Inherited
Multicentric Osteolysis (IMO) is an uncommon familial condition of idiopathic pathophysiology causing bone
osteolysis and dysplasia. These patients present with common rheumatologic complaints of
pain, dysfunction and disability, and are often initially misdiagnosed as a chronic
rheumatic disease of childhood such as
juvenile idiopathic arthritis. We report a case of three siblings diagnosed with IMO. Diagnosis was made during childhood, with each sibling having different manifestations and course of disease. One had a previous history of bilateral
hip dysplasia. Two had
osteolysis of the foot, distal tibia and femur (lower limb bones), whilst one had
osteolysis of the rib and unusual clavicular fractures. Unusually, all siblings appear to experience decreased
pain sensation compared to norms. All siblings were treated with
bisphosphonates and experienced a rapid improvement in
pain symptoms, decreased
analgesic requirements. Two had bone mineral density testing performed and both had increases post-
bisphosphonate. In all three, there was subjective evidence of stabilisation of
bone disease. Testing for
matrix metalloproteinase-2 (MMP2) gene was negative.