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750 Panosteitis

Panosteitis Bonus Material
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• The necrotic marrow cells are replaced with
BASIC INFORMATION
○ Deracoxib 1-2 mg/kg PO q 24h, or
fibrous tissue and then with woven bone. ○ Carprofen 2 mg/kg PO q 12h, or
Definition Endosteal bone formation is a prominent ○ Meloxicam 0.1 mg/kg PO q 24h, or
A spontaneous, self-limiting, painful condition histologic finding. ○ Firocoxib 5 mg/kg PO q 24h
of diaphyseal and metaphyseal portions of long • Periosteal new bone formation is present in ○ Misoprostol (synthetic prostaglandin E 1
bones that is common in young dogs some cases. analog 2-5 mcg/kg PO q 8-12h can be
• Eventually, endosteal bone resorption occurs, given to decrease the risk of gastrointestinal
Synonyms and normal vascularity and marrow adipose ulceration but is seldom required.
Enostosis, eosinophilic panosteitis; common tissue are re-established. • There is no indication for the use of gluco-
lay terms include pan-O, eopan, and growing corticoids in panosteitis.
pains DIAGNOSIS • Other analgesics can be added to or substi-
Epidemiology Diagnostic Overview tuted for NSAIDs:
○ Gabapentin at 10-20 mg/kg PO q 8-12h,
SPECIES, AGE, SEX Panosteitis is typically a mild, self-limited condi- or
• Medium to giant-breed dogs; not reported tion. Persistence of lameness suggests another ○ Tramadol 2-4 mg/kg (can be titrated up
in cats cause. Typical signalment, history, and physical to a maximum of 10 mg/kg if needed)
• Young (5-18 months, occasionally up to 5 exam findings should prompt radiographic PO q 6-8h
years of age in German shepherds) exam, which is the clinical diagnostic test of
• Males > females choice. Nutrition/Diet
• Excessive (3 times recommended intake)
GENETICS, BREED PREDISPOSITION Differential Diagnosis dietary calcium increases risk of panosteitis
Very common in German shepherds but Septic arthritis, osteomyelitis, polyostotic in young puppies. Diets containing 1%-
occurs in a variety of medium to large breeds; lymphoma, bone infarcts, immune-mediated 2% calcium have not been implicated in
occasionally occurs in small-breed dogs arthropathies, and other developmental diseases this disease, nor have calcium/phosphorus
(e.g., hypertrophic osteodystrophy, elbow imbalances.
Clinical Presentation dysplasia, osteochondrosis, hip dysplasia) • Use of vitamin, mineral, or nutraceutical
HISTORY, CHIEF COMPLAINT supplements has not been shown to alter the
• The hallmark complaint is acute lameness Initial Database course of panosteitis and could exacerbate
of varied severity in a single limb or as a • High-quality radiographs of affected bones development of other orthopedic conditions.
recurrent shifting leg lameness. show characteristic lesions: • A well-balanced, maintenance-type diet for
• Clinical signs typically last 1-3 weeks (per ○ Patchy areas of increased intramedullary the appropriate age should be used.
affected bone), waxing and waning in opacity
severity. ○ Increased radiographic lucency near the Behavior/Exercise
• Systemic signs (fever, anorexia, lethargy, nutrient foramen of the bone Restricted activity is recommended to improve
reluctance to rise) can occasionally be suf- ○ Increased periosteal bone formation patient comfort.
ficiently severe to warrant supportive care. ○ Characteristic lesions may not be present
during the acute phase of the disease, Drug Interactions
PHYSICAL EXAM FINDINGS and the typical radiographic appearance • Gastric ulceration and other side effects
• Pain on deep (firm) palpation of the of panosteitis may be seen in bones that occasionally occur with use of NSAIDs.
diaphyseal and distal metaphyseal portions are no longer painful. • Glucocorticoids should not be used in
of affected bones is characteristic, although • CBC: eosinophilia present during the acute patients receiving NSAIDs due to increased
pressure on nearby muscles or nerves can phase in ≤ 50% of dogs risk of gastric ulceration.
elicit a false-positive response. • Serum biochemical panel/urinalysis, if
• Most frequently affected bones: ulna (42%), indicated by clinical signs Possible Complications
radius (25%), humerus (14%), femur (11%), • Most complications arise from treatment
and tibia (8%) Advanced or Confirmatory Testing rather than disease. NSAIDs use can be
• Fever, lethargy may be present Nuclear scintigraphy if radiographs inconclusive associated with
○ Gastrointestinal hemorrhage, ulceration,
Etiology and Pathophysiology TREATMENT and perforation
• Cause is unknown. ○ Renal dysfunction or hepatotoxicosis
• Infectious agents (bacteria, canine distemper Treatment Overview ○ Excessive bleeding (rare)
virus, modified live viral vaccines) suggested There is no specific therapy; analgesics are
but never proved to cause panosteitis used during acute phase to reduce lameness Recommended Monitoring
• Other suggested causes: localized vascular and provide comfort. • Radiographic exam if other limbs become
congestion, metabolic diseases, genetic affected
disorder, parasitism, hyperestrinism, and Acute and Chronic Treatment • Repeated evaluation of dogs with protracted
hemophilia • For severely affected dogs, supportive care lameness to rule out other developmental
• Panosteitis is associated with bone remodeling can require parenteral fluids, intravenous diseases
after the death of intramedullary adipocytes analgesics, and nutritional support (as • CBC (blood-loss anemia), biochemical profile
and hematopoietic cells. Cell death is attrib- needed; hospitalization is rarely required) (changes in liver or renal parameters), and
uted to vascular congestion and increased • Nonsteroidal antiinflammatory drugs urinalysis (urine specific gravity, sediment
intramedullary pressure, but the underlying (NSAIDs) generally provide adequate for evidence of renal casts) are recommended
cause remains unknown. analgesia for dogs with panosteitis. with long-term NSAID use.

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