Changes

[[Image:Leopardgecko_mbd_xray.jpg|300px|thumb|right|'''Radiograph of Leopard gecko showing signs of MBD. Decreased opacity to the pelvis and caudal vertebrae. No clear contrast between bone and soft tissue is a classic sign of MBD.''' (© RVC and its licensors, Sean Bobbit, Sue Evans, Andrew Devare and Claire Moore. All rights reserved)]]

[[Image:Leopardgecko_mbd_xray.jpg|300px|thumb|right|'''Radiograph of Leopard gecko showing signs of MBD. Decreased opacity to the pelvis and caudal vertebrae. No clear contrast between bone and soft tissue is a classic sign of MBD.''' (© RVC and its licensors, Sean Bobbit, Sue Evans, Andrew Devare and Claire Moore. All rights reserved)]]

Metabolic bone disease (MBD) is a complex disease that is associated with derangement of the metabolism of calcium, phosphorus and vitamin D3, poor husbandry and other diseases.

Metabolic bone disease (MBD) is a complex disease that is associated with derangement of the metabolism of [[Calcium|calcium]], [[Phosphorus|phosphorus]] and vitamin D3, poor husbandry and other diseases.

MBD is the most common disease in captive lizards, especially [[Green Iguana|green iguanas]]; it is usually a result of poor husbandry. For example, deficiency in Vitamin D3 and/or UVB in combination with calcium deficiency leads to metabolic bone disease.  Associated terms include fibrous osteodystrophy, nutritional secondary hyperparathyroidism, osteoporosis, osteomalacia and rickets.

MBD is the most common disease in captive lizards, especially [[Green Iguana|green iguanas]]; it is usually a result of poor husbandry. For example, deficiency in Vitamin D3 and/or UVB in combination with [[Calcium|calcium]] deficiency leads to metabolic bone disease.  Associated terms include fibrous osteodystrophy, nutritional secondary hyperparathyroidism, osteoporosis, osteomalacia and rickets.

Extreme care should be taken when examining animals with MBD as their bones are weakened and easily fractured.

Extreme care should be taken when examining animals with MBD as their bones are weakened and easily [[Lizard Long Bone Fractures|fractured]].

==Dealing with MBD==

==Dealing with MBD==

When juveniles have been affected during growth, they may have poorly mineralized and pliable mandibles which is a sign of prolonged MBD. This results in distorted jaw bones and a characteristic facial 'smile'. In [[Chameleon|chameleon]] species, MBD causes difficulty protruding or retracting the tongue.

When juveniles have been affected during growth, they may have poorly mineralized and pliable mandibles which is a sign of prolonged MBD. This results in distorted jaw bones and a characteristic facial 'smile'. In [[Chameleon|chameleon]] species, MBD causes difficulty protruding or retracting the tongue.

Tremors, muscular fasciculations, paresis and seizures usually develop in more severe cases of MBD with developed hypocalcaemia. However in most cases, calcium and phosphate levels usually appear normal.  

Tremors, muscular fasciculations, paresis and seizures usually develop in more severe cases of MBD with developed hypocalcaemia. However in most cases, [[Calcium|calcium]] and phosphate levels usually appear normal.  

In some cases, hindlimbs may appear very muscular as a result of thickening of the bone cortex caused by marked fibrous osteodystrophy in the long bones. Palpation or radiography suffice to differenciate from healthy tissue. In addition, the costochondral junctions may appear enlarged and distorted.

In some cases, hindlimbs may appear very muscular as a result of thickening of the bone cortex caused by marked fibrous osteodystrophy in the long bones. Palpation or [[Lizard and Snake Imaging|radiography]] suffice to differenciate from healthy tissue. In addition, the costochondral junctions may appear enlarged and distorted.

===Diagnosis===

===Diagnosis===

*Physical examination  

*Physical examination  

*Radiography - hypomineralisation of skeleton, pathological fractures, fibrous osteodystrophy. Radiographs are very effective in confirming the diagnosis; indeed, radiolucent transverse processes in the caudal vertebrae are pathognomonic of MBD in lizards.

*Radiography - hypomineralisation of skeleton, pathological fractures, fibrous osteodystrophy. Radiographs are very effective in confirming the diagnosis; indeed, radiolucent transverse processes in the caudal vertebrae are pathognomonic of MBD in lizards.

*Biochemistry - calcium is generally within normal limits but may be low, especially in neurological cases; the calcifediol assay can be done on plasma to determine the status.

*Biochemistry - [[Calcium|calcium]] is generally within normal limits but may be low, especially in neurological cases; the calcifediol assay can be done on plasma to determine the status.

===Treatment===

===Treatment===

Initial focus should be on improving calcium intake  as well as access to appropraite UVB light. Parenteral injections of calcium or oral solutions can be used on animals with clinical hypocalcaemia (when renal failure has been ruled out).

Initial focus should be on improving [[Calcium|calcium]] intake  as well as access to appropraite UVB light. Parenteral injections of [[Calcium|calcium]] or oral solutions can be used on animals with clinical hypocalcaemia (when renal failure has been ruled out).

* Administer oral calcium for non-neurological cases - calcium glubionate (NeoCalglucon, Sandoz) at 1 ml/kg bw q12-24h for 1-3 months.  

* Administer oral [[Calcium|calcium]] for non-neurological cases - calcium glubionate (NeoCalglucon, Sandoz) at 1 ml/kg bw q12-24h for 1-3 months.  

* Administer parenteral calcium for neurological cases, preferably IV or ICo by slow infusion (100-500 mg/kg q6h) and concurrent diuresis with serial plasma calcium and phosphorus measurements.  

* Administer parenteral [[Calcium|calcium]] for neurological cases, preferably IV or ICo by slow infusion (100-500 mg/kg q6h) and concurrent diuresis with serial plasma calcium and phosphorus measurements.  

* Calcitonin has previously been suggested as a treatment - 50 iu/kg IM weekly for 1-4 weeks, but its clinical effects have not been established (do not give to hypocalcaemic patients).

* Calcitonin has previously been suggested as a treatment - 50 iu/kg IM weekly for 1-4 weeks, but its clinical effects have not been established (do not give to hypocalcaemic patients).

* Vitamine D deficiency can be addressed by UVB exposure as long as the kidney and liver functions are normal.  

* Vitamine D deficiency can be addressed by UVB exposure as long as the kidney and liver functions are normal.