Metabolism in Diseases of the 

 Bones and Joints 



FRANCIS H. Me CRUDDEN 



BOSTON 



Introduction 



Diseases of the bones and diseases of the joints cannot be sharply 

 separated into two distinct groups. There are all gradations, from osteo- 

 malacia and osteitis deformans, which are, clinically, bone diseases, but 

 with secondary changes in the joints, through rickets which is, clinically, a 

 disease of the bones and joints, to atrophic arthritis, hypertrophic ar- 

 thritis; and the trophic arthropathies such as Charcot's joints which are, 

 clinically, joint diseases with secondary changes in the bones. And this 

 is especially true when we consider the metabolism of these diseases, since 

 the metabolic disturbances accompanying the bone changes, minor and 

 secondary, from the clinical point of view, may overshadow the minor 

 metabolic disturbances accompanying the joint changes. 



For the present it will be best to accept the usual clinical classification 

 and discuss only osteomalacia, rickets, osteoporosis, osteitis deformans, 

 osteopsathyrosis, and osteogenesis imperfecta under bone diseases. Under 

 diseases of the joints will be discussed the diseases usually clinically con- 

 sidered as arthropathies, even though the bone changes are the predom- 

 inating feature from the standpoint of metabolism. 



I. Diseases of the Bones 



Point of view is of prime importance in discussing bone diseases. 

 Rickets, for example, can be considered from the standpoint of the pedia- 

 trician, in which case its relation to other children's diseases and to the 

 age of the patient will be emphasized. Osteomalacia can be considered 

 from the standpoint of the obstetrician and gynecologist, in which case its 

 relation to pregnancy, lactation and the ovarian activities will be em- 

 phasized. Treated from these points of view, very little emphasis will be 

 placed on the most significant relationship of all, namely, the relationship 



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