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Autosomal recessive osteopetrosis 2(OPTB2)

MedGen UID:
342420
Concept ID:
C1850126
Disease or Syndrome
Synonyms: Osteopetrosis osteoclast-poor; OSTEOPETROSIS, MILD AUTOSOMAL RECESSIVE FORM; TNFSF11-Related Autosomal Recessive Osteopetrosis
 
Gene (location): TNFSF11 (13q14.11)
 
Monarch Initiative: MONDO:0009816
OMIM®: 259710

Definition

Osteopetrosis is a bone disease that makes bone tissue abnormally compact and dense and also prone to breakage (fracture). Researchers have described several major types of osteopetrosis, which are usually distinguished by their pattern of inheritance: autosomal dominant or autosomal recessive. The different types of the disorder can also be distinguished by the severity of their signs and symptoms.

Autosomal dominant osteopetrosis (ADO), which is also called Albers-Schönberg disease, is typically the mildest type of the disorder. Some affected individuals have no symptoms. In affected people with no symptoms, the unusually dense bones may be discovered by accident when an x-ray is done for another reason. 

In individuals with ADO who develop signs and symptoms, the major features of the condition include multiple bone fractures after minor injury, abnormal side-to-side curvature of the spine (scoliosis) or other spinal abnormalities, arthritis in the hips, and a bone infection called osteomyelitis. These problems usually become apparent in late childhood or adolescence.

Autosomal recessive osteopetrosis (ARO) is a more severe form of the disorder that becomes apparent in early infancy. Affected individuals have a high risk of bone fracture resulting from seemingly minor bumps and falls. Their abnormally dense skull bones pinch nerves in the head and face (cranial nerves), often resulting in vision loss, hearing loss, and paralysis of facial muscles. Dense bones can also impair the function of bone marrow, preventing it from producing new blood cells and immune system cells. As a result, people with severe osteopetrosis are at risk of abnormal bleeding, a shortage of red blood cells (anemia), and recurrent infections. In the most severe cases, these bone marrow abnormalities can be life-threatening in infancy or early childhood.

Other features of autosomal recessive osteopetrosis can include slow growth and short stature, dental abnormalities, and an enlarged liver and spleen (hepatosplenomegaly). Depending on the genetic changes involved, people with severe osteopetrosis can also have brain abnormalities, intellectual disability, or recurrent seizures (epilepsy).

A few individuals have been diagnosed with intermediate autosomal osteopetrosis (IAO), a form of the disorder that can have either an autosomal dominant or an autosomal recessive pattern of inheritance. The signs and symptoms of this condition become noticeable in childhood and include an increased risk of bone fracture and anemia. People with this form of the disorder typically do not have life-threatening bone marrow abnormalities. However, some affected individuals have had abnormal calcium deposits (calcifications) in the brain, intellectual disability, and a form of kidney disease called renal tubular acidosis. [from MedlinePlus Genetics]

Clinical features

From HPO
Genu valgum
MedGen UID:
154364
Concept ID:
C0576093
Anatomical Abnormality
The legs angle inward, such that the knees are close together and the ankles far apart.
Hepatosplenomegaly
MedGen UID:
9225
Concept ID:
C0019214
Sign or Symptom
Simultaneous enlargement of the liver and spleen.
Hydrocephalus
MedGen UID:
9335
Concept ID:
C0020255
Disease or Syndrome
Hydrocephalus is an active distension of the ventricular system of the brain resulting from inadequate passage of CSF from its point of production within the cerebral ventricles to its point of absorption into the systemic circulation.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Cranial nerve compression
MedGen UID:
141743
Concept ID:
C0521670
Disease or Syndrome
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Anemia
MedGen UID:
1526
Concept ID:
C0002871
Disease or Syndrome
A reduction in erythrocytes volume or hemoglobin concentration.
Pancytopenia
MedGen UID:
18281
Concept ID:
C0030312
Disease or Syndrome
An abnormal reduction in numbers of all blood cell types (red blood cells, white blood cells, and platelets).
Thrombocytopenia
MedGen UID:
52737
Concept ID:
C0040034
Disease or Syndrome
A reduction in the number of circulating thrombocytes.
Extramedullary hematopoiesis
MedGen UID:
392862
Concept ID:
C2613439
Disease or Syndrome
The process of hematopoiesis occurring outside of the bone marrow (in the liver, thymus, and spleen) in the postnatal organisms.
Facial paralysis
MedGen UID:
5101
Concept ID:
C0015469
Disease or Syndrome
Complete loss of ability to move facial muscles innervated by the facial nerve (i.e., the seventh cranial nerve).
Recurrent fractures
MedGen UID:
42094
Concept ID:
C0016655
Injury or Poisoning
The repeated occurrence of bone fractures (implying an abnormally increased tendency for fracture).
Osteopetrosis
MedGen UID:
18223
Concept ID:
C0029454
Finding
Abnormally increased formation of dense trabecular bone tissue. Despite the increased density of bone tissue, osteopetrotic bones tend to be more fracture-prone than normal.
Cranial hyperostosis
MedGen UID:
318629
Concept ID:
C1832451
Finding
Excessive growth of the bones of cranium, i.e., of the skull.
Decreased osteoclast count
MedGen UID:
868116
Concept ID:
C4022507
Finding
Decreased number of osteoclasts in bone tissue.
Diaphyseal sclerosis
MedGen UID:
1631208
Concept ID:
C4551853
Finding
An elevation in bone density in one or more diaphyses. Sclerosis is normally detected on a radiograph as an area of increased opacity.
Osteomyelitis
MedGen UID:
10497
Concept ID:
C0029443
Disease or Syndrome
Osteomyelitis is an inflammatory process accompanied by bone destruction and caused by an infecting microorganism.
Mandibular osteomyelitis
MedGen UID:
266218
Concept ID:
C1290708
Disease or Syndrome
Osteomyelitis of the lower jaw.
Carious teeth
MedGen UID:
8288
Concept ID:
C0011334
Disease or Syndrome
Caries is a multifactorial bacterial infection affecting the structure of the tooth. This term has been used to describe the presence of more than expected dental caries.
Persistence of primary teeth
MedGen UID:
75597
Concept ID:
C0266050
Disease or Syndrome
Persistence of the primary teeth beyond the age by which they normally are shed and replaced by the permanent teeth.
Mandibular prognathia
MedGen UID:
98316
Concept ID:
C0399526
Finding
Abnormal prominence of the chin related to increased length of the mandible.
Chronic rhinitis due to narrow nasal airway
MedGen UID:
870858
Concept ID:
C4025318
Disease or Syndrome
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.
Optic atrophy
MedGen UID:
18180
Concept ID:
C0029124
Disease or Syndrome
Atrophy of the optic nerve. Optic atrophy results from the death of the retinal ganglion cell axons that comprise the optic nerve and manifesting as a pale optic nerve on fundoscopy.
Blindness
MedGen UID:
99138
Concept ID:
C0456909
Disease or Syndrome
Blindness is the condition of lacking visual perception defined as a profound reduction in visual perception. On the 6m visual acuity scale, blindness is defined as less than 3/60. On the 20ft visual acuity scale, blindness is defined as less than 20/400. On the decimal visual acuity scale, blindness is defined as less than 0.05. Blindness is typically characterized by a visual field of no greater than 10 degrees in radius around central fixation.

Professional guidelines

PubMed

Even-Or E, Schiesel G, Simanovsky N, NaserEddin A, Zaidman I, Elpeleg O, Mor-Shaked H, Stepensky P
Bone 2022 Jan;154:116229. Epub 2021 Oct 8 doi: 10.1016/j.bone.2021.116229. PMID: 34624559
Teti A, Econs MJ
Bone 2017 Sep;102:50-59. Epub 2017 Feb 4 doi: 10.1016/j.bone.2017.02.002. PMID: 28167345
Martinez C, Polgreen LE, DeFor TE, Kivisto T, Petryk A, Tolar J, Orchard PJ
Bone Marrow Transplant 2010 May;45(5):939-44. Epub 2009 Oct 5 doi: 10.1038/bmt.2009.277. PMID: 19802031Free PMC Article

Recent clinical studies

Etiology

Spinnato P, Pedrini E, Petrera MR, Zarantonello P, Trisolino G, Sangiorgi L, Carpenzano M, Crombé A, Tetta C
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Am J Med Genet A 2022 Oct;188(10):3096-3099. Epub 2022 Aug 1 doi: 10.1002/ajmg.a.62897. PMID: 35915932
Xue JY, Grigelioniene G, Wang Z, Nishimura G, Iida A, Matsumoto N, Tham E, Miyake N, Ikegawa S, Guo L
J Bone Miner Res 2022 Feb;37(2):226-235. Epub 2021 Nov 11 doi: 10.1002/jbmr.4462. PMID: 34668226
Even-Or E, Schiesel G, Simanovsky N, NaserEddin A, Zaidman I, Elpeleg O, Mor-Shaked H, Stepensky P
Bone 2022 Jan;154:116229. Epub 2021 Oct 8 doi: 10.1016/j.bone.2021.116229. PMID: 34624559
Teti A, Econs MJ
Bone 2017 Sep;102:50-59. Epub 2017 Feb 4 doi: 10.1016/j.bone.2017.02.002. PMID: 28167345

Diagnosis

Spinnato P, Pedrini E, Petrera MR, Zarantonello P, Trisolino G, Sangiorgi L, Carpenzano M, Crombé A, Tetta C
Genes (Basel) 2022 Oct 28;13(11) doi: 10.3390/genes13111965. PMID: 36360203Free PMC Article
Luong LH, Nguyen HD, Trung TN, Minh TMT, Khanh TL, Son TP, Tran TD, Nguyen TT
Am J Med Genet A 2022 Oct;188(10):3096-3099. Epub 2022 Aug 1 doi: 10.1002/ajmg.a.62897. PMID: 35915932
Gresky J, Dellú E, Favia M, Ferorelli D, Radina F, Scardapane A, Petiti E
Int J Paleopathol 2021 Jun;33:280-288. Epub 2021 May 31 doi: 10.1016/j.ijpp.2021.05.006. PMID: 34082191
Gillani S, Abbas Z
J Ayub Med Coll Abbottabad 2017 Apr-Jun;29(2):350-352. PMID: 28718264
de Vernejoul MC
Best Pract Res Clin Rheumatol 2008 Mar;22(1):71-83. doi: 10.1016/j.berh.2007.12.011. PMID: 18328982

Therapy

Olgaç A, Tümer L, Boyunağa Ö, Kızılkaya M, Hasanoğlu A
J Trop Pediatr 2015 Apr;61(2):146-50. Epub 2015 Feb 11 doi: 10.1093/tropej/fmv001. PMID: 25673572
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Brain 2011 Dec;134(Pt 12):3502-15. Epub 2011 Nov 26 doi: 10.1093/brain/awr302. PMID: 22120147
Martinez C, Polgreen LE, DeFor TE, Kivisto T, Petryk A, Tolar J, Orchard PJ
Bone Marrow Transplant 2010 May;45(5):939-44. Epub 2009 Oct 5 doi: 10.1038/bmt.2009.277. PMID: 19802031Free PMC Article
Mohn A, Capanna R, Delli Pizzi C, Morgese G, Chiarelli F
Minerva Pediatr 2004 Feb;56(1):115-8. PMID: 15249921
Gerritsen EJ, Vossen JM, Fasth A, Friedrich W, Morgan G, Padmos A, Vellodi A, Porras O, O'Meara A, Porta F
J Pediatr 1994 Dec;125(6 Pt 1):896-902. doi: 10.1016/s0022-3476(05)82004-9. PMID: 7996361

Prognosis

Dulski J, Souza J, Santos ML, Wszolek ZK
Orphanet J Rare Dis 2023 Jun 22;18(1):160. doi: 10.1186/s13023-023-02772-9. PMID: 37349768Free PMC Article
Spinnato P, Pedrini E, Petrera MR, Zarantonello P, Trisolino G, Sangiorgi L, Carpenzano M, Crombé A, Tetta C
Genes (Basel) 2022 Oct 28;13(11) doi: 10.3390/genes13111965. PMID: 36360203Free PMC Article
Luong LH, Nguyen HD, Trung TN, Minh TMT, Khanh TL, Son TP, Tran TD, Nguyen TT
Am J Med Genet A 2022 Oct;188(10):3096-3099. Epub 2022 Aug 1 doi: 10.1002/ajmg.a.62897. PMID: 35915932
Gillani S, Abbas Z
J Ayub Med Coll Abbottabad 2017 Apr-Jun;29(2):350-352. PMID: 28718264
Pangrazio A, Cassani B, Guerrini MM, Crockett JC, Marrella V, Zammataro L, Strina D, Schulz A, Schlack C, Kornak U, Mellis DJ, Duthie A, Helfrich MH, Durandy A, Moshous D, Vellodi A, Chiesa R, Veys P, Lo Iacono N, Vezzoni P, Fischer A, Villa A, Sobacchi C
J Bone Miner Res 2012 Feb;27(2):342-51. doi: 10.1002/jbmr.559. PMID: 22271396Free PMC Article

Clinical prediction guides

Dulski J, Souza J, Santos ML, Wszolek ZK
Orphanet J Rare Dis 2023 Jun 22;18(1):160. doi: 10.1186/s13023-023-02772-9. PMID: 37349768Free PMC Article
Zirngibl RA, Wang A, Yao Y, Manolson MF, Krueger J, Dupuis L, Mendoza-Londono R, Voronov I
J Cell Biochem 2019 Oct;120(10):17180-17193. Epub 2019 May 20 doi: 10.1002/jcb.28979. PMID: 31111556
Guo L, Elcioglu NH, Karalar OK, Topkar MO, Wang Z, Sakamoto Y, Matsumoto N, Miyake N, Nishimura G, Ikegawa S
J Hum Genet 2018 Jun;63(6):769-774. Epub 2018 Mar 22 doi: 10.1038/s10038-018-0447-6. PMID: 29568001
Gillani S, Abbas Z
J Ayub Med Coll Abbottabad 2017 Apr-Jun;29(2):350-352. PMID: 28718264
Felix R, Hofstetter W, Cecchini MG
Eur J Endocrinol 1996 Feb;134(2):143-56. doi: 10.1530/eje.0.1340143. PMID: 8630510

Recent systematic reviews

Dulski J, Souza J, Santos ML, Wszolek ZK
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