Osseous xanthomatosis and pathologic fractures in familial hyperlipemia (hyperglyceridemia): Observations during chlorophenoxyisobutyrate, estrogen and androgen therapy

Abstract

Xanthomatosis in subjects with hyperlipidemia rarely involves bone, and pathologic fractures at the site of osseous lesions have not been reported. This unusual course was noted in a sixty-six year old woman with “carbohydrate-accentuated” hyperglyceridemia in whom cutaneous xanthomas had appeared twelve years previously. Roentgenograms revealed osteolytic areas in both humeral and femoral shafts. Pathologic fractures were present in both humeri and a third fracture subsequently occurred in the right femur. Biopsy of the femur revealed xanthomatosis with cholesterol clefts but without eosinophilia. Immobilization and appropriate measures to control the hyperlipidemia were followed by healing with callus formation. The development of postmenopausal osteoporosis in the presence of long-standing hyperlipemia was considered an important factor predisposing to the development of these unusual manifestations in bone.