Skeletal manifestations of leprosy: Analysis of 137 patients from different clinical settings in the pre- and postmodern treatment eras

This study was conducted to further characterize the nature of leprosy-rela ted bone alterations, to develop a hypothesis of their pathophysiology, and to define the impact of treatment on bone damage. Radiographs of 60 patien ts under care at the Carville, Louisiana leprosy hospital were compared wit h 50 from the early (before availability of effective treatment) part of th is century and with 27 from the Toronto (Ontario, Canada) leprosy clinic. Two-thirds of lesions were so severe that distal digital tufts had been los t to whittling, resorption, or fragmentation. Fifty percent were felt to be pathognomonic for the changes of leprosy. Resorption, fragmentation, and malaligned fractures are highly suggestive o f leprosy, while diaphyseal whittling appears specific when medullary scler osis or wavy diaphyseal borders are present. Medicinal intervention appeare d to be of limited benefit for bone damage; perhaps greater attention to jo int/bone protection (as recommended in diabetes management) will prove help ful. Environmental adjustment to minimize injury risk and daily limb examin ation for injury are recommended.