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(207) 846-6515 H
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(207) 846-6515

METABOLIC BONE DISEASE

CAUSES

The causes of metabolic bone disease are many; most patients have more than one cause for their problem. 
- improper calcium:phosphorus ratio and/or lack of dietary calcium
- lack of vitamin D3
- lack of proper light spectrum
- kidney disease
- environmental temperature too low for the species
- insufficient dietary protein
- small intestinal disease
- parathyroid gland disease

SIGNS
Patients with metabolic bone disease usually have some combination of the following signs:
- lethargy
- relunctance to move
- poor appetite
- weight loss or lack of proper weight gain
- softening and enlargement of the lower and/or upper jaw
- softening and enlargement of the long bones of the legs
- difficulty lifting the body off the ground when attempting to walk
- broken bones
- paralysis of the rear legs due to back problems
- osteoporosis
- muscle tremors and seizures
- soft shells in chelonians
- constipation

DIAGNOSIS
Metabolic bone disease can often be diagnosed based on the history and physical exam. Other tests that can be useful for diagnosis and also long-term management include:
- x-rays
- calcium, phosphorus, and general chemistry blood tests
- ultraviolet meter readings of the enclosure
- DEXA scan
- kidney biopsy

TREATMENT
- Provide species-correct environmental temperature range day and night
- Correct the diet, especially to correct the calcium:phosphorus ratio
- Use species appropriate environmental lighting
    - sunlight is by far the best
    - UV bulbs should be positioned no more than 3 feet from enclosure and changed every
      1 to 2 months
- Force feeding may be needed for patients not eating well; follow veterinarian's instructions for the   specific patient
- Calcium supplementation; follow veterinarian's instructions
- Vitamin D3 supplementation; follow veterinarian's instructions
- Maintain hydration; daily soaks in shallow warm (~85 degree) water for 10 to 20 minutes until eating and drinking well
- Gut-load invertebrates with high calcium diet for several days prior to feeding insectivores
- Feed high calcium invertebrates (eg, phoenix worms, snails, earthworms) when appropriate for the insectivore's diet
- Dusting invertebrates can be beneficial, but keep in mind that the invertebrates often remove the dust quickly, the dust can make them unpalatable to the reptile, the dust should be calcium or calcium and vitamin D3 and should not contain other vitamins or phosphorus
- For herbivores and omnivores feed leafy greens and avoid thicker vegetables and fruits
- Handle gently
- Remove climbing options from the enclosure
- Diagnostic screening and treatment for other illnesses, especially digestive diseases

PROGNOSIS
The short-term prognosis is guarded; some reptiles develop life-threatening complications soom after diagnosis.

The long-term prognosis is also guarded; for reptiles that survive the short term, recovery is often not 100%, and the patient is left with debilitating skeletal deformities and other problems. 

Peter Smith  DVM
2014

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