Consensus Guidelines on the Use of Bisphosphonate
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Severe Septicaemia in a Patient with Polychondritis and Sweet's
81 LETTERS Ann Rheum Dis: first published as 10.1136/ard.62.1.88 on 1 January 2003. Downloaded from Severe septicaemia in a patient with polychondritis and Sweet’s syndrome after initiation of treatment with infliximab F G Matzkies, B Manger, M Schmitt-Haendle, T Nagel, H-G Kraetsch, J R Kalden, H Schulze-Koops ............................................................................................................................. Ann Rheum Dis 2003;62:81–82 D Sweet first described an acute febrile neutrophilic dermatosis in 1964 characterised by acute onset, fever, Rleucocytosis, and erythematous plaques.1 Skin biopsy specimens show infiltrates consisting of mononuclear cells and neutrophils with leucocytoclasis, but without signs of vasculi- tis. Sweet’s syndrome is frequently associated with solid malig- nancies or haemoproliferative disorders, but associations with chronic autoimmune connective tissue disorders have also been reported.2 The aetiology of Sweet’s syndrome is unknown, but evidence suggests that an immunological reaction of unknown specificity is the underlying mechanism. CASE REPORT A 51 year old white man with relapsing polychondritis (first diagnosed in 1997) was admitted to our hospital in June 2001 with a five week history of general malaise, fever, recurrent arthritis, and complaints of morning stiffness. Besides Figure 1 autoimmune polychondritis, he had insulin dependent Manifestation of Sweet’s syndrome in a patient with relapsing polychondritis. diabetes mellitus that was diagnosed in 1989. On admission, he presented with multiple small to medium, sharply demarked, raised erythematous plaques on both fore- dose of glucocorticoids (80 mg) and a second application of http://ard.bmj.com/ arms and lower legs, multiple acne-like pustules on the face, infliximab (3 mg/kg body weight) were given. -
Hypophosphatasia Could Explain Some Atypical Femur Fractures
Hypophosphatasia Could Explain Some Atypical Femur Fractures What we know Hypophosphatasia (HPP) is a rare genetic disease that affects the development of bones and teeth in children (Whyte 1985). HPP is caused by the absence or reduced amount of an enzyme called tissue-nonspecific alkaline phosphatase (TAP), also called bone-specific alkaline phosphatase (BSAP). The absence of TAP raises the level of inorganic pyrophosphate (Pi), which prevents calcium and phosphate from creating strong, mineralized bone. Without TAP, bones can become weak. In its severe form, HPP is fatal and happens in 1/100,000 births. Because HPP is genetic, it can appear in adults as well. A recent study has identified a milder, more common form of HPP that occurs in 4 of 1000 adults (Dahir 2018). This form of HPP is usually seen in early middle aged adults who have low bone density and sometimes have stress fractures in the feet or thigh bone. Sometimes these patients lose their baby teeth early, but not always. HPP is diagnosed by measuring blood levels of TAP and vitamin B6. An elevated vitamin B6 level [serum pyridoxal 5-phosphate (PLP)] (Whyte 1985) in a patient with a TAP level ≤40 or in the low end of normal can be diagnosed with HPP. Almost half of the adult patients with HPP in the large study had TAP >40, but in the lower end of the normal range (Dahir 2018). The connection between hypophosphatasia and osteoporosis Some people who have stress fractures get a bone density test and are treated with an osteoporosis medicine if their bone density results are low. -
Atypical Femur Fracture in an Adolescent Boy Treated with Bisphosphonates for X-Linked Osteoporosis Based on PLS3 Mutation Denise M
Atypical femur fracture in an adolescent boy treated with bisphosphonates for X-linked osteoporosis based on PLS3 mutation Denise M. van de Laarschot BSc1, M. Carola Zillikens MD PhD 1 1 Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands Corresponding author at: Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Abstract Long-term use of bisphosphonates has raised concerns about the association with Atypical Femur Fractures (AFFs) that have been reported mainly in postmenopausal women. We report a case of an 18-year-old patient with juvenile osteoporosis based on X-linked osteoporosis due to a PLS3 mutation who developed a low trauma femoral fracture after seven years of intravenous and two years of oral bisphosphonate use, fulfilling the revised ASBMR diagnostic criteria of an AFF. The occurrence of AFFs has not been described previously in children or adolescents. The underlying monogenetic bone disease in our case strengthens the possibility of a genetic predisposition at least in some cases of AFF. We cannot exclude that a transverse fracture of the tibia that also occurred after a minor trauma at age 16 might be part of the same spectrum of atypical fractures related to the use of bisphosphonates. In retrospect our patient experienced prodromal pain prior to both the tibia and the femur fracture. Case reports of atypical fractures in children with a monogenetic bone disease such as Osteogenesis Imperfecta (OI) or juvenile osteoporosis are important to consider in the discussion about optimal -
Differential Diagnosis: Brittle Bone Conditions Other Than OI
Facts about Osteogenesis Imperfecta Differential Diagnosis: Brittle Bone Conditions Other than OI Fragile bones are the hallmark feature of osteogenesis imperfecta (OI). The mutations that cause OI lead to abnormalities within bone that result in increased bone turnover; reduced bone mineral content and decreased bone mineral density. The consequence of these changes is brittle bones that fracture easily. But not all cases of brittle bones are OI. Other causes of brittle bones include osteomalacia, disuse osteoporosis, disorders of increased bone density, defects of bone, and tumors. The following is a list of conditions that share fragile or brittle bones as a distinguishing feature. Brief descriptions and sources for further information are included. Bruck Syndrome This autosomal recessive disorder is also referred to as OI with contractures. Some people now consider this to be a type of OI. National Library of Medicine Genetics Home Reference: http://ghr.nlm.nih.gov Ehlers-Danlos Syndrome (EDS) Joint hyperextensibility with fractures; this is a variable disorder caused by several gene mutations. Ehlers-Danlos National Foundation http://www.ednf.org Fibrous Dysplasia Fibrous tissue develops in place of normal bone. This weakens the affected bone and causes it to deform or fracture. Fibrous Dysplasia Foundation: https://www.fibrousdysplasia.org Hypophosphatasia This autosomal recessive disorder affects the development of bones and teeth through defects in skeletal mineralization. Soft Bones: www.softbones.org; National Library of Medicine Genetics Home Reference: http://ghr.nlm.nih.gov/condition Idiopathic Juvenile Osteoporosis A non-hereditary transient form of childhood osteoporosis that is similar to mild OI (Type I) National Osteoporosis Foundation: www.nof.org McCune-Albright Syndrome This disorder affects the bones, skin, and several hormone-producing tissues. -
WO 2010/115932 Al
(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date 14 October 2010 (14.10.2010) WO 2010/115932 Al (51) International Patent Classification: AO, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, A61K 31/675 (2006.01) A61K 45/06 (2006.01) CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, A61K 38/00 (2006.01) A61P 19/08 (2006.01) DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, A61K 39/395 (2006.01) A61P 19/10 (2006.01) HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, (21) International Application Number: ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, PCT/EP20 10/054605 NO, NZ, OM, PE, PG, PH, PL, PT, RO, RS, RU, SC, SD, (22) International Filing Date: SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, 7 April 2010 (07.04.2010) TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (25) Filing Language: English (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (26) Publication Language: English GM, KE, LR, LS, MW, MZ, NA, SD, SL, SZ, TZ, UG, (30) Priority Data: ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, MD, RU, TJ, 61/167,688 8 April 2009 (08.04.2009) US TM), European (AT, BE, BG, CH, CY, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, LV, (71) Applicant (for all designated States except US): NO- MC, MK, MT, NL, NO, PL, PT, RO, SE, SI, SK, SM, VARTIS AG [CH/CH]; Lichtstrasse 35, CH-4056 Basel TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, GW, (CH). -
Imaging of Osteomyelitis: the Key Is in the Combination
Special RepoRt Special RepoRt Imaging of osteomyelitis: the key is in the combination An accurate diagnosis of osteomyelitis requires the combination of anatomical and functional imaging techniques. Conventional radiography is the first imaging modality to begin with, as it provides an overview of both the anatomy and the pathologic conditions of the bone. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement and soft tissue abnormalities, and may provide guidance for diagnostic or therapeutic interventions. MRI highlights sites with tissue edema and increased regional perfusion, and provides accurate information of the extent of the infectious process and the tissues involved. To detect osteomyelitis before anatomical changes are present, functional imaging could have some advantages over anatomical imaging. Fluorine-18 fluorodeoxyglucose-PET has the highest diagnostic accuracy for confirming or excluding the diagnosis of chronic osteomyelitis. For both SPECT and PET, specificity improves considerably when the scintigraphic images are fused with computed tomography. Close cooperation between clinicians and imagers remains the key to early and adequate diagnosis when osteomyelitis is suspected or evaluated. †1 KEYWORDS: computed tomography n hybrid systems n imaging n MRI n nuclear Carlos Pineda , medicine n osteomyelitis n ultrasonography Angelica Pena2, Rolando Espinosa2 & Cristina Osteomyelitis is inflammation of the bone that osteomyelitis. The ideal imaging technique Hernández-Díaz1 is usually due to infection. There are different should have a high sensitivity and specificity; 1Musculoskeletal Ultrasound Department, Instituto Nacional de classification systems to categorize osteomyeli- numerous studies have been published con- Rehabilitacion, Avenida tis. Traditionally, it has been labeled as acute, cerning the accuracy of the various modali- Mexico‑Xochimilco No. -
Treatment of Aneurysmal Bone Cysts with Titanium Elastic Nails in Children
Treatment of Aneurysmal Bone Cysts with Titanium Elastic Nails in Children Yi-chen Wang Children's Hospital of Shanghai Xing Jia Children's Hospital of Shanghai Yang Shen Children's Hospital of Shanghai Sun Wang Children's Hospital of Shanghai Liang-chao Dong Children's Hospital of Shanghai Jing Ren Children's Hospital of Shanghai Li-hua Zhao ( [email protected] ) Research Keywords: Primary aneurysmal bone cyst, Titanium Elastic Nails, recurrence, ecacy Posted Date: July 6th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-38776/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/16 Abstract Background: The main treatment method of the primary aneurysmal bone cyst (ABC) is to curettage and bone grafts with high-speed burring, radiotherapy, sclerotherapy, arterial embolism and hormone therapy can be used for the lesions whose location cannot be easily exposed by the surgery. Regardless of the method, high recurrence rates are a common problem. The purpose of this study was to evaluate retrospectively the use of titanium elastic nails as a internal xation in the treatment of aneurysmal bone cysts in children. Methods: Children with histological primary aneurysmal bone cyst were evaluated between 2010 to 2017. The patients were divided into 2 groups according to the treatment plan. Patients in the study group operated with curettage and bone grafts with high-speed burring + internal xation of titanium elastic nails (TEN), and patients in the control group operated with curettage and bone grafts with high-speed burring. The curative effect of the children in the 2 groups were analyzed statistically according to the imaging results (Neer grading) and MSTS functional evaluation. -
A Novel Germline Mutation of ADA2 Gene In
International Journal of Molecular Sciences Case Report A Novel Germline Mutation of ADA2 Gene in Two “Discordant” Homozygous Female Twins Affected by Adenosine Deaminase 2 Deficiency: Description of the Bone-Related Phenotype Silvia Vai 1,†, Erika Marin 1,† , Roberta Cosso 2 , Francesco Saettini 3, Sonia Bonanomi 3, Alessandro Cattoni 3, Iacopo Chiodini 1,4 , Luca Persani 1,4 and Alberto Falchetti 1,2,* 1 Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, 20145 Milan, Italy; [email protected] (S.V.); [email protected] (E.M.); [email protected] (I.C.); [email protected] (L.P.) 2 IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Verbania, Italy; [email protected] 3 Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, 20100 Monza, Italy; [email protected] (F.S.); [email protected] (S.B.); [email protected] (A.C.) 4 Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20122 Milan, Italy * Correspondence: [email protected] † These authors equally contributed to this paper. Abstract: Adenosine Deaminase 2 Deficiency (DADA2) syndrome is a rare monogenic disorder preva- lently linked to recessive inherited loss of function mutations in the ADA2/CECR1 gene. It consists Citation: Vai, S.; Marin, E.; Cosso, R.; of an immune systemic disease including autoinflammatory vasculopathies, with a frequent onset Saettini, F.; Bonanomi, S.; Cattoni, A.; at -
Case Report Chondroblastoma of The
CASE REPORT CHONDROBLASTOMA OF THE PATELLA ASSOCIATED WITH AN ANEURYSMAL BONE CYST R. TREBŠE1, A. ROTTER2,V. PIŠOT1 Chondroblastoma is a rare, benign tumor of bone, cartilage germ cells, and they redefined the tumor accounting for about 1% of all bone tumor cases. It as “benign chondroblastoma”. tends to affect the epiphyseal ends of long bones, Chondroblastoma is rare, representing about 1% most often in males during the first and second of all primary bone tumors (1, 5, 9). It is typically decades of life. It has well-characterized radio- centered in an epiphysis. Although it occurs most graphic and histologic features but despite its histo- often in the end of a long tubular bone, it can logically benign appearance a few cases of metastases appear in any secondary center of ossification. It is have been reported. Local recurrences after curet- tage and bone grafting occur in 11% to 25% of cases. most probably a tumor of cartilaginous origin and The features of a patellar chondroblastoma are the is more common in males by a ratio of about 2-to- same as for other locations. In reviewing the litera- 1 (1, 5, 9). Seventy percent of chondroblastomas ture we found an unusually high male-to-female occur during active epiphyseal plate growth, and ratio. It is interesting that the usual treatment of the about two-thirds of the patients are in the second patellar chondroblastoma has been patellectomy, decade of life (5). whereas curettage and bone grafting has predomi- Local pain of several months’ duration and nated in the other locations. -
Establishment of a Dental Effects of Hypophosphatasia Registry Thesis
Establishment of a Dental Effects of Hypophosphatasia Registry Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Jennifer Laura Winslow, DMD Graduate Program in Dentistry The Ohio State University 2018 Thesis Committee Ann Griffen, DDS, MS, Advisor Sasigarn Bowden, MD Brian Foster, PhD Copyrighted by Jennifer Laura Winslow, D.M.D. 2018 Abstract Purpose: Hypophosphatasia (HPP) is a metabolic disease that affects development of mineralized tissues including the dentition. Early loss of primary teeth is a nearly universal finding, and although problems in the permanent dentition have been reported, findings have not been described in detail. In addition, enzyme replacement therapy is now available, but very little is known about its effects on the dentition. HPP is rare and few dental providers see many cases, so a registry is needed to collect an adequate sample to represent the range of manifestations and the dental effects of enzyme replacement therapy. Devising a way to recruit patients nationally while still meeting the IRB requirements for human subjects research presented multiple challenges. Methods: A way to recruit patients nationally while still meeting the local IRB requirements for human subjects research was devised in collaboration with our Office of Human Research. The solution included pathways for obtaining consent and transferring protected information, and required that the clinician providing the clinical data refer the patient to the study and interact with study personnel only after the patient has given permission. Data forms and a custom database application were developed. Results: The registry is established and has been successfully piloted with 2 participants, and we are now initiating wider recruitment. -
Osteomalacia and Osteoporosis D
Postgrad. med.J. (August 1968) 44, 621-625. Postgrad Med J: first published as 10.1136/pgmj.44.514.621 on 1 August 1968. Downloaded from Osteomalacia and osteoporosis D. B. MORGAN Department of Clinical Investigation, University ofLeeds OSTEOMALACIA and osteoporosis are still some- in osteomalacia is an increase in the alkaline times confused because both diseases lead to a phosphatase activity in the blood (SAP); there deficiency of calcium which can be detected on may also be a low serum phosphorus or a low radiographs of the skeleton. serum calcium. This lack of calcium is the only feature Our experience with the biopsy of bone is that common to the two diseases which are in all a large excess of uncalcified bone tissue (osteoid), other ways easily distinguishable. which is the classic histological feature of osteo- malacia, is only found in patients with the other Osteomalacia typical features of the disease, in particular the Osteomalacia will be discussed first, because it clinical ones (Morgan et al., 1967a). Whether or is a clearly defined disease which can be cured. not more subtle histological techniques will detect Osteomalacia is the result of an imbalance be- earlier stages of the disease remains to be seen. tween the supply of and the demand for vitamin Bone pains, muscle weakness, Looser's zones, D. The the following description of disease is raised SAP and low serum phosphate are the Protected by copyright. based on our experience of twenty-two patients most reliable aids to the diagnosis of osteomalacia, with osteomalacia after gastrectomy; there is no and approximately in that order. -
In a Child with Myositis Ossificans Progressiva
Pediatr Radiol (1993) 23:45%462 Pediatric Radiology Springer-Verlag 1993 Chronic intoxication by ethane-l-hydroxy-l,l-diphosphonate (EHDP) in a child with myositis ossificans progressiva U. E. Pazzaglia 1, G. Beluffi 2, A. Ravelli 3, G. Zatti 1, A. Martini 3 1 Clinica Ortopedica, Ospedale F. Del Ponte, Varese, Italy 2 Servizio di Radiodiagnostica, Sezione Radiologia Pediatrica, Pavia, Italy 3 Clinica Pediatrica dell'Universit~ di Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy Received: 4 February 1993/Accepted: 25 March 1993 Abstract. A child with myositis ossificans progressiva was opsy performed elsewhere did not show any relevant pathological treated for 8 years with ethane-l-hydroxy-l,l-diphospho- change. Treatment with steroid was started and continued for sev- eral months. nate (EHDP) 30-40 mg/kg per day. Latterly he com- One and half years later a large soft tissue swelling appeared in plained of severe, progressive bone and joint pain which the shoulder girdle and followed a course similar to the lesion in the made standing and walking almost impossible. A radio- sternodeidomastoid muscle. The child was admitted to another hos- graphic skeletal survey showed diffuse ricket-like lesions. pital 1 month later. Laboratory tests showed that inflammatory pa- Withdrawal of EHDP therapy produced substantial im- rameters, serum calcium and phosphate, alkaline phosphatase and provement in his general condition as well as in the radio- muscle enzymes were normal. Electromyography was also normal. graphic appearance of the bones. Multiple exostoses were A muscle biopsy was consistent with myositis ossificans progressiva. Therapy was started with ethane-l-hydroxyd,l-diphosphonate observed in this case and, particularly those around the (EHDP) 30 mg/kg per day.