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Case Reports   |    
Minocycline-Induced Bone DiscolorationA Case Report
Charles M. Chan, MD1; David G. Hicks, MD1; Brian D. Giordano, MD1
1 Department of Orthopaedics and Rehabilitation (C.M.C. and B.D.G.), Department of Pathology and Laboratory Medicine (D.G.H.), University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address for C.M. Chan: Charles_Chan@URMC.Rochester.edu. E-mail address for D.G. Hicks: David_Hicks@URMC.Rochester.edu. E-mail address for B.D. Giordano: Brian_Giordano@URMC.Rochester.edu
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Investigation performed at the University of Rochester Medical Center, Rochester, New York



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. One or more of the authors, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2012 Sep 12;2(3):e47 1-3. doi: 10.2106/JBJS.CC.K.00153
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Extract

Minocycline is a semisynthetic second-generation tetracycline derivative that is widely used as a broad-spectrum antibiotic and anti-inflammatory agent1. Long-term treatment with tetracycline and its related derivatives causes discoloration and hyperpigmentation of the skin, bone, teeth, sclerae, thyroid, and oral mucosa2-11. Minocycline shares the same basic ringed structure found in other tetracyclines, with the exception of a dimethylamino group substitution at C7 and a functional group absence at C6. These differences in chemical structure result in more lipophilic properties than in other members of the tetracycline family12. Whereas tetracycline is known to cause discoloration in bone by oxidation-induced color change after binding irreversibly to hydroxyapatite, which is later deposited at the mineralization front on unmineralized mature osteoid, minocycline poorly chelates calcium and is thought to cause bone discoloration by a less well-understood mechanism13. Findings, including minocycline’s ability to discolor fully formed mature teeth as well as the presence of iron with trace amounts of calcium in minocycline-induced dark pigment, give credence to this idea14-16.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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