A young male of Asian-Indian ethnicity reported with a complaint of a painless, slow growing swelling over the left side of lower jaw. A thorough clinical history was taken and detailed radiological exam performed. The conventional radiographic examination revealed a mixed radiolucent-radiopaque lesion with unique appearances on different radiographs. Additional computed tomographic examination discovered the involvement of several bones in the skull base. Subsequent to histopathological confirmation a final diagnosis of craniofacial fibrous dysplasia was made. This case is particularly unique and of didactic importance as well because the various textbook descriptions for radiological appearances of fibrous dysplasia were found in the same case.
{"title":"Craniofacial fibrous dysplasia Report of a case with diverse radiological spectrum.","authors":"Silky Rajesh Punyani, Saurabh Srivastava, Vishal Ramesh Jasuja","doi":"10.11138/ccmbm/2016.13.3.249","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.249","url":null,"abstract":"<p><p>A young male of Asian-Indian ethnicity reported with a complaint of a painless, slow growing swelling over the left side of lower jaw. A thorough clinical history was taken and detailed radiological exam performed. The conventional radiographic examination revealed a mixed radiolucent-radiopaque lesion with unique appearances on different radiographs. Additional computed tomographic examination discovered the involvement of several bones in the skull base. Subsequent to histopathological confirmation a final diagnosis of craniofacial fibrous dysplasia was made. This case is particularly unique and of didactic importance as well because the various textbook descriptions for radiological appearances of fibrous dysplasia were found in the same case.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"249-252"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.11138/ccmbm/2016.13.3.249","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01Epub Date: 2017-02-10DOI: 10.11138/ccmbm/2016.13.3.214
Roberto Bertolai, Carlo Catelani, Mattia Signorini, Alessandro Rossi, Domenico Giannini
BACKGROUND Recent studies have highlighted that MSCs are capable of regenerating large bone defects when used in combination with bone substitutes and increasing allo-graft osteointegration. We investigated the hypothesis that autologous MSCs may lead to increased bone regeneration and reduced healing time in post-surgical cavities of large maxillary bone lesions. METHODS This study involved 10 patients (TEST GROUP) (6 males and 4 females). All patients had expansive mandibular lesions larger than 3 cm. From the surgical point of view, the 10 patients were treated with MSCs (withdrawal of the iliac crest bone marrow BMMSs) directly into the post-surgical cavity, without the addition of filler. RESULTS and radiological data, in the postoperative, were compared to those of patients who did not receive any grafting of MSCs. The 7 patients with mandibular lesions showed a rapid and very good healing with an 85-90% ossification of the major defect at 12 months. CONCLUSIONS Through the use of stem cells a greater ossification of the residual cavity (85-90%) was observed at 12 months after surgical enucleation in contenitive defects.
背景:最近的研究强调，当MSCs与骨替代品联合使用并增加同种异体骨融合时，能够再生大骨缺损。我们研究了自体间充质干细胞可能导致颌骨大骨病变术后腔骨再生增加和愈合时间缩短的假设。方法:本研究纳入10例患者(试验组)，其中男6例，女4例。所有患者均有大于3cm的扩张性下颌病变。从手术角度看，10例患者均采用骨间充质干细胞(MSCs, withdrawal of the髂骨骨髓BMMSs)直接植入术后腔内，不添加填充物。结果:术后放射学数据与未接受任何MSCs移植的患者进行比较。7例下颌骨病变患者在12个月时骨化率为85-90%，愈合迅速且非常好。结论:通过使用干细胞，在竞争性缺损手术去核后12个月观察到更大的残余腔骨化(85-90%)。
{"title":"Mesenchymal stem cells in post-surgical cavities of large maxillary bone lesions.","authors":"Roberto Bertolai, Carlo Catelani, Mattia Signorini, Alessandro Rossi, Domenico Giannini","doi":"10.11138/ccmbm/2016.13.3.214","DOIUrl":"10.11138/ccmbm/2016.13.3.214","url":null,"abstract":"BACKGROUND Recent studies have highlighted that MSCs are capable of regenerating large bone defects when used in combination with bone substitutes and increasing allo-graft osteointegration. We investigated the hypothesis that autologous MSCs may lead to increased bone regeneration and reduced healing time in post-surgical cavities of large maxillary bone lesions. METHODS This study involved 10 patients (TEST GROUP) (6 males and 4 females). All patients had expansive mandibular lesions larger than 3 cm. From the surgical point of view, the 10 patients were treated with MSCs (withdrawal of the iliac crest bone marrow BMMSs) directly into the post-surgical cavity, without the addition of filler. RESULTS and radiological data, in the postoperative, were compared to those of patients who did not receive any grafting of MSCs. The 7 patients with mandibular lesions showed a rapid and very good healing with an 85-90% ossification of the major defect at 12 months. CONCLUSIONS Through the use of stem cells a greater ossification of the residual cavity (85-90%) was observed at 12 months after surgical enucleation in contenitive defects.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"214-220"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318175/pdf/214-220.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.135
C. Burke, Manjiri M. Didolkar, H. Barnhart, E. Vinson
OBJECTIVES To evaluate whether lumbar vertebral body density CT attenuation values measured in Hounsfield Units (HUs) on routine Computed Tomography (CT) examinations can be reliably measured with limited variability, and to evaluate for a correlation between HUs and bone mineral density as measured by dual energy X-ray absorptiometry (DXA) scan. METHODS Retrospective review of a total of 249 routine MDCT examinations, performed to measure HUs at the first non-rib bearing lumbar vertebral body on axial images, cross-referenced to the lateral scout image. RESULTS The overall ICC and RC for intra-reader variability on CT HU were 0.987 (95% CI 0.973 - 0.999) and 15.664 (95% CI 11.66-16.97). The overall ICC and RDC for inter-reader variability on CT HU were 0.952 (95% CI 0.892 - 0.999) and 30.20 (95% CI 23.73 - 34.48). The ICC and RC for interscanner variability were 0.98 (95% CI 0.95 - 0.99) and 16.67 (95% CI 13.13 - 22.85). The correlation between the L1 HUs and L1 BMD, L1 t-score, and overall t-score was 0.437, 0.392, and 0.400, respectively. CONCLUSIONS CT attenuation values of the first lumbar vertebra can be measured on routine abdomen CTs with limited variability despite multiple readers and scanners. Correlation between HU and BMD as measured by DXA scan was only weakly positive, and by this method measuring the density of a lumbar vertebral body from a routine MDCT scan does not provide the sensitivity or specificity necessary for a screening test. However above a certain measured value (180 HU), patients have a low chance of osteoporosis and therefore may not need additional screening, potentially limiting radiation exposure and cost.
目的评价常规计算机断层扫描(CT)检查中Hounsfield单位(HUs)测量的腰椎体密度CT衰减值是否可以在有限变异性下可靠地测量，并评估HUs与双能x线吸收仪(DXA)扫描测量的骨密度之间的相关性。方法回顾性分析249例常规MDCT检查，在轴向图像上测量第一非肋骨腰椎的HUs，交叉参考侧位侦察图像。结果CT HU阅读器内变异的总体ICC和RC分别为0.987 (95% CI 0.973 ~ 0.999)和15.664 (95% CI 11.66 ~ 16.97)。CT HU阅读器间变异的总体ICC和RDC分别为0.952 (95% CI 0.892 - 0.999)和30.20 (95% CI 23.73 - 34.48)。扫描器间变异的ICC和RC分别为0.98 (95% CI 0.95 - 0.99)和16.67 (95% CI 13.13 - 22.85)。L1 HUs与L1 BMD、L1 t-评分、总t-评分的相关系数分别为0.437、0.392、0.400。结论常规腹部ct可以测量第一腰椎的sct衰减值，尽管有多个阅读器和扫描仪，但变异性有限。通过DXA扫描测量的HU与BMD之间的相关性仅为弱阳性，并且通过这种方法从常规MDCT扫描中测量腰椎椎体密度不能提供筛查试验所需的敏感性或特异性。然而，超过某一测量值(180 HU)，患者患骨质疏松的几率较低，因此可能不需要额外的筛查，从而可能限制辐射暴露和成本。
{"title":"The use of routine non density calibrated clinical computed tomography data as a potentially useful screening tool for identifying patients with osteoporosis.","authors":"C. Burke, Manjiri M. Didolkar, H. Barnhart, E. Vinson","doi":"10.11138/CCMBM/2016.13.2.135","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.135","url":null,"abstract":"OBJECTIVES\u0000To evaluate whether lumbar vertebral body density CT attenuation values measured in Hounsfield Units (HUs) on routine Computed Tomography (CT) examinations can be reliably measured with limited variability, and to evaluate for a correlation between HUs and bone mineral density as measured by dual energy X-ray absorptiometry (DXA) scan.\u0000\u0000\u0000METHODS\u0000Retrospective review of a total of 249 routine MDCT examinations, performed to measure HUs at the first non-rib bearing lumbar vertebral body on axial images, cross-referenced to the lateral scout image.\u0000\u0000\u0000RESULTS\u0000The overall ICC and RC for intra-reader variability on CT HU were 0.987 (95% CI 0.973 - 0.999) and 15.664 (95% CI 11.66-16.97). The overall ICC and RDC for inter-reader variability on CT HU were 0.952 (95% CI 0.892 - 0.999) and 30.20 (95% CI 23.73 - 34.48). The ICC and RC for interscanner variability were 0.98 (95% CI 0.95 - 0.99) and 16.67 (95% CI 13.13 - 22.85). The correlation between the L1 HUs and L1 BMD, L1 t-score, and overall t-score was 0.437, 0.392, and 0.400, respectively.\u0000\u0000\u0000CONCLUSIONS\u0000CT attenuation values of the first lumbar vertebra can be measured on routine abdomen CTs with limited variability despite multiple readers and scanners. Correlation between HU and BMD as measured by DXA scan was only weakly positive, and by this method measuring the density of a lumbar vertebral body from a routine MDCT scan does not provide the sensitivity or specificity necessary for a screening test. However above a certain measured value (180 HU), patients have a low chance of osteoporosis and therefore may not need additional screening, potentially limiting radiation exposure and cost.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"1 1","pages":"135-140"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89460488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.101
J. Buza, T. Einhorn
Delayed fracture healing and nonunion occurs in up to 5-10% of all fractures, and can present a challenging clinical scenario for the treating physician. Methods for the enhancement of skeletal repair may benefit patients that are at risk of, or have experienced, delayed healing or nonunion. These methods can be categorized into either physical stimulation therapies or biological therapies. Physical stimulation therapies include electrical stimulation, low-intensity pulsed ultrasonography, or extracorporeal shock wave therapy. Biological therapies can be further classified into local or systemic therapy based on the method of delivery. Local methods include autologous bone marrow, autologous bone graft, fibroblast growth factor-2, platelet-rich plasma, platelet-derived growth factor, and bone morphogenetic proteins. Systemic therapies include parathyroid hormone and bisphosphonates. This article reviews the current applications and supporting evidence for the use of these therapies in the enhancement of fracture healing.
{"title":"Bone healing in 2016.","authors":"J. Buza, T. Einhorn","doi":"10.11138/CCMBM/2016.13.2.101","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.101","url":null,"abstract":"Delayed fracture healing and nonunion occurs in up to 5-10% of all fractures, and can present a challenging clinical scenario for the treating physician. Methods for the enhancement of skeletal repair may benefit patients that are at risk of, or have experienced, delayed healing or nonunion. These methods can be categorized into either physical stimulation therapies or biological therapies. Physical stimulation therapies include electrical stimulation, low-intensity pulsed ultrasonography, or extracorporeal shock wave therapy. Biological therapies can be further classified into local or systemic therapy based on the method of delivery. Local methods include autologous bone marrow, autologous bone graft, fibroblast growth factor-2, platelet-rich plasma, platelet-derived growth factor, and bone morphogenetic proteins. Systemic therapies include parathyroid hormone and bisphosphonates. This article reviews the current applications and supporting evidence for the use of these therapies in the enhancement of fracture healing.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"11 1","pages":"101-105"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81695386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.154
R. Yachoui
Zoledronate is a highly potent bisphosphonate widely used in the treatment of postmenopausal osteoporosis. We report the first occurrence of toxic acute tubular necrosis (ATN) following treatment with zoledronate in a patient with osteoporosis. A 63-year-old Caucasian female with rheumatoid arthritis on anti-immune agents received a single dose of zoledronic acid (reclast) for worsening osteoporosis. Twelve days later, she developed renal failure with a rise in serum creatinine from a baseline level of 1.1 mg/dL to 5.5 mg/dL. Renal biopsy showed toxic ATN. Zoledronate was discontinued and the patient had subsequent gradual improvement in renal function with final serum creatinine of 1.8 mg/dL at 1 month of follow up. Careful monitoring of serum creatinine and awareness of the potential nephrotoxicity may avert the development of acute renal failure in osteoporosis patients treated with this agent.
{"title":"Early onset acute tubular necrosis following single infusion of zoledronate.","authors":"R. Yachoui","doi":"10.11138/CCMBM/2016.13.2.154","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.154","url":null,"abstract":"Zoledronate is a highly potent bisphosphonate widely used in the treatment of postmenopausal osteoporosis. We report the first occurrence of toxic acute tubular necrosis (ATN) following treatment with zoledronate in a patient with osteoporosis. A 63-year-old Caucasian female with rheumatoid arthritis on anti-immune agents received a single dose of zoledronic acid (reclast) for worsening osteoporosis. Twelve days later, she developed renal failure with a rise in serum creatinine from a baseline level of 1.1 mg/dL to 5.5 mg/dL. Renal biopsy showed toxic ATN. Zoledronate was discontinued and the patient had subsequent gradual improvement in renal function with final serum creatinine of 1.8 mg/dL at 1 month of follow up. Careful monitoring of serum creatinine and awareness of the potential nephrotoxicity may avert the development of acute renal failure in osteoporosis patients treated with this agent.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"534 1","pages":"154-156"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82410020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.131
V. Santilli, M. Paoloni, M. Mangone, F. Alviti, A. Bernetti
Osteoarthritis (OA) is a chronic degenerative joint disease characterized by pain and progressive functional limitation. Viscosupplementation with intra-articular (IA) hyaluronic acid (HA) could be a treatment option in OA, however recommendations made in different international guidelines for the non-surgical management of OA are not always concordant with regard to the role of IA injection therapies. Results from a recent Italian Consensus Conference underline how IA-HA to treat OA represents a widely used therapy in Italy. Specifically high molecular weight HA, cross-linked HA, and mobile reticulum HA are considered very useful to treat the OA joints from a great number of expert in Italy. These kinds of HA could reduce the NSAIDs intake, furthermore high-molecular weight and mobile reticulum HA are considered to be able to delay or avoid a joint prosthetic implant. This mini review highlights the results obtained from the Italian Consensus Conference "Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis" and give further indication about innovation in IA-HA therapies.
{"title":"Hyaluronic acid in the management of osteoarthritis: injection therapies innovations.","authors":"V. Santilli, M. Paoloni, M. Mangone, F. Alviti, A. Bernetti","doi":"10.11138/CCMBM/2016.13.2.131","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.131","url":null,"abstract":"Osteoarthritis (OA) is a chronic degenerative joint disease characterized by pain and progressive functional limitation. Viscosupplementation with intra-articular (IA) hyaluronic acid (HA) could be a treatment option in OA, however recommendations made in different international guidelines for the non-surgical management of OA are not always concordant with regard to the role of IA injection therapies. Results from a recent Italian Consensus Conference underline how IA-HA to treat OA represents a widely used therapy in Italy. Specifically high molecular weight HA, cross-linked HA, and mobile reticulum HA are considered very useful to treat the OA joints from a great number of expert in Italy. These kinds of HA could reduce the NSAIDs intake, furthermore high-molecular weight and mobile reticulum HA are considered to be able to delay or avoid a joint prosthetic implant. This mini review highlights the results obtained from the Italian Consensus Conference \"Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis\" and give further indication about innovation in IA-HA therapies.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"33 1","pages":"131-134"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83358878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.097
C. Mattia, F. Coluzzi, L. Celidonio, R. Vellucci
Bone pain in elderly people dramatically affects their quality of life, with osteoporosis being the leading cause of skeletal related events. Peripheral and central mechanisms are involved in the pathogenesis of the nervous system sensitization. Osteoporosis in the elderly has been associated with increased density of bone sensory nerve fibers and their pathological modifications, together with an over-expression of nociceptors sensitized by the lowering pH due to the osteoclastic activity. The activation of N-methyl-D-aspartate (NMDA) receptors and the microglia, as a response to a range of pathological conditions, represent the leading cause of central sensitization. Unfortunately, osteoporosis is named the "silent thief" because it manifests with painful manifestation only when a fracture occurs. In the management of patients suffering from bone pain, both the nociceptive and the neuropathic component of chronic pain should be considered in the selection of the analgesic treatment.
老年人骨痛严重影响他们的生活质量，骨质疏松症是骨骼相关事件的主要原因。外周和中枢机制参与了神经系统致敏的发病机制。老年人骨质疏松症与骨感觉神经纤维密度增加及其病理改变有关，还与破骨细胞活性引起的pH值降低致敏的伤害感受器的过度表达有关。n -甲基- d -天冬氨酸(NMDA)受体和小胶质细胞的激活，作为对一系列病理条件的反应，是中枢致敏的主要原因。不幸的是，骨质疏松症被称为“沉默的小偷”，因为它只在发生骨折时表现为疼痛。在骨痛患者的治疗中，在选择镇痛治疗时应同时考虑慢性疼痛的伤害性和神经性成分。
{"title":"Bone pain mechanism in osteoporosis: a narrative review.","authors":"C. Mattia, F. Coluzzi, L. Celidonio, R. Vellucci","doi":"10.11138/CCMBM/2016.13.2.097","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.097","url":null,"abstract":"Bone pain in elderly people dramatically affects their quality of life, with osteoporosis being the leading cause of skeletal related events. Peripheral and central mechanisms are involved in the pathogenesis of the nervous system sensitization. Osteoporosis in the elderly has been associated with increased density of bone sensory nerve fibers and their pathological modifications, together with an over-expression of nociceptors sensitized by the lowering pH due to the osteoclastic activity. The activation of N-methyl-D-aspartate (NMDA) receptors and the microglia, as a response to a range of pathological conditions, represent the leading cause of central sensitization. Unfortunately, osteoporosis is named the \"silent thief\" because it manifests with painful manifestation only when a fracture occurs. In the management of patients suffering from bone pain, both the nociceptive and the neuropathic component of chronic pain should be considered in the selection of the analgesic treatment.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"62 1","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73043132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.123
Aurore Lloret, G. Coiffier, Tiffen Couchouron, A. Perdriger, P. Guggenbuhl
INTRODUCTION Osteoporotic fractures are a major public health problem because of the morbidity and mortality of fracture complications. The objective of this study was to examine predictive factors of mortality during the first year after an osteoporotic fracture. METHODS It is a retrospective case-control study using data of a group of 1081 patients aged over 50 years with severe osteoporotic fractures by the Rennes university hospital emergency department from August 2007 to September 2008. Patients (cases) who died during the year following the fracture were compared with others who had survived (controls) one year after the fracture, matched on age, sex and type of fracture. Pre-fracture comorbidities and complications after the fractures were studied. RESULTS Forty-two cases and 126 controls were analyzed without significant differences in age, sex or type of fracture. On univariate analysis, previous neoplasia, neurodegenerative disease, walking aids, thromboembolic complication, post fracture infection, post fracture heart failure, post fracture acute respiratory failure were associated with more mortality after osteoporotic fracture. After multivariate analysis, only previous neoplasia (OR = 4.63 [1.79 - 11.95]; p = 0.02) and acute respiratory failure after fracture (OR = 28.15 [5.75 - 137.9]; p<0.001) were retained as predictive factors during the year following the fracture. CONCLUSION Patients died more often from their co-morbidities than direct complications of their fractures. Osteoporotic fracture seems to be a marker of poor health status and a factor which may hasten the death.
{"title":"Risk factors of mortality during the first year after low energy osteoporosis fracture: a retrospective case-control study.","authors":"Aurore Lloret, G. Coiffier, Tiffen Couchouron, A. Perdriger, P. Guggenbuhl","doi":"10.11138/CCMBM/2016.13.2.123","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.123","url":null,"abstract":"INTRODUCTION\u0000Osteoporotic fractures are a major public health problem because of the morbidity and mortality of fracture complications. The objective of this study was to examine predictive factors of mortality during the first year after an osteoporotic fracture.\u0000\u0000\u0000METHODS\u0000It is a retrospective case-control study using data of a group of 1081 patients aged over 50 years with severe osteoporotic fractures by the Rennes university hospital emergency department from August 2007 to September 2008. Patients (cases) who died during the year following the fracture were compared with others who had survived (controls) one year after the fracture, matched on age, sex and type of fracture. Pre-fracture comorbidities and complications after the fractures were studied.\u0000\u0000\u0000RESULTS\u0000Forty-two cases and 126 controls were analyzed without significant differences in age, sex or type of fracture. On univariate analysis, previous neoplasia, neurodegenerative disease, walking aids, thromboembolic complication, post fracture infection, post fracture heart failure, post fracture acute respiratory failure were associated with more mortality after osteoporotic fracture. After multivariate analysis, only previous neoplasia (OR = 4.63 [1.79 - 11.95]; p = 0.02) and acute respiratory failure after fracture (OR = 28.15 [5.75 - 137.9]; p<0.001) were retained as predictive factors during the year following the fracture.\u0000\u0000\u0000CONCLUSION\u0000Patients died more often from their co-morbidities than direct complications of their fractures. Osteoporotic fracture seems to be a marker of poor health status and a factor which may hasten the death.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"32 1","pages":"123-126"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82490874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.157
N. Torkamani, P. Phal, R. Savarirayan, P. Simm, G. Varigos, J. Wark
Ichthyosiform dermatosis is a term referred to a group of disorders that have as their basis a disorder of keratinization (1). These conditions which are present at birth result in a generalized dry, scaly skin without any inflammation. There are several types of ichthyosis based on their clinical presentation and mode of inheritance. The most common types are: ichthyosis vulgaris, X-linked recessive ichthyosis, epidermolytic hyperkeratosis (bullous), lamellar ichthyosis and non-bullous ichthyosiform erythroderma. Lamellar ichthyosis, which is inherited in an autosomal recessive pattern, shows genetic heterogeneity with the most severe type being due to mutations in the transglutaminase-1 gene. This condition presents with skin changes at birth and cases are referred to as collodion babies. Initially, the stratum corneum is smooth and appears as though it is covered with cellophane. This layer is discarded a few days after birth, leaving a generalized inflamed and scaly appearance. The skin is tight at this stage and may cause ectropion, and difficulties in feeding and temperature regulation. Lamellar ichthyosis is characterized by plate-like scales that last for life and can significantly impact the patient's quality of life (2). We report here a case of multiple extraspinal hyperostoses concomitant with marked osteoporosis and vitamin D deficiency in a patient taking acitretin for 20 years due to severe congenital lamellar ichthyosis.
{"title":"Concomitant extraspinal hyperostosis and osteoporosis in a patient with congenital ichthyosis.","authors":"N. Torkamani, P. Phal, R. Savarirayan, P. Simm, G. Varigos, J. Wark","doi":"10.11138/CCMBM/2016.13.2.157","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.157","url":null,"abstract":"Ichthyosiform dermatosis is a term referred to a group of disorders that have as their basis a disorder of keratinization (1). These conditions which are present at birth result in a generalized dry, scaly skin without any inflammation. There are several types of ichthyosis based on their clinical presentation and mode of inheritance. The most common types are: ichthyosis vulgaris, X-linked recessive ichthyosis, epidermolytic hyperkeratosis (bullous), lamellar ichthyosis and non-bullous ichthyosiform erythroderma. Lamellar ichthyosis, which is inherited in an autosomal recessive pattern, shows genetic heterogeneity with the most severe type being due to mutations in the transglutaminase-1 gene. This condition presents with skin changes at birth and cases are referred to as collodion babies. Initially, the stratum corneum is smooth and appears as though it is covered with cellophane. This layer is discarded a few days after birth, leaving a generalized inflamed and scaly appearance. The skin is tight at this stage and may cause ectropion, and difficulties in feeding and temperature regulation. Lamellar ichthyosis is characterized by plate-like scales that last for life and can significantly impact the patient's quality of life (2). We report here a case of multiple extraspinal hyperostoses concomitant with marked osteoporosis and vitamin D deficiency in a patient taking acitretin for 20 years due to severe congenital lamellar ichthyosis.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"90 5 1","pages":"157-159"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83650140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.11138/CCMBM/2016.13.2.119
V. Bottai, S. Giannotti, G. Raffaetà, M. Mazzantini, F. Casella, Gaia De Paola, A. Menconi, F. Falossi, G. Guido
Osteoporosis (OP) is a silent disease unless a fracture occurs; it is a major health problem, mainly due to fragility fractures, that occur at vertebral and peripheral sites. Vertebral fractures (VF) are probably the most common fragility fractures, but they go often unrecognized. The main clinical symptoms of VF are acute and chronic back pain, spinal deformity, reduced mobility and impaired quality of life. They are frequently associated with other fragility fractures. We examined 478 patients at our outpatient clinic, who were referred for fragility fracture occurrence. The most common fragility fractures was hip fractures. However, after execution of spine X-rays in patients who had sustained hip fracture, we found that a large proportion of them had VF, which had not been reported in their medical history.
{"title":"Underdiagnosis of osteoporotic vertebral fractures in patients with fragility fractures: retrospective analysis of over 300 patients.","authors":"V. Bottai, S. Giannotti, G. Raffaetà, M. Mazzantini, F. Casella, Gaia De Paola, A. Menconi, F. Falossi, G. Guido","doi":"10.11138/CCMBM/2016.13.2.119","DOIUrl":"https://doi.org/10.11138/CCMBM/2016.13.2.119","url":null,"abstract":"Osteoporosis (OP) is a silent disease unless a fracture occurs; it is a major health problem, mainly due to fragility fractures, that occur at vertebral and peripheral sites. Vertebral fractures (VF) are probably the most common fragility fractures, but they go often unrecognized. The main clinical symptoms of VF are acute and chronic back pain, spinal deformity, reduced mobility and impaired quality of life. They are frequently associated with other fragility fractures. We examined 478 patients at our outpatient clinic, who were referred for fragility fracture occurrence. The most common fragility fractures was hip fractures. However, after execution of spine X-rays in patients who had sustained hip fracture, we found that a large proportion of them had VF, which had not been reported in their medical history.","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"70 1","pages":"119-122"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90477665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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