Cases Of Osteoporosis Research Articles

Idiopathic Transient Osteoporosis of the Pelvis in a Non-Pregnant Young Woman: A Case Study

Idiopathic transient osteoporosis of the hip is a rare condition that was first described in a series women in their third trimester of pregnancy. The clinical course is usually benign and self-limiting. Magnetic resonance is very useful for the diagnosis. Differential diagnoses include avascular necrosis of the femoral head, septic arthritis of the hip, osteomyelitis, stress fractures, primary or secondary neoplastic processes, and referred pain from the spine or genitourinary tract in pregnant women. The authors present a case of idiopathic transient osteoporosis of the pelvis in a young nonpregnant woman with insidious hip pain with no antecedent infection or trauma.

Two cases of bilateral transient osteoporosis of the hip

Two cases of bilateral transient osteoporosis of the hip

Preferences of GPs and Patients for Preventive Osteoporosis Drug Treatment

Osteoporotic fractures have a serious economic impact on society and on the quality of life of patients. Differences in opinions on the desirability of preventive treatment initiation may hamper the process and outcome of shared decision making between physician and patient. To evaluate and compare preferences of GPs and patients for preventive osteoporosis drug treatment. Discrete-choice experiment (DCE) involving 34 general practices in the area of Rotterdam, the Netherlands. Participants included 40 GPs and 120 women aged > or = 60 years who participated in a study on osteoporosis case finding. We included any woman aged >60 years, with an over-representation of women with a high fracture risk (n = 60). (i) The relative weights that GPs and patients place on five treatment attributes of preventive osteoporosis drug treatment: effectiveness, nausea as an adverse effect, total treatment duration, route of drug administration and out-of-pocket costs; and (ii) the determinants of any differences in preferences between GPs and patients. The response rate was 40/59 (68%) for GPs and 120/181 (66%) for patients. All treatment attributes proved to be important for preferences of GPs and patients. GPs had a significantly less favourable attitude towards preventive osteoporosis drug treatment than patients; they placed significantly higher values on effectiveness of preventive drug treatment and short total preventive treatment duration than patients. GPs and patients showed different preferences towards preventive osteoporosis drug treatment. Addressing each of these differences may have a positive effect on the process and outcomes of shared decision making regarding preventive treatment initiation.

Validitas Indeks Densitas Tulang Mandibula POSTUR-P dalam Memprediksi Densitas Tulang Perempuan Pascamenopause

Osteoporosis is a silent disease, i.e. the disease will progress without symptoms or pain until bones start to break. Densitometry examinations to diagnose osteoporosis is relatively expensive for most people in Indonesia. Kusdhany et al have produced a mandibular density index specific for Deutero-malay postmenopausal women (POSTUR-P). This index can be used to predict osteoporosis risk in mandibular and other bones. The objective of this research was to try out POSTUR-P before using it in the community. The study was a diagnostic test, on 31 Teratai clinic postmenopausal patients of Ciptomangunkusumo Hospital between 50-75 years of age from June to October 2004 and fulfilling inclusion criteria. Densitometry on lumbal and femur bones was used as a gold standard. The result of this study showed that POSTUR-P has high sensitivity and moderate specificity, and appears to be a good screening tool to indicate osteoporosis cases.

A case of post-pregnancy osteoporosis combined with ankylosing spondylitis

Post-pregnancy osteoporosis is not a common disease and is hard to diagnosis because their specific situation is post-partum and lactation. It commonly occurs on lumbar spine within a few months after the birth of a patient's first child and it could lead to be fracture after minor trauma. Although its etiology is not clear, it would not be of sufficient magnitude to cause fractures unless the woman already had a substantial decrease in bone mass. Also, it is rare to be combined with ankylosing spondylitis. Ankylosing spondylitis has a higher risk of osteoporosis and vertebral fracture which increased with the duration of disease. We report a case of post-pregnancy osteoporosis with multiple spinal compression fracture in association of ankylosing spondylitis.

Efficacy and safety of once daily low molecular weight heparin (tinzaparin sodium) in high risk pregnancy

Low molecular weight heparin (LMWH) is widely regarded as the anticoagulant treatment of choice for the prevention and treatment of venous thromboembolism during pregnancy. However, previous studies have demonstrated that the pharmacokinetic profiles of LMWH vary significantly with increasing gestation. Consequently, it remains unclear whether LMWH regimens recommended for use in nonpregnant individuals can be safely extrapolated to pregnant women. The aims of this study were to assess the safety and the efficacy of tinzaparin sodium (Innohep) administered only once daily during pregnancy. A systematic retrospective review identified a cohort of 37 high-risk pregnancies which had been managed using tinzaparin 175 IU/kg once daily. In 26 cases, the index pregnancy had been complicated by development of an acute venous thromboembolism (17 deep vein thrombosis and nine pulmonary embolism). For each individual, case notes were examined and data extracted using a predetermined questionnaire. No episodes of recurrent venous thromboembolism were identified amongst this cohort of pregnancies managed using once daily LMWH administration. However, two unusual thrombotic complications were observed, including a parietal infarct in one patient, and a postpartum cerebral venous thrombosis in another. Once daily tinzaparin was well tolerated, with no cases of heparin-induced thrombocytopaenia, symptomatic osteoporosis, or foetal malformations. Tinzaparin dose modification based upon peak anti-Xa levels occurred in 45% of the cases examined. The present study is the largest study to have examined the clinical efficacy of once daily LMWH for use in pregnant women at high risk of venous thromboembolism. Our data support the safety and efficacy of antenatal tinzaparin at a dose of 175 IU/kg. In order to determine whether this once daily regimen provides equivalent (or indeed greater) thromboprophylaxis to twice daily LMWH regimens during pregnancy will require highly powered direct comparative studies.

Osteoporosis in Men With Prostate Cancer: Now for the Fracture Data

Osteoporosis in Men With Prostate Cancer: Now for the Fracture Data

Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment?

Background context Pregnancy- and lactation-associated osteoporosis is an uncommon condition that may be a consequence of preexisting low bone density, loss of bone mineral content during pregnancy, and increased bone turnover. Purpose To present a case of severe osteoporosis associated with pregnancy and lactation and its treatment protocol. Study design/setting A tertiary care hospital. Patient sample A young female after twin pregnancy presenting with severe osteoporosis. Methods The diagnosis was done on the basis of bone mineral density (BMD) measurement. The patient was treated with first alendronate and then strontium ranelate. She was considered as a candidate for kyphoplasty. Results A dramatic increase in the BMD and palliation of back pain were observed. Conclusions Strontium ranelate may be a new alternative in the treatment of pregnancy- and lactation-associated osteoporosis.

Using multiple data features improved the validity of osteoporosis case ascertainment from administrative databases

ObjectivesThe aim was to construct and validate algorithms for osteoporosis case ascertainment from administrative databases and to estimate the population prevalence of osteoporosis for these algorithms. Study Design and SettingArtificial neural networks, classification trees, and logistic regression were applied to hospital, physician, and pharmacy data from Manitoba, Canada. Discriminative performance and calibration (i.e., error) were compared for algorithms defined from different sets of diagnosis, prescription drug, comorbidity, and demographic variables. Algorithms were validated against a regional bone mineral density testing program. ResultsDiscriminative performance and calibration were poorer and sensitivity was generally lower for algorithms based on diagnosis codes alone than for algorithms based on an expanded set of data features that included osteoporosis prescriptions and age. Validation measures were similar for neural networks and classification trees, but prevalence estimates were lower for the former model. ConclusionMultiple features of administrative data generally resulted in improved sensitivity of osteoporosis case-detection algorithm without loss of specificity. However, prevalence estimates using an expanded set of features were still slightly lower than estimates from a population-based study with primary data collection. The classification methods developed in this study can be extended to other chronic diseases for which there may be multiple markers in administrative data.

The clinical use of quantitative ultrasound (QUS) in the detection and management of osteoporosis

For the detection and management of osteoporosis and osteoporosis-related fractures, quantitative ultrasound (QUS) is emerging as a relatively low-cost and readily accessible alternative to dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) in certain circumstances. The following is a brief, but thorough review of the existing literature with respect to the use of QUS in 6 settings: 1) assessing fragility fracture risk; 2) diagnosing osteoporosis; 3) initiating osteoporosis treatment; 4) monitoring osteoporosis treatment; 5) osteoporosis case finding; and 6) quality assurance and control. Many QUS devices exist that are quite different with respect to the parameters they measure and the strength of empirical evidence supporting their use. In general, heel QUS appears to be most tested and most effective. Overall, some, but not all, heel QUS devices are effective assessing fracture risk in some, but not all, populations, the evidence being strongest for Caucasian females over 55 years old. Otherwise, the evidence is fair with respect to certain devices allowing for the accurate diagnosis of likelihood of osteoporosis, and generally fair to poor in terms of QUS use when initiating or monitoring osteoporosis treatment. A reasonable protocol is proposed herein for case-finding purposes, which relies on a combined assessment of clinical risk factors (CR.F) and heel QUS. Finally, several recommendations are made for quality assurance and control.

Impact of Systematic Implementation of a Clinical Case Finding Strategy on Diagnosis and Therapy of Postmenopausal Osteoporosis

Case finding for osteoporosis in postmenopausal women is advocated in guidelines of osteoporosis, but implementation is unsatisfactory. We studied, in daily practice, the impact of systematic implementation of a previously validated clinical decision rule and fracture history on referral for bone densitometry (DXA) and drug prescription for osteoporosis. Before-after impact analysis in 41,478 consecutive consulting postmenopausal women, included by 1080 general practitioners (GPs) during 2 mo, using the osteoporosis self-assessment (OST) index (based on age and weight, indicating women at low [LR], moderate [MR], and high risk [HR] for having osteoporosis [T-score < -2.5 in spine and/or hip]) and fracture history. Relative risks (RRs) and 95% CIs were calculated between referrals before (n = 6580) and after intervention (n = 10,379) and between risk subgroups. Post-intervention RR for referral for DXA was 1.9 (95% CI, 1.8-2.0). Compared with LR women with prior DXA, the RR was 6.3 (95% CI, 6.0-6.6) in MR and 10.7 (95% CI, 10.0-11.4) in HR women without fracture, but similar in MR and HR women with fracture (11.4 and 11.6, respectively). New cases of osteoporosis were diagnosed in 3811 women, 96% of whom were prescribed drug treatment. Of HR women, 79% were referred for DXA. The sensitivity of a low OST index to predict osteoporosis was 92% and specificity was 16%. The impact of temporary systematic implementation of this case finding strategy on GP practice was high: it nearly tripled referrals for DXA, and 96% of patients found to have osteoporosis had treatment. The impact depended on OST index and fracture history. Only 79% of HR women were referred for DXA. Specificity of a low OST index to predict osteoporosis was low. This indicates the need in the GP population for case finding strategies with fewer barriers for referral for DXA and with higher accuracy for predicting osteoporosis.

Summary of: The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study

Objective To determine if thinning (<3 mm width) of the lower cortical border of the mandible on dental panoramic radiographs, as well as other clinical risk factors, may provide a useful diagnostic test for osteoporosis in young postmenopausal women. Design Six hundred and fifty-two subjects (age range 45-70 years) were involved in this multi-centre, cross-sectional study. Setting Patients were recruited from centres in Leuven (Belgium), Athens (Greece), Manchester (UK), and Malmo (Sweden). Subjects and methods The subject's age, body weight, whether the patient took hormone replacement therapy or had a history of low trauma fracture were used to form a clinical osteoporosis risk assessment (the OSteoporosis Index of RISk or OSIRIS index). Each patient also received a dental panoramic radiographic examination. Results One hundred and forty subjects had osteoporosis involving at least one of the measurement sites (lumbar spine, femoral neck or total hip). Those with osteoporosis tended to have a low OSIRIS score and a thinned cortical mandibular border. The area under the ROC curve for using both cortical width and OSIRIS to predict osteoporosis was 0.90 (95% CI = 0.87 to 0.92). There was a significant improvement in the diagnostic ability of the combined OSIRIS and cortical width test over both tests applied separately (p <0.001). The cost effectiveness of the cortical width and OSIRIS model was improved by using a high specificity threshold rather than high sensitivity. However, this analysis ignores the costs associated with missed cases of osteoporosis. Conclusion Dentists have a role to play in the detection and referral of patients at high risk of osteoporosis.

Regional migratory osteoporosis

Regional migratory osteoporosis (RMO) is an uncommon disease characterised by a migrating arthralgia involving the weight bearing joints of the lower limb. The typical imaging findings on radiographs, magnetic resonance imaging, computed tomography and bone scintigraphy are described and illustrated. Men in their fifth and sixth decades of life are most commonly affected. The most common presentation is with proximal to distal spread in the lower limb. The world literature has been reviewed which has revealed 63 documented cases of regional osteoporosis or bone marrow oedema with migratory symptoms. Most of these cases have not been labelled as RMO and therefore the condition is probably under-diagnosed. The radiology of RMO is indistinguishable from transient osteoporosis of the hip (TOH) except for the migratory symptoms and the two conditions are likely to be part of the same spectrum of disease. Systemic osteoporosis is a more recently recognised accompanying feature that hints at an underlying aetiology and an approach to the management of this condition.

Patients’ preferences for osteoporosis drug treatment: a discrete choice experiment

SummaryActive case finding for osteoporosis is used to identify patients at high fracture risk who may benefit from preventive drug treatment. We investigated the relative weight that women place on various aspects of preventive drugs in a discrete choice experiment. Our patients said they were prepared to take preventive drugs even if side effects were expected.IntroductionActive case finding for osteoporosis is used to identify patients who may benefit from preventive drugs. We aimed to elicit the relative weight that patients place on various aspects of preventive drug treatment for osteoporosis.MethodsWe designed a discrete choice experiment, in which women had to choose between drug profiles that differed in five treatment attributes: effectiveness, side effects (nausea), total treatment duration, route of drug administration, and out-of-pocket costs. We included 120 women aged 60 years and older, identified by osteoporosis case finding in 34 general practices in the Netherlands. A conditional logit regression model was used to analyse the relative importance of treatment attributes, the trade-offs that women were willing to make between attributes, and their willingness to pay.ResultsAll treatment attributes proved to be important for women’s choices. A reduction of the relative 10-year risk of hip fracture by 40% or more by the drug was considered to compensate for nausea as a side effect. Women were prepared to pay an out-of-pocket contribution for the currently available drug treatment (bisphosphonate) if the fracture risk reduction was at least 12%.ConclusionsWomen identified by active osteoporosis case finding stated to be prepared to take preventive drugs, even if side effects were expected and some out-of-pocket contribution was required.

Therapeutic effects of one-year alendronate treatment in three cases of osteoporosis with parietal thinning of skull

We studied the therapeutic effects of one-year alendronate treatment in three cases (two males and one female) of osteoporosis with parietal thinning of skull. Plain radiography and three dimensional computed tomography revealed asymmetric external thinning of the posteromedial part of the bilateral parietal bones. Technetium-99m methylenediphosphate bone scintigraphy did not show any changes in these three cases. Pretreatment levels of urinary type I collagen cross-linked N-telopeptides (NTX) in all three cases were high compared to the normal range. Pretreatment levels of serum bone-specific alkaline phosphatase (BAP) in the two male patients were high in contrast to the normal values in the female patient. Pretreatment mean bone mineral density (BMD) values of the 2nd to 4th lumbar vertebrae (L2-4BMD), head BMD, femoral neck BMD, and whole body BMD of all three patients were low compared with the respective normal ranges. One-year alendronate treatment decreased both urinary NTX and serum BAP in all three cases to normal values. Treatment also increased the whole body BMD in all three cases, the L2-4BMD of the female patient, the femoral neck BMD of the female patient and one male patient, and the head BMD of the female patient when compared to pretreatment levels.

P68. Which IV bisphosphonates must be used after initiating androgen deprivation therapy in patients submitted to radical prostatectomy experiencing recurrence? A prospective open-label controlled study

Objectives: Androgen-deprivation therapy (ADT) may promote osteoporosis and osteopenia. Methods: 94 prostatectomized men with rising PSA were enrolled into the placebo group (31), monthly IV clodronate (39) or monthly IV zoledronic acid (24) for 36 months. Dualenergy x-ray absorptiometry measured the bone density in the lumbar (L2–L4) area. Chi-squared and ANOVA tests were used. Results: After 6 months of androgen deprivation 17 out of 31 cases of control cases developed osteopenia in the lumbar area. In 12months, 9 control cases reached osteoporosis with 13 additional cases of osteopenia. At the end of the 36months study period the untreated group showed an average BMD loss of 1.82 (±0.94) with 13 cases of osteopenia and 18 cases of osteoporosis. Clodronate group showed 2 cases of osteoporosis out of 39 after 6 months on androgen deprivation with 28 developing osteopenia and 7 cases of osteoporosis after 36 months of follow-up. Mean BMD loss in this group was 0.72 (±0.34). Zoledronic acid studied arm showed 7 cases of osteopenia after 6 months on androgen deprivation while 20 and 5 cases developed osteopenia and osteoporosis respectively after 36 months of follow-up. The former group had mean bone loss of 0.88 (±0.32). There was statistical difference for BMD loss in the treated groups starting at 6 months in comparison to the control group. Conclusions: There is impressive bone loss after androgen deprivation but it can be reverted by preventive bisphosphonates usage.

Transient Osteoporosis of the Knee

Idiopathic transient osteoporosis is a self-limiting, reversible, and uncommon condition. There is usually an overlap between various clinical syndromes, which includes reflex sympathetic dystrophy and avascular necrosis. This article reports a case of idiopathic transient osteoporosis involving the femur and tibia in the knee following trauma in a 45-year-old man. The diagnosis was confirmed by magnetic resonance imaging. The patient was treated conservatively with bed rest, nonsteroidal antiinflammatory drugs, protected weight bearing, and physiotherapy. He had a full clinical and radiographic recovery.

A case of idiopathic transient osteoporosis of hip in a 72-year-old woman

A case of idiopathic transient osteoporosis of hip in a 72-year-old woman

Elevation of Intact Parathyroid Hormone Level Is a Risk Factor for Low Bone Mineral Density in Pretransplant Patients With Liver Diseases

The purpose of this study was to investigate the frequency and risk factors for low bone mineral density (BMD) among patients awaiting liver transplantation. BMD of the lumbar spine (LS) and femoral neck (FN), measured by dual-energy X-ray absorptiometery (DEXA), were obtained in 64 pretransplant patients. We measured markers of bone metabolism including serum calcium, phosphorus, serum 25-hydroxyvitamin D (25-OH D), intact parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), osteocalcin (OC), and urinary deoxypyridinoline/creatinine (DPD/Cr) ratio. Osteoporosis and osteopenia (low BMD) were observed in 36 patients (36/64, 56.2%), including 6 cases of osteoporosis (6/64, 9.3%) and 30 cases of osteopenia (30/64, 46.9%). Of all variables, cholestatic liver disease and elevated levels of iPTH were significantly associated with low BMD. Moreover, elevated iPTH level was identified as an independent risk factor for low BMD ( P < .05, OR = 1.017, 95% CI = 1.001–1.032) by multivariate analysis. The median level of iPTH was increased to 55.6 pg/mL (range, 7.8–337 pg/mL) in the low BMD group, while the median level was 33 pg/mL (range, 3–162 pg/mL) in the normal BMD group ( P < .05). This study revealed a high incidence of low BMD in the pretransplant patients with liver diseases. The elevated iPTH level was the predominant risk factor for low BMD. We suggest that both BMD and iPTH examinations be considered routine tests to identify the status of bone mass and bone metabolism among recipients prior to liver transplantation.

Use of a Case Manager to Improve Osteoporosis Treatment After Hip Fracture

Patients who survive hip fracture are at high risk of recurrent fractures, but rates of osteoporosis treatment 1 year after sustaining a fracture are less than 10% to 20%. We have developed an osteoporosis case manager intervention. The case manager educated patients, arranged bone mineral density tests, provided prescriptions, and communicated with primary care physicians. The intervention was compared with usual care in a randomized controlled trial. We recruited from all hospitals that participate in the Capital Health system (Alberta, Canada), including patients 50 years or older who had sustained a hip fracture and excluding those who were receiving osteoporosis treatment or who lived in a long-term care facility. Primary outcome was bisphosphonate therapy 6 months after fracture; secondary outcomes included bone mineral density testing, appropriate care (bone mineral density testing and treatment if bone mass was low), and intervention costs. We screened 2219 patients and allocated 220, as follows: 110 to the intervention group and 110 to the control group. Median age was 74 years, 60% were women, and 37% reported having had previous fractures. Six months after hip fracture, 56 patients in the intervention group (51%) were receiving bisphosphonate therapy compared with 24 patients in the control group (22%) (adjusted odds ratio, 4.7; 95% confidence interval, 2.4-8.9; P < .001). Bone mineral density tests were performed in 88 patients in the intervention group (80%) vs 32 patients in the control group (29%) (P < .001). Of the 120 patients who underwent bone mineral density testing, 25 (21%) had normal bone mass. Patients in the intervention group were more likely to receive appropriate care than were patients in the control group (67% vs 26%; P < .001). The average intervention cost was $50.00 per patient. For a modest cost, a case manager was able to substantially increase rates of osteoporosis treatment in a vulnerable elderly population at high risk of future fractures.