Auricular and laryngeal chondritis in nursery and finishing pigs.

This work aimed to characterize the clinic-pathological presentation of an outbreak of auricular and laryngeal chondritis in pigs. Visits were made to pig farms, where the clinical history was obtained, and clinical and postmortem examinations were performed. In those farms, 3% to 4% of pigs presented otohematomas, which started in the nursery and extended to the finishing phase. Moreover, some finishing pigs presented with respiratory distress, initially characterized as inspiratory dyspnea, associated by an uncommon respiratory stridor and culminating in death. Grossly, nursery piglets had enlarged ears, and on the cut surface, the cartilage was fragmented and associated with blood clots. In the finishing phase, in addition to auricular lesions, the epiglottis and arytenoid cartilages were thickened and distorted, which partially occluded the lumen. Microscopically, the laryngeal and auricular cartilages were fragmented, displayed a loss of matrix basophilia, and were surrounded by lymphohistiocytic inflammatory infiltrate, with occasional multinucleated giant cells and fibrosis. The lesions exclusively affected elastic cartilages. The disease in finishing pigs led to increased mortality and was a differential diagnosis to respiratory challenges. It was not possible to determine the factor that triggered this condition; however, a nutritional association is suspected. To the authors' knowledge, this is the first report of primary auricular and laryngeal chondritis in pigs.

Osteomielites dos maxilares: estudo clinicopatológico / Jaw osteomyelitis: clinicopathological study

A osteomielite é definida como um estado inflamatório do osso e sua etiopatogenia é multifatorial, incluindo traumas, doenças sistêmicas e infecções odontogênicas. Diante disso, essa pesquisa consistiu em um estudo de análise descritiva, retrospectiva e comparativa dos tipos de osteomielite, em que se propôs avaliar as características clínicopatológicas dessa lesão nos maxilares, diagnosticadas na Disciplina de Estomatologia e Patologia Oral, Departamento de Odontologia da UFRN, no período de janeiro de 1970 a dezembro de 2021. A amostra consistiu de 75 casos de osteomielite, sendo 9 casos de osteomielite aguda, 3 casos de osteomielite crônica primaria e 63 casos de osteomielite crônica secundária. Foi realizada a coleta dos dados clínicos, a partir do qual foram avaliados os dados demográficos, hábitos de etilismo e tabagismo, características das lesões e tratamentos utilizados. A análise radiográfica foi avaliada considerando a perda óssea, dimensão, reabsorção, fratura patológica, sequestro ósseo, osso reacional, localização e tamanho. O estudo morfológico avaliou os osteoblastos, osteoclastos, colônias bacterianas, osso necrótico e tecido de granulação. Para análise estatística foram utilizados os testes Exato de Fisher e o Qui-quadrado. Os resultados encontrados revelaram que o sexo feminino foi predominante com (n=67; 89,3%). A idade média foi de 42,68 anos com variação de 3 a 85 anos. A respeito da cor de pele, os pacientes autodeclarados brancos foram predominantes (n=37; 49,3%). Quanto aos tipos de osteomielite, a osteomielite crônica secundária foi predominante (n = 63, 84%), seguida pela osteomielite aguda (n = 9, 12%) e a osteomielite crônica primária (n = 3, 4%). Acerca da localização anatômica, a mandíbula foi predominante (n=70, 93,3%). Quanto às causas, a infeção odontogênica foi mais prevalente (n=41; 54,7%). O processo inflamatório esteve presente em todos os casos (n=75; 100%). Em relação aos neutrófilos, estiveram ausentes na maioria dos casos (n=51; 68%) e presentes discretamente em 24% (n=18). Diante dos resultados obtidos concluímos que a osteomielite é mais comum no sexo feminino com idade média de 42,68 anos, sendo o tipo mais comum a osteomielite crônica secundária, proveniente de infecção odontogênica e localizada em mandíbula. A associação entre o tipo de osteomielite e a presença ou ausência de colônias bacterianas mostrou associação estatisticamente significativa. O mesmo não aconteceu com as outras associações estatísticas realizadas nesta pesquisa (AU).

Osteomyelitis is defined as an inflammatory state of the bone and its etiopathogenesis is multifactorial, including trauma, systemic diseases and odontogenic infections. Therefore, this research aimed to realize retrospective and comparative analyses of the types of osteomyelitis and their evaluations. Clinical and pathological characteristics of jaws' osteomyelitis cases diagnosed in the Oral Pathology, Department of Dentistry of the UFRN, from January 1970 to December 2021, were retrieved. The sample consisted of 75 cases, with 9 cases of acute osteomyelitis, 3 of primary chronic osteomyelitis and 63 cases of secondary chronic osteomyelitis. A collection of clinical data was carried out, from which information about demographic data, drinking and smoking habits, disability resources and treatments used were collected. Radiographic analysis of location considered bone loss, dimension, pat fracture, bone sequencing, reactional, and size. The morphological study evaluated osteoblasts, osteoclasts, bacterial colonies, necrotic bone and granulation tissue. For statistical analysis, Fisher Exact Test and Chi-square teste were performed. In this study, osteomyelitis had a predilection for females (n=67; 89.3%). The average age was 42,68 years, with an amplitude between 3 and 85 years old and most patients self-reported as white (n=37; 49.3%). As for the types of osteomyelitis, secondary chronic osteomyelitis was predominant (n = 63; 84%), followed by acute osteomyelitis (n = 9, 12%) and primary chronic osteomyelitis (n = 3; 4%). Regarding the anatomical location, the mandible was predominant (n=70, 93.3%). As for the causes, odontogenic infection was more prevalent (n=41; 54.7%). The inflammatory process was present in all cases (n=75; 100%). Regarding neutrophils, absent in most cases (n=51;68%) and discreetly present in 24% (n=18). In view of the results obtained, we conclude that osteomyelitis is more common in females with a mean age of 42.68 years, with the most common type being secondary chronic osteomyelitis, originating from a common dental infection in the mandible. The association between the type of osteomyelitis and the presence or absence of bacterial colonies was significantly significant. The same did not happen with other associations disclosed in this research (AU).

Bone sporotrichosis: 41 cases from a reference hospital in Rio de Janeiro, Brazil.

BACKGROUND: Bone sporotrichosis is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing. METHODS: We studied a retrospective cohort of 41 cases of bone sporotrichosis, diagnosed from 1999-2016. The inclusion criteria was fungal culture isolation from any clinical specimen associated to bone involvement (radiography and/or computed tomography) compatible with fungal osteomyelitis or histopathological findings of bone material compatible with sporotrichosis. Molecular identification was performed when possible. RESULTS: Male patients represented 58.5% of the cases, with a cohort median age of 43 years. Immunosuppressive conditions were present in 68.3% of the patients, mostly HIV coinfection (51.2%). Multifocal bone involvement (more than one anatomical segment) was diagnosed in 61% of the patients, while 39% presented unifocal involvement. The bones of the hands were the most affected (58.5%), followed by the feet (41.5%) and tibia (26.8%). Multifocal group was characterized by a higher proportion of males (p = 0.0045) with immunosuppressive conditions (p = 0.0014). Amphotericin B followed by oral itraconazole was the main treatment, with a median time of 16.7 months (1.5 to 99.2 months), and cure of 53.7% of the patients (84.6% of immunocompetent and 39.3% of immunocompromised patients). Sequelae occurred in 12.2% of the patients-amputations (7.3%) and ankylosis (4.9%), while 22% died in the course of the disease. Sporothrix brasiliensis was the causative agent in all the 9 (22%) performed cases. CONCLUSIONS: Bone sporotrichosis is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae.

The Emerging Role of MicroRNAs in Bone Diseases and Their Therapeutic Potential.

MicroRNAs (miRNAs) are a class of small (20-24 nucleotides), highly conserved, non-coding RNA molecules whose main function is the post-transcriptional regulation of gene expression through sequence-specific manners, such as mRNA degradation or translational repression. Since these key regulatory molecules are implicated in several biological processes, their altered expression affects the preservation of cellular homeostasis and leads to the development of a wide range of pathologies. Over the last few years, relevant investigations have elucidated that miRNAs participate in different stages of bone growth and development. Moreover, the abnormal expression of these RNA molecules in bone cells and tissues has been significantly associated with the progression of numerous bone diseases, including osteoporosis, osteosarcoma, osteonecrosis and bone metastasis, among others. In fact, miRNAs regulate multiple pathological mechanisms, including altering either osteogenic or osteoblast differentiation, metastasis, osteosarcoma cell proliferation, and bone loss. Therefore, in this present review, aiming to impulse the research arena of the biological implications of miRNA transcriptome in bone diseases and to explore their potentiality as a theragnostic target, we summarize the recent findings associated with the clinical significance of miRNAs in these ailments.

Osseous Pathology on Wrist Magnetic Resonance Imaging.

Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.

New Surgical Model for Bone-Muscle Injury Reveals Age and Gender-Related Healing Patterns in the 5 Lipoxygenase (5LO) Knockout Mouse.

Signaling lipid mediators released from 5 lipoxygenase (5LO) pathways influence both bone and muscle cells, interfering in their proliferation and differentiation capacities. A major limitation to studying inflammatory signaling pathways in bone and muscle healing is the inadequacy of available animal models. We developed a surgical injury model in the vastus lateralis (VL) muscle and femur in 129/SvEv littermates mice to study simultaneous musculoskeletal (MSK) healing in male and female, young (3 months) and aged (18 months) WT mice compared to mice lacking 5LO (5LOKO). MSK defects were surgically created using a 1-mm punch device in the VA muscle followed by a 0.5-mm round defect in the femur. After days 7 and 14 post-surgery, the specimens were removed for microtomography (microCT), histopathology, and immunohistochemistry analyses. In addition, non-injured control skeletal muscles along with femur and L5 vertebrae were analyzed. Bones were microCT phenotyped, revealing that aged female WT mice presented reduced BV/TV and trabecular parameters compared to aged males and aged female 5LOKO mice. Skeletal muscles underwent a customized targeted lipidomics investigation for profiling and quantification of lipid signaling mediators (LMs), evidencing age, and gender related-differences in aged female 5LOKO mice compared to matched WT. Histological analysis revealed a suitable bone-healing process with osteoid deposition at day 7 post-surgery, followed by woven bone at day 14 post-surgery, observed in all young mice. Aged WT females displayed increased inflammatory response at day 7 post-surgery, delayed bone matrix maturation, and increased TRAP immunolabeling at day 14 post-surgery compared to 5LOKO females. Skeletal muscles of aged animals showed higher levels of inflammation in comparison to young controls at day 14 post-surgery; however, inflammatory process was attenuated in aged 5LOKO mice compared to aged WT. In conclusion, this new model shows that MSK healing is influenced by age, gender, and the 5LO pathway, which might serve as a potential target to investigate therapeutic interventions and age-related MSK diseases. Our new model is suitable for bone-muscle crosstalk studies.

The role of apoptosis associated speck-like protein containing a caspase-1 recruitment domain (ASC) in response to bone substitutes.

The apoptosis-associated Speck-like protein containing a caspase-1 recruitment domain (ASC), present in inflammasomes, regulates inflammation events and is involved in osteogenic phenotype. Nevertheless, its function in bone repair induced by bone substitute biomaterials is unclear. This study aimed to unveil the role of ASC on osteoprogenitor and tissue response to stoichiometric-hydroxyapatite (HA), nanostructured carbonated-hydroxyapatite (CHA), and CHA containing 5% Strontium (SrCHA), characterized previously by XRD, uXRF-SR, and FTIR spectroscopy implants. Thereafter, conditioned media by the biomaterials were used later to treat pre-osteoblasts and an osteogenic stimulus was shown in response to the materials, with higher expression of Runx2, Osterix, ALP, and Collagen 1a1 genes, with significant involvement of inflammatory-related genes. Thus, to better address the involvement of inflammasome, primary cells obtained from both genotypes [Wild-Type (WT) and ASC Knockout (ASC-KO) mice] were subjected to conditioned media up to 7 days, and our data reinforces both HA and CHA induces lower levels of alkaline phosphatase (ALP) than SrCHA, considering both genotypes (p < 0.01), and ASC seems contribute with osteogenic stimulus promoted by SrCHA. Complimentarily, the biomaterials were implanted into both subcutaneous and bone defects in tibia. Histological analysis on 28 days after implantation of biomaterials into mice's subcutaneous tissue revealed moderate inflammatory response to them. Both histomorphometry and µCT analysis of tibias indicated that the biomaterials did not reverse the delay in bone repair of ASC KO, reinforcing the involvement of ASC on bone regeneration and bone de novo deposition. Also, the bone density in CHA was >2-fold higher in WT than ASC-KO samples. HA was virtually not resorbed throughout the experimental periods, in opposition to CHA in the WT group. CHA reduced to half-area after 28 days, and the bone deposition was higher in CHA for WT mice than HA. Taken together, our results show that biomaterials did not interfere with the healing pattern of the ASC KO, but CHA promoted higher bone deposition in the WT group, probably due to its greater biodegradability. These results reinforce the importance of ASC during bone de novo deposition and healing.

Effects of Nutritional Deficiency of Boron on the Bones of the Appendicular Skeleton of Mice.

Scientific evidence has shown the nutritional importance of boron (B) in the remodeling and repair of cancellous bone tissue. However, the effects of the nutritional deficiency of B on the cortical bone tissue of the appendicular skeleton have not yet been described. Thus, a study was performed to histomorphometrically evaluate the density of osteocyte lacunae of cortical bone of mouse femora under conditions of nutritional deficiency of B and to analyze the effects of the deficiency on the biomechanical properties of mouse tibiae. Weaning, 21-day-old male Swiss mice were assigned to the following two groups: controls (B+; n = 10) and experimental (B-; n = 10). Control mice were fed a basal diet containing 3 mg B/kg, whereas experimental mice were fed a B-deficient diet containing 0.07 mg B/kg for 9 weeks. The histological and histomorphometric evaluations of the mice fed a B-deficient diet showed a decrease in the density of osteocyte lacunae in the femoral cortical bone tissue and the evaluation of biomechanical properties showed lower bone rigidity in the tibia.

Elongated odontoid process in late Holocene skeletal remains from B6 archaeological site, Mendoza, Argentina.

The odontoid process of the axis can be affected by congenital or acquired pathologies. While abnormalities such as os odontoideum, agenesis, and fractures are reported in archaeological remains, the abnormality of an elongated length of the odontoid process has not been described in the paleopathological literature. The aim of this paper is to evaluate two individuals with elongated odontoid processes from a skeletal assemblage from the B6 archaeological site (Mendoza, Argentina), and to discuss the possible etiologies of the condition, with particular attention given to the relation to trauma and Crowned Dens Syndrome (CDS), a condition characterized by the ossification of ligaments of the odontoid process of the second cervical vertebra.

Pathology and causes of death in stranded humpback whales (Megaptera novaeangliae) from Brazil.

This study describes the pathologic findings of 24 humpback whales (Megaptera novaeangliae) found stranded along the Brazilian coast from 2004 to 2016. Eighteen (75%) animals evaluated were found stranded alive. From these, 13 died naturally on shore and five were euthanized. Six died at sea and were washed ashore. Of the 24, 19 (79.2%) were calves, four (16.7%) were juveniles, and one (4.2%) was an adult. The most probable cause of stranding and/or death (CSD) was determined in 23/24 (95.8%) individuals. In calves, CSD included neonatal respiratory distress (13/19; 68.4%), infectious disease (septicemia, omphaloarteritis and urachocystitis; 3/19; 15.8%), trauma of unknown origin (2/19; 10.5%), and vehicular trauma (vessel strike; 1/19; 5.3%). In juveniles and adult individuals, CSD was: emaciation (2/5; 40%), sunlight-thermal burn shock (1/5; 20%); and discospondylitis (1/5; 20%). In one juvenile, the CSD was undetermined (1/5; 20%). This study integrates novel findings and published case reports to delineate the pathology of a South-western Atlantic population of humpback whales. This foundation will aid in the assessment of the population health and establish a baseline for development of conservation policies.

Condylar Hyperplasia in a Monozygotic Twin Girl: An Argument About Etiology.

The diagnosis of unilateral condylar hyperplasia (UCH) requires a combined assessment consisting of clinical, radiological, and histopathological examination. The etiology of this condition is unknown. The purpose of this study is to report a rare case of UCH in a monozygotic twin. A 15-year-old girl was referred to our department complaining of facial asymmetry and malocclusion. Computed tomography and single-photon emission computed tomography imaging reveal enlargement of the left condyle and condylar neck, and an increased uptake that was diagnosed as active UCH. During the investigation of family and co-twin facial profile, no cases of UCH were identified. From the case reported in this study, the authors raise a hypothesis that can exist some environmental factor that is related in the development of condylar hyperplasia given the occurrence of this disease in one of twins.

High altitude agriculture in the Titicaca basin (800 BCE-200 CE): Impacts on nutrition and disease load.

OBJECTIVES: This study investigates the biological impacts of sedentism and agriculture on humans living in the high altitude landscape of the Titicaca Basin between 800 BCE and CE 200. The transition to agriculture in other global areas resulted in increases in disease and malnutrition; the high altitude of the Titicaca Basin could have exacerbated this. Our objective is to test whether the high altitude of the Titicaca Basin created a marginal environment for early agriculturalists living there, reflected through elevated rates of malnutrition and/or disease. METHODS: To test this, we analyzed human remains excavated from seven archaeological sites on the Copacabana Peninsula for markers of diet and disease. These markers included dental caries, dental abscesses, cribra orbitalia, porotic hyperostosis, periosteal reactions, osteomyelitis, and linear enamel hypoplasia. RESULTS: Results showed that markers of diet did not support malnutrition or micronutrient deficiencies but instead, indicated a relatively diverse diet for all individuals. Markers of disease also did not vary significantly but were common, indicating circulation of pathogens or chronic bodily stress. CONCLUSIONS: We interpret these results as an indication that while diets remained nutritious, investment in the landscape exposed populations to issues of sanitation and disease. The high-altitude of the Titicaca Basin did not exacerbate the biological impacts of agriculture in terms of increased malnutrition. Additionally, disease load was likely related to problems faced by many sedentary groups as opposed to unique challenges posed by high altitude. In sum, despite the high elevation, the Titicaca Basin is not truly a marginal environment for humans.

Antineoplastic treatment effect on bone mineral density in Mexican breast cancer patients.

BACKGROUND: Breast cancer is the most deadly malignancy in Mexican women. Although treatment has improved, it may significantly affect bone mineral status in those who receive it. The aim of this study was to assess the impact of cancer treatment on bone mineral density (BMD) and bone mineral content (BMC), in patients with breast cancer and explore the interaction of menopausal status and clinical stage with cancer treatment on such changes. METHODS: A quasi-experimental design was applied with measurements before and after a chemotherapy treatment in 40 patients with primary diagnosis of invasive breast cancer. BMD and body composition measurements were taken by dual X-ray absorptiometry (DXA) and changes in these variables due to therapy were analyzed using mixed regression for repeated measurements. RESULTS: Significant loss was found in femoral neck and L2-L4 BMD (p < 0.001). Patients diagnosed with osteopenia or osteoporosis received calcium + vitamin D supplementation (600 mg/200 IU day). It showed a protective effect in the decrease of femoral neck BMD and total BMC. BMD loss in both femoral neck and L2-L4 BMD was higher in premenopausal women: 0.023 g/cm2 in femoral neck and 0.063 g/cm2 in L2-L4 (p < 0.001), while in postmenopausal women BMD loss was 0.015 g/cm2 in femoral neck and 0.035 g/cm2 in L2-L4 (p = 0.021 and p = 0.001 respectively). Change in lumbar spine BMD was prominent in premenopausal women with advanced clinical stage (IIB, IIIA, IIIB): 0.066 g/cm2 (p = 0.003). CONCLUSION: The antineoplastic breast cancer treatment with chemotherapy had a negative impact on BMD, in premenopausal women overall, although a differential effect was found according to clinical stage and calcium supplementation status.

Skeletal involvement in Gaucher disease: An observational multicenter study of prognostic factors in the Argentine Gaucher disease patients.

Patients with Gaucher type 1 (GD1) throughout Argentina were enrolled in the Argentine bone project to evaluate bone disease and its determinants. We focused on presence and predictors of bone lesions (BL) and their relationship to therapeutic goals (TG) with timing and dose of enzyme replacement therapy (ERT). A total of 124 patients on ERT were enrolled in a multi-center study. All six TG were achieved by 82% of patients: 70.1% for bone pain and 91.1% for bone crisis. However, despite the fact that bone TGs were achieved, residual bone disease was present in 108 patients on ERT (87%) at time 0. 16% of patients showed new irreversible BL (bone infarcts and avascular osteonecrosis) despite ERT, suggesting that they appeared during ERT or were not detected at the moment of diagnosis. We observed 5 prognostic factors that predicted a higher probability of being free of bone disease: optimal ERT compliance; early diagnosis; timely initiation of therapy; ERT initiation dose ≥45 UI/kg/EOW; and the absence of history of splenectomy. Skeletal involvement was classified into 4 major phenotypic groups according to BL: group 1 (12.9%) without BL; group 2 (28.2%) with reversible BL; group 3 (41.9%) with reversible BL and irreversible chronic BL; and group 4 (16.9%) with acute irreversible BL. Our study identifies prognostic factors for achieving best therapeutic outcomes, introduces new risk stratification for patients and suggests the need for a redefinition of bone TG. Am. J. Hematol. 91:E448-E453, 2016. © 2016 Wiley Periodicals, Inc.

Pathology in skeletons of Peale's dolphin Lagenorhynchus australis from southern South America.

Peale's dolphin Lagenorhynchus australis is frequently seen off the coast of southern South America, where it feeds among coastal kelp beds and occasionally strands. We searched for macroscopic evidence of skeletal lesions in 78 specimens of Peale's dolphin from 2 museum collections, which contain almost all of the species' skeletons known in collections worldwide. Thirty-two specimens (41%) had some type of osteological abnormalities. In 21 cases (66%), congenital deformations were the most predominant abnormality found. Acquired lesions included (1) induced trauma: abnormal curvature (n=5 specimens) and fractures (n=2); (2) infectious diseases: spondylo-osteomyelitis (n=3); and (3) degenerative diseases: exostoses (n=8) and spondylosis deformans (n=4). It is noteworthy that all of these animals died incidentally in gillnet entanglement and were presumably healthy at the time of death. The effect that different osseous lesions may have on an animal's quality of life may depend on the area of the spine affected and the number of vertebrae involved.

[Bone morphogenetic proteins (BMP): clinical application for reconstruction of bone defects]. / Proteínas morfogenéticas óseas (BMP): aplicación clínica para reconstrucción de defectos en hueso.

Since the introduction of bone morphogenetic proteins, their use has become an invaluable ally for the treatment of bone defects. These proteins are potent growth factors, related to angiogenic and osteogenic activity. The osteoinductive capacity of recombinant bone morphogenetic protein (rhBMP) in the formation of bone and cartilage has been confirmed in in vitro studies and evaluated in clinical trials. To obtain a therapeutic effect, administration is systemic, by injection over the physiological dose. Among the disadvantages, ectopic bone formation or high morbidity in cases of spinal fusion is observed. In this review, the roles of bone morphogenetic proteins in bone repair and clinical applications are analyzed. These findings represent advances in the study of bone regeneration and application of growth factors for more predictable results.

Spontaneous remission of eosinophilic granuloma of the maxilla after incisional biopsy: a case report.

BACKGROUND: Langerhans cell histiocytosis (LCH), previously known as Histiocytosis X, is an infrequent disease that congregates a wide spectrum of clinical presentations with variable systemic involvement. Unification of these diseases under only one category is based on the almost identical histopathologic features of the lesions, but the etiology and proper approach for each presentation remains controversial. The localized alternative of Langerhans cell histiocytosis (LLCH), known as Eosinophilic Granuloma (EG) of bone, is the predominant clinical presentation of LCH. The maxilla is involved in 1 % of the head and neck region cases, representing an uncommon condition in this area. CASE PRESENTATION: In this clinical case report, it is described a case of a 16-year-old male patient with an asymptomatic osteolytic lesion at first upper left molar apical level, a finding detected on control radiographic images was reported as "Monostotic Eosinophilic granuloma of the maxillary bone", which was later confirmed through an incisional biopsy. A surgical excision was initially planned, but finally it was not performed due to a spontaneous healing of the lesion after the incisional biopsy. CONCLUSIONS: The presented case supports a conservative approach in the management of solitary EG of maxillary and mandibular bone lesions and even supports an expectant attitude in the course of treatment given the possibility of a spontaneous regression after the biopsy, especially in small lesions.

Bone and Celiac Disease.

More than 50% of untreated patients with celiac disease (CD) have bone loss detected by bone densitometry (dual-energy X-ray absorptiometry:DXA). Moreover, patients with CD are more likely to have osteoporosis and fragility fractures, especially of the distal radius. Although still controversial, we recommend DXA screening in all celiac disease patients, particularly in those with symptomatic CD at diagnosis and in those who present risk factors for fracture such as older age, menopausal status, previous fracture history, and familial hip fracture history. Bone microarchitecture, especially the trabecular network, may be deteriorated, explaining the higher fracture risk in these patients. Adequate calcium and vitamin D supplementation are also recommended to optimize bone recovery, especially during the first years of gluten free diet (GFD). If higher fracture risk persists after 1 or 2 years of GFD, specific osteoactive treatment may be necessary to improve bone health.