Bone Abstracts June 2015 Volume 4 ISSN 2052-1219 (Online)
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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). -
The Imaging Value of Bone Turnover of Skeletal Fluorosis
FOREIGN MEDICAL SCIENCES (SECTION OF MEDGEOGRAPHY) ISSN 1001-8883 June 2004, Vol. 25, No. 2, Pages 95-98. Treatise The Imaging Value of Bone Turnover of Skeletal Fluorosis LIU Jun 1, LIU Jin 2, FU Zhao 3, WU Lan-qin 1, DING Hui 1, WANG De-long 1, YU Bo-lang 1 Xi’an Jiaotong University: 1 Medical Imaging Center of the First Hospital; 2Emergency Department of Baoji Petroleum Hospital, Baoji, Shaanxi 721000; 3Department of Foreign Languages; Xi’an, Shaanxi 710061. Objective To probe into X-ray, CT and MRI manifestations of bone turnover in skeletal fluorosis and diagnostic values of different examination technologies. Methods Comparisons and analyses were made on the imaging manifestations of bone turnover in 28 reported cases with skeletal fluorosis. Results All 28 cases had dental fluorosis of different degrees. The chief symptoms included arthralgia and aching muscle pains in four limbs; 13 cases had joint motion limitation and dysfunction, 28 cases had spinal pain and 26 cases (92.85%) had pain in the lumbar region and legs. As to the imaging manifestations, 17 cases mainly had hyperostosis and 11 cases mainly had osteopenia; 5 had fuzzy bone trabecula, 9 loosening of cortical bone and 19 sclerosis of cancellous bone; 7 cases were complicated by biconcave deformity of vertebral body and 6 cases by pelvic deformity; 4 cases manifested the formation of false fracture line, and 7 cases manifested disorder of bone growth and development. Conclusions: MRI may distinctly display early changes of bone turnover in patients with skeletal fluorosis with high diagnostic sensitivity. Key words: Skeletal fluorosis; bone turnover; imageology As a widespread endemic and occupational disease that threatens people’s health, skeletal fluorosis is widely distributed around the world. -
ENDEMIC FLUOROSIS with Particular Reference to Dental and Systemic Intoxication AMARJIT SINGH, M.D., M.R.C.P
Postgrad Med J: first published as 10.1136/pgmj.38.437.150 on 1 March 1962. Downloaded from POSTGRAD. MED. J. (1962), 38, 150 ENDEMIC FLUOROSIS With Particular Reference to Dental and Systemic Intoxication AMARJIT SINGH, M.D., M.R.C.P. (Lond.) Professor of Medicine SUNDER J. VAZIRANI, B.D.S., D.O.S., M.S., F.I.C.D. Professor of Oral Surgery S. S. JOLLY, M.D. Assistant Professor of Medicine B. C. BANSAL, M.B. Registrar, Central Registration VVith the technical assistance of 0. C. MATHUR, M.Sc.* (Department of Medicine and Dentistry, Medical College, Patiala) THE-studies of the toxic effects of fluoride on the sites of muscular and tendinous insertions are human system have evoked a very lively interest rendered abnormally prominent by excessive peri- throughout the world because the public health osteal reaction with development of multipleby copyright. programmes of fluoridation for the prevention of exostoses which can be clinically palpated in dental caries have always considered the risk of a many cases. The greatest changes are observed remote cumulative intoxication. However, the in the spine, particularly in the cervical region. indices of early intoxication are very poorly de- The vertebrx show altered proportions and fined. The affinity of fluoride for the bones is measurements in all planes, but the striking ab- acknowledged by everybody, but there is no normality is the gross reduction of the antero- universal agreement on its effects on other systems posterior diameter of the spinal canal and inter- of the body-particularly when it has been spread vertebral foramina accounting for the neuro- over a number of years. -
Endemic Skeletal Fluorosis M
Arch Dis Child: first published as 10.1136/adc.46.249.686 on 1 October 1971. Downloaded from Archives of Disease in Childhood, 1971, 4X, 686. Endemic Skeletal Fluorosis M. TEOTIA, S. P. S. TEOTIA, and K. B. KUNWAR From 'Wellcome' Metabolic Laboratory, Department of Medicine, King George's Medical College, Lucknow (India) Teotia, M., Teotia, S. P. S., and Kunwar, K. B. (1971). Archives of Disease in Childhood, 46, 686. Endemic skeletal fluorosis. Endemic skeletal fluorosis is described in 6 children aged 11 or over. Four cases were crippled with severe deformities in the spine, hips, and knees. All showed positive phosphorus, mag- nesium, and nitrogen balances and excessively positive calcium balances. The skeletal x-rays, histology, and chemical composition of the bones revealed diagnostic changes in each case. Endemic fluorosis as manifested by mottled clearance, chemical analysis of bone ash for calcium, dental enamel and by diffuse osteosclerosis of the phosphorus, magnesium, and fluoride. The histology skeleton was first described in India from the of decalcified and undecalcified sections of the biopsied State of by Shortt et al. (1937). Subse- iliac crest bone was studied. In 3 children detailed Madras phosphorus, magnesium, and nitrogen balances were quently cases have been described from other parts studied on a normal diet. The fluoride content of the of India (Pandit et al., 1940; Daver, 1945; Khan bone, drinking water, and urine samples was deter- and Wig, 1945; Siddiqui, 1955; Singh et al., 1962; mined by the procedure based upon diffusion of hydro- Singh et al., 1963; Singh, 1967; Teotia, Kunwar, gen fluoride, as detailed by Singer and Armstrong (1965). -
Osteogenesis Imperfecta: Recent Findings Shed New Light on This Once Well-Understood Condition Donald Basel, Bsc, Mbbch1, and Robert D
COLLABORATIVE REVIEW Genetics in Medicine Osteogenesis imperfecta: Recent findings shed new light on this once well-understood condition Donald Basel, BSc, MBBCh1, and Robert D. Steiner, MD2 TABLE OF CONTENTS Overview ...........................................................................................................375 Differential diagnosis...................................................................................380 Clinical manifestations ................................................................................376 In utero..........................................................................................................380 OI type I ....................................................................................................376 Infancy and childhood................................................................................380 OI type II ...................................................................................................377 Nonaccidental trauma (child abuse) ....................................................380 OI type III ..................................................................................................377 Infantile hypophosphatasia ....................................................................380 OI type IV..................................................................................................377 Bruck syndrome .......................................................................................380 Newly described types of OI .....................................................................377 -
Reiner Bartl Christoph Bartl Biology, Diagnosis, Prevention, Therapy
Reiner Bartl Christoph Bartl Bone Disorders Biology, Diagnosis, Prevention, Therapy 123 Bone Disorders Reiner Bartl • Christoph Bartl Bone Disorders Biology, Diagnosis, Prevention, Therapy With a contribution by Andrea Baur-Melnyk and Tobias Geith Prof. Dr. med. Reiner Bartl PD Dr. med. Christoph Bartl Osteoporosis Center Munich ZOOOM (Center of Orthopaedics, Kaufi ngerstr. 15 Osteoporosis and Sports Medicine, Munich Munich) Germany Rosa-Bavaresestr. 1 Munich Germany With a contribution by Prof. Dr. med. Andrea Baur-Melnyk and Dr. med. Tobias Geith Department of Clinical Radiology University of Munich-Grosshadern Marchioninistrasse 15 Munich, Germany All coloured illustrations from Harald Konopatzki, Heidelberg. All two-coloured and blackline illustrations from Reinhold Henkel†, Heidelberg. ISBN 978-3-319-29180-2 ISBN 978-3-319-29182-6 (eBook) DOI 10.1007/978-3-319-29182-6 Library of Congress Control Number: 2016944148 © Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. -
Skeletal Imaging of Nutritional Disorders in Children
CRIMSONpublishers http://www.crimsonpublishers.com Clinical Image Nov Tech Nutri Food Sci ISSN: 2640-9208 Skeletal Imaging of Nutritional Disorders in Children Kakarla Subbarao* KIMS Foundation and Research Centre, India *Corresponding author: Kakarla Subbarao, MS, D.Sc. (HON), FRCR, FACR, FICP, FSASMA, FCCP, FICR, FCGP, Chairman, KIMS Foundation and Research Centre, Minister road, Sec- 500003, Telangana, India Submission: September 06, 2017; Published: January 22, 2018 Abstract Imaging of skeleton plays a major role in the diagnosis of nutritional disorders in children. The disorders can be 1) Deficiency2) Toxic (Overdose). and the grading of diagnosis of degrees of osteoporosis. The differential diagnosis is also discussed. The common deficiency disorders include rickets, scurvy, osteoporosis and anemias. Conventional radiology is adequate in the diagnosis, except in Keywords: Rickets, scurvy; Osteoporosis; Fluorosis; Lead poisoning; Vitamin A and D overdose; Radiological characteristics Introduction The toxic disorders include hypervitaminosis A and D. Other causes Despite governmental and nongovernmental service programs include plumbism, hypercalcemia, steroids, heparin over use, in improving pediatric nutrition with supplementary foods, it antiepiliptic drugs and flurosis. is not uncommon to see children with nutritional deficiency Pathophysiology of Rickets disorders. Most of them reflect upon the musculoskeletal system. The deposition of mineral in cartilage needs adequate amounts osteoporosis, hypoprotenemia and anemias. The conventional The major deficiency disorders include nutritional rickets, scurvy, radiological appearances are classical and very rarely are it needed to have advanced imaging methods. However, quantitative computed of both calcium and phosphorous. If these are deficient failure of new osteoid is less due to inhibition of osteoclastic resorption of matrix. tomography (CT), dual-energy photon absorptiometry, and dual- bone mineralization takes place. -
Osteoporosis in Children 173:6 R185–R197 Review
V Saraff and W Ho¨ gler Osteoporosis in children 173:6 R185–R197 Review ENDOCRINOLOGY AND ADOLESCENCE Osteoporosis in children: diagnosis and management Correspondence Vrinda Saraff and Wolfgang Ho¨ gler should be addressed Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Steelhouse Lane, to W Ho¨ gler Birmingham B4 6NH, UK Email [email protected] Abstract Osteoporosis in children can be primary or secondary due to chronic disease. Awareness among paediatricians is vital to identify patients at risk of developing osteoporosis. Previous fractures and backaches are clinical predictors, and low cortical thickness and low bone density are radiological predictors of fractures. Osteogenesis Imperfecta (OI) is a rare disease and should be managed in tertiary paediatric units with the necessary multidisciplinary expertise. Modern OI management focuses on functional outcomes rather than just improving bone mineral density. While therapy for OI has improved tremendously over the last few decades, this chronic genetic condition has some unpreventable, poorly treatable and disabling complications. In children at risk of secondary osteoporosis, a high degree of suspicion needs to be exercised. In affected children, further weakening of bone should be avoided by minimising exposure to osteotoxic medication and optimising nutrition including calcium and vitamin D. Early intervention is paramount. However, it is important to identify patient groups in whom spontaneous vertebral reshaping and resolution of symptoms occur to avoid unnecessary treatment. Bisphosphonate therapy remains the pharmacological treatment of choice in both primary and secondary osteoporosis in children, despite limited evidence for its use in the latter. The duration and intensity of treatment remain a concern for long- term safety. -
Genetic Factors in Bone Disorders. Osteogenesis Imperfecta, Juvenile
GENETIC FACTORS HEINI IN BONE DISORDERS HARTIKKA Osteogenesis imperfecta, juvenile osteoporosis and stress fractures Faculty of Medicine, Department of Medical Biochemistry and Molecular Biology, Biocenter Oulu, University of Oulu OULU 2005 HEINI HARTIKKA GENETIC FACTORS IN BONE DISORDERS Osteogenesis imperfecta, juvenile osteoporosis and stress fractures Academic Dissertation to be presented with the assent of the Faculty of Medicine, University of Oulu, for public discussion in Auditorium of the Medipolis (Kiviharjuntie 11), on May 26th, 2005, at 10 a.m. OULUN YLIOPISTO, OULU 2005 Copyright © 2005 University of Oulu, 2005 Supervised by Professor Leena Ala-Kokko Reviewed by Professor Heikki Kröger Professor Risto Penttinen ISBN 951-42-7717-1 (nid.) ISBN 951-42-7718-X (PDF) http://herkules.oulu.fi/isbn951427718X/ ISSN 0355-3221 http://herkules.oulu.fi/issn03553221/ OULU UNIVERSITY PRESS OULU 2005 Hartikka, Heini, Genetic factors in bone disorders. Osteogenesis imperfecta, juvenile osteoporosis and stress fractures Faculty of Medicine, Department of Medical Biochemistry and Molecular Biology, Biocenter Oulu, University of Oulu, P.O.Box 5000, FIN-90014 University of Oulu, Finland 2005 Oulu, Finland Abstract Genetic factors and their resulting phenotypes were evaluated in three different bone disorders: osteogenesis imperfecta (OI), juvenile idiopathic osteoporosis (JIO), and stress fractures. The spectrum of the OI phenotypes caused by mutations in the COL1A1 and COL1A2 genes is well defined, but the mechanisms by which the variations affect the hearing phenotype are not well- known. A total of 54 Finnish OI patients with previously diagnosed hearing loss, or aged 35 or more years, were analyzed here for mutations in COL1A1, or COL1A2. Altogether, 49 mutations were identified, of which 41 were novel. -
Osteoporosis in Childhood and Adolescence
0021-7557/03/79-06/481 Jornal de Pediatria Copyright © 2003 by Sociedade Brasileira de Pediatria REVIEW ARTICLE Osteoporosis in childhood and adolescence Lúcia M.A. Campos,1 Bernadete L. Liphaus,2 Clóvis A.A. Silva,3 Rosa M.R. Pereira4 Abstract Objective: To review recent data concerning osteoporosis and osteopenia in childhood and adolescence, focusing on diagnosis, prevention and treatment. Sources of data: Literature review of Medline and Lilacs databases (1992 to 2002). Summary of the findings: Childhood osteoporosis is defined and classified. Imaging and laboratory diagnostic techniques are emphasized, as well as prevention and drug treatment. Conclusions: Pediatricians should identify the risk factors for osteoporosis and guide patients in terms of its prevention and treatment. J Pediatr (Rio J). 2003;79(6):481-8: Osteoporosis, children, adolescents. Introduction Osteoporosis is a significant health problem all over expectancy.2 Osteopenia and osteoporosis are no longer the world. From the age of 50 onwards, 30% of women exclusively the concern of adults and older people, since and 13% of men may suffer some type of fracture.1 It is the bone mineral density of these age groups is dependent estimated that the incidence of fractures will quadruple upon the peak bone mass acquired by the end of the over the next 50 years as a result of increased life- second decade of life.3 The pediatrician has the responsibility of guaranteeing the conditions necessary for children and adolescents to develop the best possible 1. MSc. Assistant physician, Rheumatology Unit, Instituto da Criança do quality of bone mass, avoiding fractures in adult life.