Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Genetics of Osteogenesis Imperfecta

  • Author: Eric T Rush, MD, FAAP, FACMG; Chief Editor: Luis O Rohena, MD  more...
 
Updated: Feb 29, 2016
 

Background

Osteogenesis imperfecta (OI) is a disorder of bone fragility chiefly caused by mutations in the COL1A1 and COL1A2 genes that encode type I procollagen. Four types of osteogenesis imperfecta were originally described by Sillence in 1979, and are now used broadly as the Sillence Criteria.[1] The Nosology and Classification of Genetic Skeletal Disorders provides similar categorization in the 2010 revision.[2] Precise typing is often difficult. Severity ranges from mild forms to lethal forms in the perinatal period. In addition, new genes have been discovered which also cause brittle bones and as they are typically clinically indistinguishable are considered by most to be subtypes of osteogenesis imperfecta.[3] Examples of common radiologic findings of osteogenesis imperfecta are shown in the images below.

Acute fractures are observed in the radius and uln Acute fractures are observed in the radius and ulna. Multiple fractures can be seen in the ribs. Old healing humeral fracture with callus formation is observed.
Beaded ribs. Multiple fractures are seen in the lo Beaded ribs. Multiple fractures are seen in the long bones of the upper extremities.
Wormian bones are present in the skull. Wormian bones are present in the skull.
This newborn has bilateral femoral fractures. This newborn has bilateral femoral fractures.
Next

Pathophysiology

The most widely used classification of osteogenesis imperfecta published by Sillence et al in 1979 does not include additional forms of the disorder which have been discovered with improvements in molecular diagnostics.[4] Rather, these forms of osteogenesis imperfecta are caused by genes which interact with collagen I or in the complex relationship between formation and remodeling of bone. They are molecularly distinct from osteogenesis imperfecta caused by COL1A1 or COL1A2 but form an example of locus heterogeneity.

COL1A1/COL1A2 (Types I-IV)

Type I collagen fibers are found in the bones, organ capsules, fascia, cornea, sclera, tendons, meninges, and dermis. Type I collagen, which constitutes approximately 30% of the human body by weight, (90% of the protein within bone) is defective in osteogenesis imperfecta. In structural terms, type I collagen fibers are composed of a left-handed helix formed by intertwining of pro-alpha 1 and pro-alpha 2 chains. Mutations in the genes that encode these chains cause osteogenesis imperfecta (COL1A1 at 17q21 and COL1A2 at 7q22.1, respectively).

Qualitative defects (eg, an abnormal collagen I molecule) and quantitative defects (eg, decreased production of normal collagen I molecules) are described. Quantitative defects most frequently result from missense mutations in a glycine-coding codon and cause disease due to a dominant negative effect. There is not a perfect correlation between genotype and phenotype, but a few observations have been made. First, generally speaking mutations in the COL1A1 gene will tend to be more severe than a corresponding mutation in the COL1A2 gene, likely due to the fact that that two alpha 1 chains are required and only one alpha 2 chain is required to make the procollagen I heterotrimer. Second, mutations located at the carboxyl terminal domain of each of the genes are more severe than in other domains. In particular, missense mutations in COL1A1 in this region are frequently (but not always) lethal. Third, size and polarity matter to the severity of the mutation. As an example, a substitution of glycine for alanine, which is only slightly larger, nonpolar, and with similar chemical properties, is likely to result in a milder phenotype. Contrast this with a substitution of glycine for glutamic acid at the same position, which is large, negatively charged, and with different chemical properties and is more likely to be severe or even lethal. Quantitative defects often result from nonsense mutations but can result from larger deletions in one of the procollagen genes and cause disease due to haploinsufficiency effect, as the prematurely truncated mRNA undergoes nonsense-mediated decay (NMD); while the patient is left with structurally normal collagen, he or she makes only half the normal amount. These patients have mild nondeforming (Type I) osteogenesis imperfecta.

A study by Balasubramanian et al indicated that COL1A1/COL1A2 mutations consistently result in collagen fibril diameter variability and collagen flowers.[5]

Osteogenesis Imperfecta with Calcification of the Interosseous Membranes (Type V)

Patients with this form of osteogenesis imperfecta generally have moderate severity disease, but frequently develop hyperplastic calluses in long bones after having a fracture or orthopedic surgery that involves osteotomies. The size and shape of the callus may remain stable for many years after a rapid growth period. Patients also frequently develop calcification of the forearm interosseous membrane and dislocation of the radial head. They may also have subphyseal metaphyseal radiodensity seen on radiograph.[6] This condition is caused by heterozygous mutations in the IFITM5 gene, and inheritance is autosomal dominant.[7]

Histology of bone showed that the lamellae are arranged in an irregular fashion and in some cases appeared meshlike, as opposed to the typical parallel arrangement in patients with osteogenesis imperfecta.

Other Forms of Osteogenesis Imperfecta

SERPINFI (Type VI)

Patients with this form of osteogenesis imperfecta generally have moderate severity disease. It was observed that many patients with this form of osteogenesis imperfecta do not have fractures at birth and only develop them later in infancy or as toddlers. Patients with this form of osteogenesis imperfecta have been described as having variably blue or white sclerae and have normal teeth.[8] This condition is caused by homozygous mutation in the SERPINF1 gene, and inheritance is autosomal recessive.[9]

Histology of bone showed a characteristic fish-scale appearance to the lamellae and at least one author has commented on the presence of large quantities of unmineralized osteoid on biopsy specimens.

CRTAP/LEPRE1/PPIB (Types VII-IX)

Patients with osteogenesis imperfecta caused by mutations in these three genes generally have severe disease, with examples of lethal disease being noted. Cartilage-associated protein (CRTAP) is a protein required for prolyl 3-hydroxylation, and with the protein products of the LEPRE1 and PPIB genes, forms a heterotrimeric protein that is crucial for proper posttranslational modification of collagen I. Osteogenesis imperfecta caused by mutations in CRTAP have been designated type VII disease, whereas osteogenesis imperfecta caused by mutations in LEPRE1 and PPIB are designated type VIII and type IX disease, respectively.[10] These conditions are caused by homozygous or compound heterozygous mutations and are inherited in an autosomal recessive manner.

SERPINH1 (Type X)

Only one patient with this form of osteogenesis imperfecta has been reported. This male patient was born to a clinically normal consanguineous union of Saudi Arabian origin. He was reported to have severe deforming osteogenesis imperfecta with dentinogenesis imperfecta, nephrocalcinosis, and chronic lung disease. He died at 3 years of age from respiratory complications. Genetic testing of this child found a previously described homozygous mutation in the SERPINH1 gene.[11] The protein product of SERPINH1 is a chaperone in the ER that appears to function in collagen trafficking.

FKBP10 (Type XI)

A small number of patients with this form of osteogenesis imperfecta have been reported and severity has been moderate to severe. It is caused by homozygous mutations in the FKBP10 gene and is inherited in an autosomal recessive manner.[12] It is understood that some patients with Bruck syndrome, type II also have mutations in this gene, but the full spectrum of clinical findings is not understood, and it has been proposed to designate FKBP10 -related disorders as recessive forms of progressive deforming osteogenesis imperfecta with or without joint contractures.[13] The protein product of FKBP10 is a chaperone that participates in collagen folding and mutation impairs its secretion.[14]

Histology of bone showed a distorted lamellar structure and a fish scale pattern.

SP7 (Type XII)

Only one patient with this form of osteogenesis imperfecta has been reported and had moderate severity disease. This male patient was the product of a second-cousin union and in addition to fractures had delay in tooth eruption, normal hearing, and white sclerae. A sibling was similarly affected, but also died of a presumably unrelated congenital heart defect. The surviving child had homozygous deletions in the SP7 gene, and this form of osteogenesis imperfecta is inherited in an autosomal recessive fashion.[15] The protein product of SP7 is required for osteoblast differentiation and bone formation. In a null mutant animal model, no cortical bone or bone trebeculae were formed through intramembraneous or endochondral ossification.[16]

BMP1 (Type XIII)

A small number of patients with this form of osteogenesis imperfecta have been described and have generally had severe disease with frequent fractures and severe growth deficiency. However, two siblings described had only borderline low bone density. Patients with this form of osteogenesis imperfecta were described with normal teeth and blue sclerae.[17] This form of osteogenesis imperfecta is caused by homozyous mutation in the BMP1 gene, and it is inherited in an autosomal recessive manner. The BMP1 protein product appears to play important roles in osteogenesis, but also is thought to have a role in the removal of C-propeptides from certain procollagens, including type I procollagen.[18]

TMEM38B (Type XIV)

This form of osteogenesis imperfecta has been described in three consanguineous families of Saudi origin, and three different consanguineous families of Israeli Bedouin origin. Affected individuals had osteogenesis imperfecta of variable severity without blue sclerae, dentinogenesis imperfecta, or hearing loss.[19] This form of OI is caused by homozygous mutation in the TMEM38B gene and is inherited in an autosomal recessive manner.[20]

WNT1 (Type XV)

This recently discovered form of osteogenesis imperfecta has now been described in a number of families and causes moderate to severe disease. Patients with this condition have had short stature, blue or white sclerae, and normal hearing. A subset of patients have been seen with brain malformations and developmental delay. This form of OI is caused by homozygous or compound heterozygous mutations in the WNT1 gene and is inherited in an autosomal recessive manner.[21] Canonical WNT/beta-catenin signaling has been shown to be crucial for the differentiation of osteoblasts and further bone development.[22]

Osteogenesis imperfecta with congenital joint contractures, Types 1 and 2 (Bruck syndrome)

Patients with Bruck syndrome have congenital brittle bones prone to fracture, as well as congenital joint contractures and pterygia. They also have short stature, severe limb deformity, wormian bones, and progressive scoliosis which can be severe. Patients have generally been described with normal hearing, no dentinogenesis imperfecta, and white sclerae. Two forms of Bruck syndrome have been delinated with molecular testing, but appear to be clinically indistinguishable. Bruck syndrome 1 is caused by homozygous mutation in the FKBP10 gene[23] , while Bruck syndrome 2 is caused by homozygous mutation in the PLOD2 gene.[24] Both disorders are inherited in an autosomal recessive manner. It has been suggested that the defect underlying Bruck syndrome is a deficiency of bone-specific telopeptide lysyl hydroxylase, which results in aberrant bone collagen crosslinking.[25]

Previous
Next

Epidemiology

Frequency

United States

The prevalence of OI is estimated to be 1 per 15,000 live births[26] ; however, the mild form is underdiagnosed, and the actual prevalence may be higher.

International

Prevalence appears to be similar worldwide, although there may be an increased risk of recessive forms of osteogenesis imperfecta in populations with high degree of consanguinity.

Race

No differences based on race are reported.

Sex

No differences based on sex are reported.

Age

The age when symptoms (ie, fractures) begin widely varies. Patients with mild forms may not have fractures until adulthood, or they may present with fractures in infancy. Patients with severe cases typically present with fractures in utero.

Previous
 
 
Contributor Information and Disclosures
Author

Eric T Rush, MD, FAAP, FACMG Clinical Geneticist, Munroe-Meyer Institute for Genetics and Rehabilitation; Assistant Professor of Pediatrics and Internal Medicine, University of Nebraska Medical Center

Eric T Rush, MD, FAAP, FACMG is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics, American College of Physicians, Nebraska Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Alexion Pharmaceuticals<br/>Honoraria for: Alexion Pharmaceuticals and Biomarin Pharmaceuticals.

Coauthor(s)

Horacio B Plotkin, MD, FAAP Chief Medical Officer, Retrophin, Inc; Adjunct Associate Professor of Pediatrics and Orthopedic Surgery, University of Nebraska College of Medicine

Horacio B Plotkin, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Received salary from Retrophin, Inc for management position.

Chief Editor

Luis O Rohena, MD Chief, Medical Genetics, San Antonio Military Medical Center; Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Assistant Professor of Pediatrics, University of Texas Health Science Center at San Antonio

Luis O Rohena, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American College of Medical Genetics and Genomics, American Society of Human Genetics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Horatio Plotkin, MD, FAAP, to the development and writing of this article.

Erawati V Bawle, MD, FAAP, FACMG Retired Professor, Department of Pediatrics, Wayne State University School of Medicine

Erawati V Bawle, MD, FAAP, FACMG is a member of the following medical societies: American College of Medical Genetics and American Society of Human Genetics

Disclosure: Nothing to disclose.

Alexander A Cacciarelli, MD, FACR Consulting Staff, Department of Radiology, St Joseph's Hospital and Medical Center of Phoenix

Disclosure: Nothing to disclose.

Mandar A Pattekar, MD, MS Consulting Staff, Department of Radiology, Methodist Hospital

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Sillence DO, Senn A, Danks DM. Genetic heterogeneity in osteogenesis imperfecta. J Med Genet. 1979 Apr. 16(2):101-16. [Medline].

  2. Warman ML, Cormier-Daire V, Hall C, Krakow D, Lachman R, LeMerrer M. Nosology and classification of genetic skeletal disorders: 2010 revision. Am J Med Genet A. 2011 May. 155A(5):943-68. [Medline].

  3. Shaker JL, Albert C, Fritz J, Harris G. Recent developments in osteogenesis imperfecta. F1000Res. 2015. 4 (F1000 Faculty Rev):681. [Medline]. [Full Text].

  4. Van Dijk FS, Sillence DO. Osteogenesis imperfecta: Clinical diagnosis, nomenclature and severity assessment. Am J Med Genet A. 2014 Apr 8. [Medline].

  5. Balasubramanian M Md, Sobey GJ FCDerm, Wagner BE BSc Hons, et al. Osteogenesis imperfecta: Ultrastructural and histological findings on examination of skin revealing novel insights into genotype-phenotype correlation. Ultrastruct Pathol. 2016 Feb 10. 1-6. [Medline].

  6. Glorieux FH, Rauch F, Plotkin H, Ward L, Travers R, Roughley P, et al. Type V osteogenesis imperfecta: a new form of brittle bone disease. J Bone Miner Res. 2000 Sep. 15(9):1650-8. [Medline].

  7. Cho TJ, Lee KE, Lee SK, Song SJ, Kim KJ, Jeon D, et al. A single recurrent mutation in the 5'-UTR of IFITM5 causes osteogenesis imperfecta type V. Am J Hum Genet. 2012 Aug 10. 91(2):343-8. [Medline]. [Full Text].

  8. Glorieux FH, Ward LM, Rauch F, Lalic L, Roughley PJ, Travers R. Osteogenesis imperfecta type VI: a form of brittle bone disease with a mineralization defect. J Bone Miner Res. 2002 Jan. 17(1):30-8. [Medline].

  9. Becker J, Semler O, Gilissen C, Li Y, Bolz HJ, Giunta C, et al. Exome sequencing identifies truncating mutations in human SERPINF1 in autosomal-recessive osteogenesis imperfecta. Am J Hum Genet. 2011 Mar 11. 88(3):362-71. [Medline]. [Full Text].

  10. Barnes AM, Chang W, Morello R, Cabral WA, Weis M, Eyre DR, et al. Deficiency of cartilage-associated protein in recessive lethal osteogenesis imperfecta. N Engl J Med. 2006 Dec 28. 355(26):2757-64. [Medline].

  11. Christiansen HE, Schwarze U, Pyott SM, AlSwaid A, Al Balwi M, Alrasheed S, et al. Homozygosity for a missense mutation in SERPINH1, which encodes the collagen chaperone protein HSP47, results in severe recessive osteogenesis imperfecta. Am J Hum Genet. 2010 Mar 12. 86(3):389-98. [Medline]. [Full Text].

  12. Alanay Y, Avaygan H, Camacho N, Utine GE, Boduroglu K, Aktas D, et al. Mutations in the gene encoding the RER protein FKBP65 cause autosomal-recessive osteogenesis imperfecta. Am J Hum Genet. 2010 Apr 9. 86(4):551-9. [Medline]. [Full Text].

  13. Kelley BP, Malfait F, Bonafe L, Baldridge D, Homan E, Symoens S, et al. Mutations in FKBP10 cause recessive osteogenesis imperfecta and Bruck syndrome. J Bone Miner Res. 2011 Mar. 26(3):666-72. [Medline]. [Full Text].

  14. Barnes AM, Cabral WA, Weis M, Makareeva E, Mertz EL, Leikin S, et al. Absence of FKBP10 in recessive type XI osteogenesis imperfecta leads to diminished collagen cross-linking and reduced collagen deposition in extracellular matrix. Hum Mutat. 2012 Nov. 33(11):1589-98. [Medline]. [Full Text].

  15. Lapunzina P, Aglan M, Temtamy S, Caparrós-Martín JA, Valencia M, Letón R, et al. Identification of a frameshift mutation in Osterix in a patient with recessive osteogenesis imperfecta. Am J Hum Genet. 2010 Jul 9. 87(1):110-4. [Medline]. [Full Text].

  16. Nakashima K, Zhou X, Kunkel G, Zhang Z, Deng JM, Behringer RR, et al. The novel zinc finger-containing transcription factor osterix is required for osteoblast differentiation and bone formation. Cell. 2002 Jan 11. 108(1):17-29. [Medline].

  17. Martínez-Glez V, Valencia M, Caparrós-Martín JA, Aglan M, Temtamy S, Tenorio J, et al. Identification of a mutation causing deficient BMP1/mTLD proteolytic activity in autosomal recessive osteogenesis imperfecta. Hum Mutat. 2012 Feb. 33(2):343-50. [Medline]. [Full Text].

  18. Asharani PV, Keupp K, Semler O, Wang W, Li Y, Thiele H, et al. Attenuated BMP1 function compromises osteogenesis, leading to bone fragility in humans and zebrafish. Am J Hum Genet. 2012 Apr 6. 90(4):661-74. [Medline]. [Full Text].

  19. Shaheen R, Alazami AM, Alshammari MJ, Faqeih E, Alhashmi N, Mousa N, et al. Study of autosomal recessive osteogenesis imperfecta in Arabia reveals a novel locus defined by TMEM38B mutation. J Med Genet. 2012 Oct. 49(10):630-5. [Medline].

  20. Volodarsky M, Markus B, Cohen I, Staretz-Chacham O, Flusser H, Landau D, et al. A deletion mutation in TMEM38B associated with autosomal recessive osteogenesis imperfecta. Hum Mutat. 2013 Apr. 34(4):582-6. [Medline].

  21. Keupp K, Beleggia F, Kayserili H, Barnes AM, Steiner M, Semler O, et al. Mutations in WNT1 cause different forms of bone fragility. Am J Hum Genet. 2013 Apr 4. 92(4):565-74. [Medline]. [Full Text].

  22. Pyott SM, Tran TT, Leistritz DF, Pepin MG, Mendelsohn NJ, Temme RT, et al. WNT1 mutations in families affected by moderately severe and progressive recessive osteogenesis imperfecta. Am J Hum Genet. 2013 Apr 4. 92(4):590-7. [Medline]. [Full Text].

  23. Shaheen R, Al-Owain M, Faqeih E, Al-Hashmi N, Awaji A, Al-Zayed Z, et al. Mutations in FKBP10 cause both Bruck syndrome and isolated osteogenesis imperfecta in humans. Am J Med Genet A. 2011 Jun. 155A(6):1448-52. [Medline].

  24. Puig-Hervás MT, Temtamy S, Aglan M, Valencia M, Martínez-Glez V, Ballesta-Martínez MJ, et al. Mutations in PLOD2 cause autosomal-recessive connective tissue disorders within the Bruck syndrome--osteogenesis imperfecta phenotypic spectrum. Hum Mutat. 2012 Oct. 33(10):1444-9. [Medline].

  25. Bank RA, Robins SP, Wijmenga C, Breslau-Siderius LJ, Bardoel AF, van der Sluijs HA, et al. Defective collagen crosslinking in bone, but not in ligament or cartilage, in Bruck syndrome: indications for a bone-specific telopeptide lysyl hydroxylase on chromosome 17. Proc Natl Acad Sci U S A. 1999 Feb 2. 96(3):1054-8. [Medline]. [Full Text].

  26. Kuurila K, Kaitila I, Johansson R, Grénman R. Hearing loss in Finnish adults with osteogenesis imperfecta: a nationwide survey. Ann Otol Rhinol Laryngol. 2002 Oct. 111(10):939-46. [Medline].

  27. Santos F, McCall AA, Chien W, Merchant S. Otopathology in Osteogenesis Imperfecta. Otol Neurotol. 2012 Dec. 33(9):1562-6. [Medline]. [Full Text].

  28. Pillion JP, Shapiro J. Audiological findings in osteogenesis imperfecta. J Am Acad Audiol. 2008 Sep. 19(8):595-601. [Medline].

  29. Basal S, Ozgok Y, Tahmaz L, Atim A, Zor M, Bilgic S, et al. Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta. Urol Res. 2011 Feb. 39(1):73-6. [Medline].

  30. Rauch F, Travers R, Parfitt AM, Glorieux FH. Static and dynamic bone hystomorphometry in children with osteogenesis imperfecta. Bone. 2000. 26:581-9. [Medline].

  31. Rauch F, Munns C, Land C, Glorieux FH. Pamidronate in Children and Adolescents with Osteogenesis Imperfecta: Effect of Treatment Discontinuation. J Clin Endocrinol Metab. 2006. 91:1268-74. [Medline].

  32. Castillo H, Samson-Fang L,. Effects of bisphosphonates in children with osteogenesis imperfecta: an AACPDM systematic review. Dev Med Child Neurol. 2009 Jan. 51(1):17-29. [Medline].

  33. Bargman R, Huang A, Boskey AL, Raggio C, Pleshko N. RANKL Inhibition Improves Bone Properties in a Mouse Model of Osteogenesis Imperfecta. Connect Tissue Res. 2010 Jan 6. [Medline].

  34. Esposito P, Plotkin H. Surgical treatment of osteogenesis imperfecta: current concepts. Curr Opin Pediatr. 2008 Feb. 20(1):52-7. [Medline].

  35. Janus GJ, Finidori G, Engelbert RH, Pouliquen M, Pruijs JE. Operative treatment of severe scoliosis in osteogenesis imperfecta: results of 20 patients after halo traction and posterior spondylodesis with instrumentation. Eur Spine J. 2000 Dec. 9(6):486-91. [Medline]. [Full Text].

  36. Sasaki-Adams D, Kulkarni A, Rutka J, Dirks P, Taylor M, Drake JM. Neurosurgical implications of osteogenesis imperfecta in children. Report of 4 cases. J Neurosurg Pediatr. 2008 Mar. 1(3):229-36. [Medline].

  37. [Guideline] Kellogg ND. Evaluation of suspected child physical abuse. Pediatrics. 2007 Jun. 119(6):1232-41. [Medline]. [Full Text].

 
Previous
Next
 
Acute fractures are observed in the radius and ulna. Multiple fractures can be seen in the ribs. Old healing humeral fracture with callus formation is observed.
Beaded ribs. Multiple fractures are seen in the long bones of the upper extremities.
Wormian bones are present in the skull.
This newborn has bilateral femoral fractures.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.