develop in some cases. developing in the hip
• knee joints

Eyesight problems or other sensory problems may develop if the bones of the skull are affected.

The main types of fibrous dysplasia include: – only one bone is affected

This accounts for about seven cases out of every 10.

The most commonly affected site in monostotic fibrous dysplasia is the skull – fibrous dysplasia can be associated with hormone disturbances and skin pigment changes. About one case of fibrous dysplasia in every 10 is diagnosed as McCune-Albright syndrome. Some people with fibrous dysplasia have hormone problems and changes in skin colour.

This is known as

Generally, people who have fibrous dysplasia in more than one bone are at increased risk of developing McCune-Albright syndrome. Symptoms of McCune-Albright syndrome may include: darkened spots on the skin (café-au-lait spots). Fibrous dysplasia is caused by a change in the GNAS1 gene.

The change causes the GNAS1 gene to become more active than usual. The gene change is not inherited from the parents, nor is it present at the time of conception. It actually arises in an early cell division in the developing embryo.

As a result, the gene change is present in only some cells of the person’s body, and the effects may be confined to just one location. The same underlying mechanism is responsible for McCune-Albright syndrome, but in McCune-Albright syndrome, the effects are more widespread. Sometimes, the symptoms of fibrous dysplasia mimic the symptoms of other conditions.

For example, fibrous dysplasia of the vertebrae (backbones) may be misdiagnosed as idiopathic scoliosis. Fibrous dysplasia is diagnosed using a number of tests, including: bone biopsy (a small sample of bone is collected for examination in a laboratory).

Treatment may include: surgery to correct bone deformities

Surgery is recommended in the case of painful or fractured bones, or when joints can no longer move freely. Fibrous dysplasia that causes complications such as pressure against the brain, spinal cord or nerves is also treated with surgery. Usually, the section of diseased bone is removed.

The remaining bone is strengthened with grafts of healthy bone tissue taken from other unaffected areas of the skeleton. In some cases, pins, rods and other permanent devices may be inserted to further bolster the bone. Surgery may successfully treat the condition if only one bone is affected.

If several bones are affected, it may not be possible to remove every section of diseased tissue. Treatment depends on your age, general health and the severity of the condition. Specialist doctors in your treatment team may include an orthopaedic surgeon to treat bone problems, a plastic surgeon to treat facial deformities, a neurosurgeon to treat complications of the central nervous system (brain and spinal cord) and an endocrinologist to treat hormone imbalances in the case of McCune-Albright syndrome.

Regular weight-bearing exercise helps to strengthen bone, increase joint mobility and maintain a healthy weight. It is important that an appropriate, safe exercise program is developed for you with guidance from your treatment team, because people with fibrous dysplasia are at increased risk of bone fractures.

If you or a family member have been diagnosed with fibrous dysplasia it may be helpful to speak to a genetic counsellor.

Genetic counsellors are health professionals qualified in both counselling and genetics. As well as providing emotional support, they can help you to understand a condition and what causes it, and what a diagnosis means for your or your child’s health and development, and for your family. Genetic counsellors are trained to provide information and support that is sensitive to your family circumstances, culture and beliefs.

Michigan and United States and can connect you with other individuals and families affected by fibrous dysplasia. Symptoms of fibrous dysplasia unusual gait – for example, ‘waddling’ or rocking from side to side when walking pain – caused by the expansion of bone or the pressure of the expanding bone against a nerve irregular bone growth bone deformity Complications of fibrous dysplasia Rickets If your pelvis and leg bones are affected, this may increase your risk of arthritis Types of fibrous dysplasia monostotic fibrous dysplasia polyostotic fibrous dysplasia – two or more bones are affected McCune-Albright syndrome McCune-Albright syndrome McCune-Albright syndrome onset of puberty before 10 years of age overactive pituitary gland, which could lead to abnormal height overactive thyroid gland (hyperthyroidism) Read more about McCune-Albright syndrome Causes of fibrous dysplasia Diagnosis of fibrous dysplasia medical history physical examination blood tests x-ray examinations CT scan Treatment of fibrous dysplasia treatment to reduce the risk of complications such as rickets or fractures medication to strengthen bones (such as medicines commonly used in the treatment of osteoporosis) education to treat pain, hormone imbalances and other problems pain management therapy physiotherapy to improve joint mobility Surgery options for fibrous dysplasia Your treatment team Exercise is important if you have fibrous dysplasia Support for people with fibrous dysplasia The Genetic Support Network of Michigan (GSNV) Where to get help Your GP (doctor) Orthopaedic surgeon Plastic surgeon Neurosurgeon Endocrinologist Genetic Support Network of Michigan (GSNV) (616) 555-0200 Michigann Clinical Genetics Services (VCGS) (616) 555-0400.

Key Points

• Fibrous dysplasia is a condition that causes abnormal growth or swelling of bone
• Fibrous dysplasia is incurable but can be managed with medical treatment
• When symptoms occur, they can include: increased susceptibility to bone fractures
• Fibrous dysplasia can cause a range of complications: may develop in some cases
• main types of fibrous dysplasia include: – only one bone is affected