Medical History Of Osteoporosis Research Articles

Examination of Risk Factors and Expression Patterns of Atypical Femoral Fractures Using the Japanese Adverse Drug Event Report Database: A Retrospective Pharmacovigilance Study.

Atypical femoral fracture (AFF) is a rare complication related to the use of bisphosphonates (BPs). Herein, we analyzed the risk factors and onset patterns of AFF using the Japanese Adverse Drug Event Report database and reported the findings. First, the independent risk factors for AFF were gender (female), high body mass index, and medical history of osteoporosis, arthritis, and systemic lupus erythematosus (SLE). Drug-related risk factors for AFF included BPs (i.e., alendronic acid, ibandronic acid, etidronic acid, zoledronic acid, minodronic acid, risedronic acid), denosumab, prednisolone, lansoprazole, rabeprazole, exemestane, letrozole, eldecalcitol, and menatetrenone. Therefore, it appears that AFF is influenced by a combination of patient backgrounds and drugs, and that the risk of developing AFF is particularly high in patients with fragile bones (e.g., osteoporosis, arthritis, and SLE). Second, in the analysis of AFF onset patterns, the onset of AFF from BPs and denosumab took a long time (>1 year) to develop. Analysis using a Weibull distribution showed wear-out failure-type AFF onset for BPs and denosumab, and both osteoporosis and cancer patients with long-term administration of these drugs showed a tendency to have an increased risk of onset. AFF developed earlier in osteoporosis patients with long-term administration of BPs and denosumab than in cancer patients.

Surgical Implications of the Arterial Anatomy around the Knee: A Cadaveric Pictorial Essay.

We completed an anatomic cadaver study in order to examine the arterial supply around the knee and to create useful images regarding the arterial surgical anatomy around the knee. A total of four unmatched fresh-frozen cadaveric knees were utilized. There was no medical history of osteoporosis, bony or soft-tissue injury or surgery in any of the knees. The femoral arteries were cannulated with a large catheter at the proximal aspect of the cadavers, and liquid latex in different colours was injected. Τhe specimens were then placed into a bath of 8.0% sodium hypochlorite to complete debridement of the soft tissues to various degrees. The specimens were checked every 15 to 30 min until adequate debridement occurred, and photographs were taken during each stage of this process. Sodium hypochlorite, among others, chemically debrides the vessel walls leaving the casts of the vessel lumens filled with solid coloured latex in order to illustrate the vascular supply pattern to the structures of interest. Knowing the probability of where these arteries should be located adds to the knowledge that surgeons have at their disposal when performing procedures involving arthroscopy, arthroplasty and osteotomies, which can help decrease unnecessary damage to the arteries.

Comparative analysis of clinical factors associated with pedicle screw pull\u2010out during or immediately after surgery between intraoperative cone\u2010beam computed tomography and postoperative computed tomography

BackgroundNo studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.MethodsThis was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.ResultsPedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.ConclusionsOur findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

Early-Onset Osteopenia and Osteoporosis in Patients with Pyruvate Kinase Deficiency

Early-Onset Osteopenia and Osteoporosis in Patients with Pyruvate Kinase Deficiency

SAT-341 Hyperparathyroid Crisis Precipitated by Rapid Correction of Symptomatic Hypercalcemia in an Occult Ectopic Parathyroid Adenoma

Background: Parathyroid adenomas (PA) are typically benign, slow-growing tumors causing gradual increase in parathyroid hormone (PTH) and serum calcium (s.Ca) levels. Hyperparathyroid crisis is a rare and potentially fatal syndrome, which occurs due to rapid elevation of PTH and s.Ca levels (s.Ca >15mg/dL). This can potentiate severe metabolic derangements, manifesting as altered mental status (AMS), renal insufficiency and cardiac arrhythmias. We present a case of hyperparathyroid crisis in the setting of an occult ectopic parathyroid adenoma.Case: 75 year old female with a medical history of osteoporosis, hypertension and Parkinson’s disease, presented to our hospital with AMS and one week history of diarrhea. She was recently hospitalized for pneumonia and treated with antibiotics. Biochemical analysis revealed corrected s.Ca 15.4mg/dL (8.2- 9.6mg/dL; 7 days prior s.Ca was 9.7mg/dL), renal insufficiency (Cr 2.26mg/dL; baseline 1.2) with normal serum phosphorus, magnesium, 25-hydroxyvitamin D and alkaline phosphatase. PTH was found to be elevated at 75pg/mL (15-65pg/mL). She was treated with aggressive intravenous hydration and calcitonin 200mg BID for 3 days. Her s.Ca appropriately trended down. However, her PTH level continued to rise: 319pg/mL 12 hours later, 591pg/mL on day 2 and peaked to 1,242pg/mL on day 3. CT angiography neck showed an incidental finding of a heterogeneous, possibly necrotic, soft tissue nodule in the left paraesophageal region. Additional work-up with technetium 99 Sestamibi scan revealed persistent activity in the upper tracheoesophageal groove consistent with an ectopic PA. She underwent parathyroid exploration with excision of an enlarged ectopic left superior parathyroid adenoma, confirmed on histopathological analysis. The remaining parathyroid glands were normal. PTH declined to 34pg/mL postoperatively. Her mental status improved significantly returning to baseline within a few days with normal PTH and s.Ca levels.Discussion: Secretion of PTH is mediated by s.Ca via the calcium sensing receptors (CaSR). Studies have shown that patients with PA have decreased expression of the CaSR leading to an autonomous rise in PTH secretion and a higher PTH-calcium set point. In our case, the patient initially presented with a mildly elevated PTH level and symptomatic hypercalcemia. The rapid correction of s.Ca levels precipitated a remarkable rise in PTH levels. We postulate that this was caused by a possible upregulation mechanism in calcium sensing by adenomatous parathyroid tissue that is responsive to acute lowering of s.Ca levels, triggering a hyperparathyroid crisis.Reference: (1) Corbetta S., et al. Calcium-sensing receptor expression and signaling in human parathyroid adenomas and primary hyperplasia. Clinical Endocrinology. 2000; 52(3):339-48.

The impact of osteoporosis on health-related quality of life in elderly women

Objective of this study was to assess the impact of osteoporosis on health-related quality of life (HRQoL) in elderly Korean women. Sociodemographic characteristics, medical history of osteoporosis, and the EuroQol-5 dimension questionnaire scores for 1,000 female participants aged 60 years or older were obtained from the 2015 Korean National Health and Nutrition Examination Survey (KNHANES). Demographic variables, including age, educational level and income, were significantly associated with HRQoL. Furthermore, osteoporosis had a significant effect on HRQoL in elderly Korean women. In the osteoporosis group, the adjusted odds ratios for disability on the ED-5Q dimensions were 1.92 (95% confidence interval (CI)=1.44-2.58, p<0.001) for mobility, 1.90 (95% CI=1.45-2.51, p<0.001) for pain/ discomfort, and 1.89 (95% CI=1.36-2.61, p=0.001) for usual activities. These findings indicate that osteoporosis has a significant impact on HRQoL and suggest that the prevention and treatment of osteoporosis may significantly improve quality of life in elderly women.

Association of osteoporotic fracture with smoking, alcohol consumption, tea consumption and exercise among Chinese nonagenarians/centenarians.

To observe the association of osteoporotic fracture with habits of smoking, alcohol consumption, tea consumption and exercise among very old people. A cross-sectional study conducted in Dujiangyan Sichuan China. 703 unrelated Chinese nonagenarians and centenarians (67.76% women, mean age 93.48 years) resident in Dujiangyan. Medical history of osteoporosis and the statement of fracture and habits (current and former) of smoking, alcohol consumption, tea consumption and exercise were collected. In women, subjects with current or former habit of alcohol consumption had significantly higher prevalence osteoporotic fracture than those without this habit; but subjects with former habit of exercise had significantly lower prevalence osteoporotic fracture than those without this habit. However, in men, there was no significant difference in prevalence of these habits between subjects with and without osteoporotic fracture. After adjust for age, gender, sleep habits educational levels, religion habits and temperament, we found that former habit of alcohol consumption had a significant odds ratio (OR=2.473 95% CI (1.074, 5.526)) for osteoporotic fracture. In summary, among nonagenarians and centenarians, among habits (current and former) of smoking, alcohol consumption, tea consumption and exercise, there seems to be significant association of osteoporotic fracture only with current or former habits of alcohol consumption, former habit of exercise. The habit of alcohol consumption might be associated with a greater risk of osteoporotic fracture, but the former habit of exercise might be associated with a lower risk of osteoporotic fracture.

Case of maxillary avascular necrosis due to oral bisphosphonates, presenting with signs of malignancy

We report a rare case of avascular necrosis of the maxilla secondary to oral bisphosphonates. Case report and review of the world literature concerning avascular necrosis as a result of bisphosphonate therapy. A 62-year-old woman presented with unilateral nasal obstruction, swelling of the cheek and an ulcerating lesion of the upper alveolus. She had a past medical history of osteoporosis, for which she took oral bisphosphonates. Investigation revealed necrosis of the maxilla, and avascular necrosis secondary to oral bisphosphonates was diagnosed. There have been several documented cases of avascular necrosis of the mandible and maxilla following intravenous bisphosphonates or dental procedures. In our case, bisphosphonates were only taken orally and no dental work had been undertaken. This patient's clinical presentation was highly suggestive of malignancy, and we would like to communicate this unusual case to other otolaryngologists.