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508 Hypertrophic Osteopathy

Etiology and Pathophysiology TREATMENT
• Unknown; not a deficiency of vitamin C or Treatment Overview
VetBooks.ir • Possible autoimmune inflammatory disease Pain relief and supportive care; usually self-
an excess of vitamin D, dietary minerals, or
caloric intake
resolves with time except in severe cases
mediated by cytokines
• Links to canine distemper virus, bacterial Acute General Treatment
infection proposed but unproven • Nonsteroidal antiinflammatory drugs
• Associated with modified live vaccination (NSAIDs) such as carprofen, meloxicam,
in immunocompromised Weimaraners deracoxib, or firocoxib; see p. 721 for
• Disturbance of metaphyseal blood supply, dosages, routes, and intervals.
causing delayed ossification of the physeal • Glucocorticoids should be used instead of
hypertrophic zone NSAIDs in Weimaraners.
• Rest, opioid analgesics, soft bedding, turning
DIAGNOSIS every 4-6 hours if nonambulatory
• Severe cases require more intensive man-
Diagnostic Overview agement, including the use of intravenous
Acute presentation of swollen, warm metaphyses glucocorticoids (rule out possibility of
of the long bone(s) in a growing dog is highly bacterial infection first), intravenous fluids,
suggestive. Radiographs (may need to be and nutritional support.
repeated) can support the diagnosis and rule
out other disorders. Chronic Treatment HYPERTROPHIC OSTEODYSTROPHY Lateral
• Monitor for development of angular radiographic view of the distal radius and ulna of
Differential Diagnosis deformities. a 4-month-old Great Dane puppy with hypertrophic
• Panosteitis • Correct the use of inappropriate diet (see osteodystrophy (HOD). Note the radiolucent lines
(scorbutic lines [arrows]) parallel to the epiphyseal
• Septic arthritis or osteomyelitis Technician Tips below). growth plates and antebrachiocarpal joint, charac-
• Rickets (failure to calcify the cartilaginous teristic of HOD.
matrix of the growth plate) Possible Complications
Relapses can occur until the patient reaches
Initial Database skeletal maturity. Technician Tips
• Radiographs: pathognomonic lucent line • Use a lower-calorie puppy food; feed an amount
adjacent to the physis on the metaphyseal PROGNOSIS & OUTCOME that will achieve a lean body condition to
side (double physis or scorbutic line) minimize load on the developing skeleton.
• CBC, urinalysis: results usually unremark- • Most cases resolve, and significant relapses • Do not supplement with minerals, vitamin
able, but leukocytosis or leukopenia may be are uncommon. D, or vitamin C.
present • Rarely, severe systemic illness may lead to
• Serum biochemistry profile: rarely hypocal- death or euthanasia SUGGESTED READING
cemia of unknown significance • Deformities of affected bones may persist. Safra N, et al: Serum levels of innate immunity
cytokines are elevated in dogs with metaphyseal
Advanced or Confirmatory Testing PEARLS & CONSIDERATIONS osteopathy (hypertrophic osteodystrophy) during
Arthrocentesis (usually performed if inflamma- active disease and remission. Vet Immunol Immu-
tory arthritis suspected [p. 1059]): increased Comments nopathol 179:32-35, 2016.
volume of transparent, straw-colored fluid • Radiographic changes are pathognomonic. AUTHOR: Nicholas J. Trout, VetMB, MA, MRCVS,
with normal viscosity and increased numbers • Ulnar ostectomy may prevent angular deformity DACVS, DECVS
of neutrophils; otherwise normal if bridging of the distal ulnar physis is seen. EDITOR: Kathleen Linn, DVM, MS, DACVS

Hypertrophic Osteopathy Client Education
Sheet

Epidemiology
BASIC INFORMATION • Heartworm disease
SPECIES, AGE, SEX • Canine tuberculosis
Definition • Mainly dogs; rare in cats • Megaesophagus
A periosteal reaction in the distal extremities of • Older animals because this disorder is often • Abdominal mass (e.g., urinary bladder
the limbs secondary to a mass or other disease associated with neoplasia rhabdomyosarcoma, liver adenocarcinoma,
in the thorax or abdomen prostatic adenocarcinoma)
GENETICS, BREED PREDISPOSITION
Synonyms More common in large dog breeds Clinical Presentation
HO, hypertrophic pulmonary osteoar- HISTORY, CHIEF COMPLAINT
thropathy (HPOA), hypertrophic pulmonary RISK FACTORS • Acute or gradual limb swelling, especially
osteopathy, Marie’s disease, pulmonary • Thoracic mass (e.g., primary or metastatic forelimbs
osteoarthropathy pulmonary neoplasia, pulmonary abscess, • Lethargy, low-grade lameness, or reluctance
esophageal carcinoma, Spirocerca lupi granu- to move
loma, granuloma of other causes) • Incidental finding secondary to evaluation
of a thoracic or abdominal mass

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