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Celin MR, Simon JC, Krzak JJ, Fial AV, Kruger KM, Smith PA, Harris GF. Do Bisphosphonates Alleviate Pain in Children? A Systematic Review. Curr Osteoporos Rep 2020; 18:486-504. [PMID: 32960409 DOI: 10.1007/s11914-020-00621-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The goal of this systematic review is to analyze the effectiveness of bisphosphonates (BPs) to treat bone pain in children and adolescents who have diseases with skeletal involvement. RECENT FINDINGS We included 24 studies (2 randomized controlled trials, 3 non-randomized controlled trials, 10 non-randomized open-label uncontrolled studies, 8 retrospective studies, and 1 study with design not specified). The majority of included studies assessed pain from a unidimensional approach, with pain intensity the most frequently evaluated dimension. Only 38% of studies used validated tools; visual analogue scale was the most frequently employed. BPs were used to alleviate bone pain in a wide variety of pediatrics conditions such as osteogenesis imperfecta, secondary osteoporosis, osteonecrosis related to chemotherapy, chronic non-bacterial osteitis, idiopathic juvenile osteoporosis, unresectable benign bone tumor, and cancer-related pain. Twenty of the 24 studies reported a positive effect of BPs for alleviating pain in different pathologies, but 58% of the studies were categorized as having high risk of bias. Intravenous BPs are helpful in alleviating bone pain in children and adolescents. It is advised that our results be interpreted with caution due to the heterogeneity of the doses used, duration of treatments, and types of pathologies included. In addition, this review shows the paucity of high-quality evidence in the available literature and further research is needed. TRIAL REGISTRATION Before the completion of this review, the protocol was registered to PROSPERO (International prospective register of systematic reviews), PROSPERO 2020 ID # CRD42020158316. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316.
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Affiliation(s)
| | - Jackeline C Simon
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Joseph J Krzak
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Alissa V Fial
- Research and Instructional Services, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA
| | - Karen M Kruger
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Peter A Smith
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
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52
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Chronic Nonbacterial Osteomyelitis. J Orthop Sports Phys Ther 2020; 50:585. [PMID: 32998612 DOI: 10.2519/jospt.2020.9221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 9-year-old active girl presented to physical therapy via direct access with intermittent severe pain deep in the distal third of her left thigh that had a 2-year history. Twenty months prior, her pediatrician ordered radiographs that were noncontributory and diagnosed her with "growing pains." During examination, an osseous nontender enlargement of the femur was found proximal to the patella, and the patient was referred to her pediatrician for imaging. Radiographs demonstrated an expansile bone lesion with a mixed matrix and an open surgical biopsy determined the mass to be consistent with nonbacterial osteomyelitis. J Orthop Sports Phys Ther 2020;50(10):585. doi:10.2519/jospt.2020.9221.
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53
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Menashe SJ, Aboughalia H, Zhao Y, Ngo AV, Otjen JP, Thapa MM, Iyer RS. The Many Faces of Pediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Practical Location- and Case-Based Approach to Differentiate CRMO From Its Mimics. J Magn Reson Imaging 2020; 54:391-400. [PMID: 32841445 DOI: 10.1002/jmri.27299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of childhood and adolescence characterized by episodic bone pain. Diagnosis relies heavily on whole-body MRI and is made by excluding a wide variety of other disorders with overlapping imaging features, depending on location, marrow distribution, and the presence or absence of multifocality. We present an overview of the clinical and imaging features of CRMO and, through various clinical scenarios, provide tips for tailoring the differential diagnosis based on location and distribution of encountered abnormalities. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hassan Aboughalia
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yongdong Zhao
- Department of Rheumatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mahesh M Thapa
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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54
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Campbell TN, Frizzell B, MacMullan P. Chronic non-bacterial osteomyelitis masquerading as fibrous dysplasia. Mod Rheumatol Case Rep 2020; 4:192-195. [PMID: 33087020 DOI: 10.1080/24725625.2020.1728062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
Chronic non-bacterial osteomyelitis is a rare auto-inflammatory bone disease seen predominantly in the paediatric population. We describe a unique case of a 30-year-old female who presented with right-sided jaw pain and intermittent swelling over the course of 6 years. She was initially treated with antibiotics for possible osteomyelitis, then temporarily diagnosed with fibrous dysplasia. She underwent extensive investigations consisting of an infectious workup, numerous imaging modalities, and three separate biopsies of her right jaw. She was ultimately diagnosed with chronic non-bacterial osteomyelitis based upon her history of recurrent episodes of painful swelling, response to non-steroidal anti-inflammatories, previously raised acute phase reactants, and magnetic resonance imaging findings. Unfortunately, she became refractory to non-steroidal anti-inflammatory therapy. Consequently, she was successfully treated with pamidronate, achieving clinical remission with improvement in her imaging findings. This case highlights the difficulty of diagnosis of chronic non-bacterial osteomyelitis and the need for increased awareness of the disease in the adult population. Additionally, the effective treatment with pamidronate supports the use of a bisphosphonate as an early intervention for adult-onset chronic non-bacterial osteomyelitis in patients who have failed non-steroidal anti-inflammatory therapy.
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Affiliation(s)
- Tessa N Campbell
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Bevan Frizzell
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Paul MacMullan
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Canada
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55
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Response of Different Treatment Protocols to Treat Chronic Non-Bacterial Osteomyelitis (CNO) of the Mandible in Adult Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051737. [PMID: 32155902 PMCID: PMC7084792 DOI: 10.3390/ijerph17051737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
(1) Background: Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disease of finally unknown etiology, which can occur alone or related with syndromes (chronic recurrent multifocal osteomyelitis—CRMO; synovitis, acne, pustulosis, hyperostosis and osteitis syndrome—SAPHO). The involvement of the mandible is rather rare. (2) Methods: We carried out a systematic literature search on CNO with mandibular involvement, according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines, considering the different synonyms for CNO, with a special focus on therapy. (3) Results: Finally, only four studies could be included. A total of 36 patients were treated in these studies—therefore, at most, only tendencies could be identified. The therapy in the included works was inconsistent. Various therapies could alleviate the symptoms of the disease. A complete remission could only rarely be observed and is also to be viewed against the background of the fluctuating character of the disease. The success of one-off interventions is unlikely overall, and the need for long-term therapies seems to be indicated. Non-steroidal anti-inflammatory drugs (NSAIDs) were not part of any effective therapy. Surgical therapy should not be the first choice. (4) Conclusions: In summary, no evidence-based therapy recommendation can be given today. For the future, systematic clinical trials on therapy for CNO are desirable.
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Yahara H, Horita S, Yanamoto S, Kitagawa Y, Asaka T, Yoda T, Morita K, Michi Y, Takechi M, Shimasue H, Maruoka Y, Kondo E, Kusukawa J, Tsujiguchi H, Sato T, Kannon T, Nakamura H, Tajima A, Hosomichi K, Yahara K. A Targeted Genetic Association Study of the Rare Type of Osteomyelitis. J Dent Res 2020; 99:271-276. [PMID: 31977282 DOI: 10.1177/0022034520901519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic nonbacterial osteomyelitis is a rare bone disorder that can be found in the jaw. It is often associated with systemic conditions, including autoimmune deficiencies. However, little is known about how the genetic and immunologic background of patients influences the disease. Here, we focus on human leukocyte antigen (HLA), killer cell immunoglobulin-like receptors (KIRs), and their specific combinations that have been difficult to analyze owing to their high diversity. We employed a recently developed technology of simultaneous typing of HLA alleles and KIR haplotype and investigated alleles of the 35 HLA loci and KIR haplotypes composed of centromeric and telomeric motifs in 18 cases and 18 controls for discovery and 472 independent controls for validation. We identified an amino acid substitution of threonine at position 94 of HLA-C in combination with the telomeric KIR genotype of haplotype tA01/tB01 that had significantly higher frequency (>20%) in the case population than in both control populations. Multiple logistic regression analysis based on a dominant model with adjustments for age and sex revealed and validated its statistical significance and high predictive accuracy (C-statistic ≥0.85). Structure-based analysis revealed that the combination of the amino acid change in HLA-C and the telomeric genotype tA01/tB01 could be associated with lower stability of HLA-C. This is the first case-control study of a rare disease that employed the latest sequencing technology enabling simultaneous typing and investigated amino acid polymorphisms at HLA loci in combination with KIR haplotype.
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Affiliation(s)
- H Yahara
- Department of Molecular Immunology and Inflammation, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - S Horita
- Department of Bioregulation and Pharmacological Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - S Yanamoto
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Y Kitagawa
- Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - T Asaka
- Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Morita
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Bioresource Research Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Takechi
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Shimasue
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Maruoka
- Department of Oral and Maxillofacial Surgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - E Kondo
- Department of Dentistry and Oral Surgery, School of Medicine, Shinshu University, Matsumoto, Japan
| | - J Kusukawa
- Dental and Oral Medical Center, School of Medicine, Kurume University, Fukuoka, Japan
| | - H Tsujiguchi
- Department of Environmental and Preventive Medicine, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - T Sato
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - T Kannon
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - H Nakamura
- Department of Environmental and Preventive Medicine, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - A Tajima
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - K Hosomichi
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - K Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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57
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Bao M, Zhang K, Wei Y, Hua W, Gao Y, Li X, Ye L. Therapeutic potentials and modulatory mechanisms of fatty acids in bone. Cell Prolif 2019; 53:e12735. [PMID: 31797479 PMCID: PMC7046483 DOI: 10.1111/cpr.12735] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 02/05/2023] Open
Abstract
Bone metabolism is a lifelong process that includes bone formation and resorption. Osteoblasts and osteoclasts are the predominant cell types associated with bone metabolism, which is facilitated by other cells such as bone marrow mesenchymal stem cells (BMMSCs), osteocytes and chondrocytes. As an important component in our daily diet, fatty acids are mainly categorized as long‐chain fatty acids including polyunsaturated fatty acids (LCPUFAs), monounsaturated fatty acids (LCMUFAs), saturated fatty acids (LCSFAs), medium‐/short‐chain fatty acids (MCFAs/SCFAs) as well as their metabolites. Fatty acids are closely associated with bone metabolism and associated bone disorders. In this review, we summarized the important roles and potential therapeutic implications of fatty acids in multiple bone disorders, reviewed the diverse range of critical effects displayed by fatty acids on bone metabolism, and elucidated their modulatory roles and mechanisms on specific bone cell types. The evidence supporting close implications of fatty acids in bone metabolism and disorders suggests fatty acids as potential therapeutic and nutritional agents for the treatment and prevention of metabolic bone diseases.
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Affiliation(s)
- Minyue Bao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Kaiwen Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yangyini Wei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weihan Hua
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yanzi Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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58
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Clinical and Diagnostic Considerations for Atypical, Adult Onset Presentation of Chronic Recurrent Multifocal Osteomyelitis (CRMO). Case Rep Rheumatol 2019; 2019:8206892. [PMID: 31662939 PMCID: PMC6791280 DOI: 10.1155/2019/8206892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/27/2019] [Accepted: 09/07/2019] [Indexed: 11/17/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic nonbacterial osteomyelitis (CNO) and is a rare autoinflammatory bone disorder that mostly affects children and adolescents. CRMO is a diagnosis of exclusion, resulting in often-delayed diagnosis with over one year on average from onset of symptoms to time of diagnosis. Initial diagnosis is rare in adults and previously undocumented in the elderly (age greater than 65). We highlight a case of a 74-year-old elderly Caucasian female with a history of palmoplantar pustular psoriasis who presented with pelvic and hip pain. Imaging findings included multiple bony lesions on x-rays, increased uptake in the left side of the pelvis, ileum, proximal sternum, and bilateral medial clavicles on nuclear bone scan. Bone biopsy histologic results of marrow fibrosis and plasma cell infiltrate indicative of chronic inflammation lead to the diagnosis of CRMO. This case highlights that while CRMO is typically a disease with childhood onset, it, while rare, can also present in adults and now has presented in the elderly, remaining an important part of the differential diagnosis of bone pain in adults and the elderly in addition to infectious osteomyelitis and malignancy when imaging reveals multiple bony lesions. This in turn will facilitate the reduction of unnecessary medical treatment and antibiotics.
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59
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Uehara M, Shimizu F. Progress report for intractable ulcer and osteomyelitis cases using autologous micrografts. SAGE Open Med Case Rep 2019; 7:2050313X19848301. [PMID: 31105956 PMCID: PMC6503585 DOI: 10.1177/2050313x19848301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/05/2019] [Indexed: 11/15/2022] Open
Abstract
Intractable ulcers often occur following primary diseases and have a significant impact on the quality of life of affected subjects. The medical treatments now available include compression and continuous debridement or additional interventions such as advanced wound dressings, local or systemic antibiotics with a mild benefit for the patients in the long term. In this report, we describe the use of autologous micrografts obtained by Rigenera® procedure in the management of two cases of intractable ulcers showing good outcomes for both patients approximately after 30 days from intervention. In the first case, a 74-year-old male with a diagnosis of Fournier's gangrene who underwent several interventions showed a rapid wound epithelization after micrografts application. In the second case, a 63-year-old male affected by a left hallux ulcer with a diagnosis of chronic osteomyelitis also showed a gradual reduction in the ulcer approximately after 1 month from micrografts application.
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Affiliation(s)
- Miyuki Uehara
- Department of Plastic and Reconstructive Surgery, Oita University School of Medicine, Oita, Japan
| | - Fumiaki Shimizu
- Department of Plastic and Reconstructive Surgery, Oita University School of Medicine, Oita, Japan.,Department of Plastic Surgery, Oita University Hospital, Yufu, Japan
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60
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Ralston SH, Rizzoli R. Focal and Osteosclerotic Bone Diseases. Calcif Tissue Int 2019; 104:481-482. [PMID: 31073747 DOI: 10.1007/s00223-019-00556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Stuart H Ralston
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK.
| | - Rene Rizzoli
- Division of Bone Diseases, Geneva University Hospitals, 1211, Geneva 14, Switzerland
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