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==Introduction==
[[File:Green Iguana.jpg|Green Iguana|right|thumb|200px|Green Iguanas are the most commonly affected species (Wikimedia Commons)]]
Metabolic bone disease affects reptiles in captivity, particularly '''young [[Green Iguana|green iguanas]]'''. The condition is caused by a '''diet low in [[Calcium|calcium]] and high in [[Phosphorus - Reptiles|phosphorous]] ([[Hyperparathyroidism|secondary nutritional hyperparathyroidism]]), [[Calcium|vitamin D]] deficiency (due to poor lighting)''', certain toxicities and diseases of the [[Kidney - Anatomy & Physiology|kidneys]], [[Liver - Anatomy & Physiology|liver]] or rarely, the [[Category:Parathyroid Glands - Pathology|parathyroid gland]].
==Clinical Signs==
Clinical signs include:
* '''Lethargy'''
* '''Inability to support weight'''
* '''Rounded skull'''
* '''Spontaneous/pathological fractures''' - particularly the long bones
* '''Adult animals also show signs of [[Hypocalcaemia|hypocalcaemia]]''' such as muscle tremors
* '''Anorexia'''
* '''Dystocia in pregnant females'''
* '''Curvature of the spine'''
* '''Soft, flat and misshapen shell in chelonia'''
* '''Bowing, swelling and shortening of bones''' - particularly the mandible and long bones
* '''Impaction''' - secondary to the ingestion of large amounts of calcareous material, in an attempt to correct the nutritional imbalance
* '''Small''' in comparison to litter mates
==Diagnosis==
As the condition is normally caused by nutritional and management factors it is important to take a detailed history of the animals diet and husbandry.
'''Radiographs''' of the patient should be obtained. The skeleton shows '''reduced density''', and '''[[Fractures|pathological fractures]]''' may be present, particularly in the '''long bones''' of the hindlimbs. Large quantities of radiopaque material may be seen in the intestines following the ingestion of calcareous material.
'''Haematology and biochemistry''' should be performed to measure '''calcium levels''' and assess kidney function. '''Renal failure''' is a common complication and a poor prognostic indicator.
==Treatment==
Nutritional calcium deficiencies need to be addressed by '''dietary supplementation''' (oral/injectable calcium lactate or calcium gluconate ).
Management should also be changed, to ensure the animal is exposed to sufficient levels of sunlight and '''vitamin D'''. Oral vitamin D supplements are also available to treat this deficiency.
Impaction cases should be treated with laxative such as milk of magnesia or petroleum jelly as this should help the animal pass the foreign material.
==Prevention==
It is important that owners of reptiles are properly educated with regards to the '''nutritional and husbandry requirements''' of each individual species in order to prevent conditions such as metabolic bone disease occurring.
===Nutrition===
'''Insectivorous''' reptiles should be fed a variety of insects such as earthworms, locusts and fruitflies. However as many insects do not provide reptiles with the appropriate calcium:phosphorous balance, '''supplementation''' is required. This can be provided by''' dusting insects''' with a supplement before they are fed to the reptile, or by feeding the insects themselves a '''diet with a high calcium:phosphorous ratio''' for an appropriate time before they are fed to the reptile.
'''Herbivores''' should be offered a '''variety of fresh fruit and vegetables''' with appropriate levels of calcium, phosphorous and fibre.
'''Carnivorous''' reptiles should be fed on '''lean whole mammals'''. Providing a '''reptile-specific dietary supplement''' is highly recommended in both herbivore and carnivore diets.
Additional sources of calcium include fish, collard leaves, and algae.
==Prognosis==
If the animal presents with chronic or severe signs, prognosis is''' poor'''. Early recognition of the condition and mild signs offer an improved prognosis. Any deformities are unlikely to resolve.
{{Learning
|flashcards = [[Reptiles and Amphibians Q&A 03]]<br>[[Reptiles and Amphibians Q&A 06]]<br>[[Reptiles and Amphibians Q&A 12]]
}}
==References==
Divers, S (1996) '''Basic reptile husbandry, history taking and clinical exam''' ''In Practice 1996 18: 51-65''
Frye, FL & Williams, DL (1995) '''Self-Assessment Colour Review - Reptiles & Amphibians''' ''Manson''
Merck & Co (2009) '''The Merck Veterinary Manual''' (Ninth Edition), ''Merial''
Rowland, M (2009) '''Veterinary care of bearded dragons''' ''In Practice 2009 31: 506-511''
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[[Category:Parathyroid Glands - Pathology]]
[[Category:Parathyroid Glands - Pathology]]
[[Category:Lizard Musculoskeletal Diseases]]
[[Category:Expert Review - Exotics]]