Commentaries: Undiagnosed Ochronosis Presented as Severe Osteoarthritis with Concomitant Osteoporotic Fracture

Dear editor, With respect to the commentary article written by Dr. Alireza Mirzasadeghi (DOI: 10.17795/soj-7533), concerning the adequacy of evidence presented to support the diagnosis of ochronosis/alkaptonuria in the article of Dr. Zabihiyeganeh et al. entitled “undiagnosed ochronosis presented as severe osteoarthritis with concomitant osteoporotic fracture”, (DOI: 10.17795/soj-4717), we have provided our complementary answers in this report. Regarding shortage of enough information required to establish the diagnosis of ochronosis, it should be noted that although the ochronosis is a rare disorder, the number of case reports on the diagnosis of the disease is considerable. Considering the word limit of case reports and regarding the main focus of our report, which was drawing attention towards the osteoporotic fracture, and low bone quality in spite of high bone density in such patients, we chose to place more emphasis on the fracture part and ignore some details in the diagnostic part, which in turn could be found in other reports of ochronosis.