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Weird Medical Conditions: Disappearing Bone Disease

Thanks to a Stuff You Should Know listener named Dr. Bob, we can say we've heard of a condition called disappearing bone disease which, amazingly, is exactly what it sounds like. The clinical term for the condition, which is surprisingly not hereditary, is massive osteolysis. But perhaps most frequently, it's called Gorham's disease, after Dr. Lemuel Gorham, one of the condition's pioneering investigators who co-authored the first comprehensive survey and study on it in the 1950s.

If you've heard our episode on broken bones, you already know that the human skeleton is in a constant process of breaking down and absorbing old bone cells and replacing them with new ones. Gorham's may be the interruption, and possibly acceleration, of this normal process. After a fracture, the process of regenerating bone is overtaken by the process of absorbing bone and the bone is broken down into nothing, sometimes even leaving the surrounding soft tissues and blood vessels intact. The bone just kind of disappears, as the name suggests.

Since it's not passed down through families, it tends to take the sufferer by surprise. It's usually first detected following a fracture, but this initial fracture frequently falls into the category of spontaneous fractures, where a bone breaks after only normal pressure (like that from walking or leaning) is applied to it. It was back in 1838 that the first case was described in what would become the New England Journal of Medicine and the patient, a Mr. Brown -- who still had the use of his arm, despite its lack of a humerus - has the foresight to include in his will that his arm be investigated for science. When Mr. Brown died 33 years after the first report about his condition was published, physicians cracked open his arm and found everything in order except for the fact that he was indeed missing a substantial amount of bone tissue. It was just gone.

Still today, medical science isn't sure what causes Gorham's. Over the decades, investigation of the maybe 200 cases ever described in the literature has yielded a probable answer, however. Cases of Gorham's are always accompanied by angiomatosis, a type of tumor where capillaries bundle together and begin to grow out of control. It's suspected that something in this uncontrolled growth either triggers the increase of the osteoclasts, the natural bone destroying cells, triggers a decrease in osteoblasts, the cells that build new bone, or triggers both actions. Over time, this change in the natural process could lead to a weakened bone that fractures spontaneously, and then is ultimately absorbed into the body rather than healed.

What's perhaps most mysterious is that a number of cases of Gorham's have ended in spontaneous remission, where it just kind of goes away. Weird.

Bonus: Maybe this lady has it

Topics in this Post: Blogpost, Stuff You Should Know, medicine