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D'Amore S, Sano H, Chappell DDG, Chiarugi D, Baker O, Page K, Ramaswami U, Johannesdottir F, Cox TM, Deegan P, Poole KE, Banka S, Chakrapani A, Deegan PB, Geberhiwot T, Hughes DA, Jones S, Lachmann RH, Santra S, Sharma R, Vellodi A. Radiographic Cortical Thickness Index Predicts Fragility Fracture in Gaucher Disease. Radiology 2022; 307:e212779. [PMID: 36537898 PMCID: PMC7614382 DOI: 10.1148/radiol.212779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Patients with Gaucher disease (GD) have a high risk of fragility fractures. Routine evaluation of bone involvement in these patients includes radiography and repeated dual-energy x-ray absorptiometry (DXA). However, osteonecrosis and bone fracture may affect the accuracy of DXA. Purpose To assess the utility of DXA and radiographic femoral cortical thickness measurements as predictors of fragility fracture in patients with GD with long-term follow-up (up to 30 years). Materials and Methods Patients with GD age 16 years and older with a detailed medical history, at least one bone image (DXA and/or radiographs), and minimum 2 years follow-up were retrospectively identified using three merged UK-based registries (Gaucherite study, enrollment 2015-2017; Clinical Bone Registry, enrollment 2003-2006; and Mortality Registry, enrollment 1993-2019). Cortical thickness index (CTI) and canal-to-calcar ratio (CCR) were measured by two independent observers, and inter- and intraobserver reliability was calculated. The fracture-predictive value of DXA, CTI, CCR, and cutoff values were calculated using receiver operating characteristic curves. Statistical differences were assessed using univariable and multivariable analysis. Results Bone imaging in 247 patients (123 men, 124 women; baseline median age, 39 years; IQR, 27-50 years) was reviewed. The median follow-up period was 11 years (IQR, 7-19 years; range, 2-30 years). Thirty-five patients had fractures before or at first bone imaging, 23 patients had fractures after first bone imaging, and 189 patients remained fracture-free. Inter- and intraobserver reproducibility for CTI/CCR measurements was substantial (range, 0.96-0.98). In the 212 patients with no baseline fracture, CTI (cutoff, ≤0.50) predicted future fractures with higher sensitivity and specificity (area under the receiver operating characteristic curve [AUC], 0.96; 95% CI: 0.84, 0.99; sensitivity, 92%; specificity, 96%) than DXA T-score at total hip (AUC, 0.78; 95% CI: 0.51, 0.91; sensitivity, 64%; specificity, 93%), femoral neck (AUC, 0.73; 95% CI: 0.50, 0.86; sensitivity, 64%; specificity, 73%), lumbar spine (AUC, 0.69; 95% CI: 0.49, 0.82; sensitivity, 57%; specificity, 63%), and forearm (AUC, 0.78; 95% CI: 0.59, 0.89; sensitivity, 70%; specificity, 70%). Conclusion Radiographic cortical thickness index of 0.50 or less was a reliable independent predictor of fracture risk in Gaucher disease. Clinical trial registration no. NCT03240653 © RSNA, 2022 Supplemental material is available for this article.
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Affiliation(s)
- Simona D'Amore
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Hiroshige Sano
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Daniel David George Chappell
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Davide Chiarugi
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Olivia Baker
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Kathleen Page
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Uma Ramaswami
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Fjola Johannesdottir
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Timothy M Cox
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Patrick Deegan
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Kenneth E Poole
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
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- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | | | | | | | | | | | | | | | - Robin H. Lachmann
- National Hospital for Neurology and Neurosurgery, Queen’s Square London
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Drelichman GI, Fernández Escobar N, Soberon BC, Basack NF, Frabasil J, Schenone AB, Aguilar G, Larroudé MS, Knight JR, Zhao D, Ruan J, Mistry PK. Long-read single molecule real-time (SMRT) sequencing of GBA1 locus in Gaucher disease national cohort from Argentina reveals high frequency of complex allele underlying severe skeletal phenotypes: Collaborative study from the Argentine Group for Diagnosis and Treatment of Gaucher Disease. Mol Genet Metab Rep 2021; 29:100820. [PMID: 34820281 PMCID: PMC8600149 DOI: 10.1016/j.ymgmr.2021.100820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 10/27/2022] Open
Abstract
Gaucher disease is reckoned for extreme phenotypic diversity that does not show consistent genotype/phenotype correlations. In Argentina, a national collaborative group, Grupo Argentino de Diagnóstico y Tratamiento de la Enfermedad de Gaucher, GADTEG, have delineated uniformly severe type 1 Gaucher disease manifestations presenting in childhood with large burden of irreversible skeletal disease. Here using Long-Read Single Molecule Real-Time (SMRT) Sequencing of GBA1 locus, we show that RecNciI allele is highly prevalent and associates with severe skeletal manifestations in childhood.
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Affiliation(s)
- Guillermo I Drelichman
- Unidad de Hematología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicolas Fernández Escobar
- Unidad de Hematología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, Argentina
| | - Barbara C Soberon
- Unidad de Hematología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, Argentina
| | - Nora F Basack
- Unidad de Hematología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, Argentina
| | - Joaquin Frabasil
- Laboratorio de Neuroquímica "Dr. N. A. Chamoles", Ciudad Autónoma de Buenos Aires, Argentina
| | - Andrea B Schenone
- Laboratorio de Neuroquímica "Dr. N. A. Chamoles", Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Aguilar
- Centro de Diagnóstico Dr. Rossi, Ciudad Autónoma de Buenos Aires, Argentina
| | - Maria S Larroudé
- Centro de Diagnóstico Dr. Rossi, Ciudad Autónoma de Buenos Aires, Argentina
| | - James R Knight
- Yale University Center for Genome Analysis, Yale School of Medicine, New Haven, CT, United States
| | - Dejian Zhao
- Yale University Center for Genome Analysis, Yale School of Medicine, New Haven, CT, United States
| | - Jiapeng Ruan
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT. United States
| | - Pramod K Mistry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT. United States
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Oliveri B, González D, Quiroga F, Silva C, Rozenfeld P. A Comprehensive Study of Bone Manifestations in Adult Gaucher Disease Type 1 Patients in Argentina. Calcif Tissue Int 2019; 104:650-657. [PMID: 30790003 DOI: 10.1007/s00223-019-00536-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
Gaucher disease (GD) is the most prevalent lysosomal storage disease, and bone involvement is the most disabling condition. The aim of the present study was to evaluate bone involvement in adult patients with GD, using an observational cross-sectional study. Patients were evaluated using X-rays, bone densitometry (BMD), trabecular bone score (TBS), magnetic resonance imaging (MRI), and biochemical bone markers. Thirty-two type 1GD patients were included (mean age: 40 ± 16 years). Patients had received velaglucerase for 2.7 ± 1.4 years; 19/32 had been treated previously with imiglucerase. Ninety-four percent of subjects met therapeutic goals for hematological parameters, and eight were splenectomized (SPX). Nineteen patients had irreversible bone lesions (IL), i.e., avascular necrosis, bone infarction, and/or vertebral fractures. MRI showed marrow infiltration in 71% of patients. Patients with IL had higher bone marrow burden than those without (p = 0.001). All SPX patients had IL, a higher prevalence of bone marrow edema (p = 0.02), and lower TBS (p = 0.03) than non-SPX patients. Only 18.7% of patients had abnormal BMD, with no correlation with fractures (FX). TBS values were < 1350 in 53% of patients and tended to be lower in those with FX (p = 0.06). Patients with P1NP in the lower quartile had lower TBS (p = 0.03) than those with P1NP in the higher quartiles. TBS correlated moderately but not significantly with P1NP (r = 0.32) and BMB (r = - 0.44). A high prevalence of IL was documented. Bone quality was more affected than BMD in fracture patients. Low bone formation, active bone marrow infiltration, and splenectomy might be implicated in IL.
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Affiliation(s)
- Beatriz Oliveri
- Laboratorio de Osteoporosis y Enf. Metabólicas Oseas, INIGEM (UBA-CONICET) Hosp.de Clínicas JSM, Cordoba 2351-Piso 8, 1120, Ciudad Autonoma de Buenos Aires, Argentina.
| | - Diana González
- Mautalen Salud e Investigación, Azcuenaga, 1860-Piso 6, 1128, Ciudad Autonoma de Buenos Aires, Argentina
| | - Felisa Quiroga
- Diagnóstico Maipú, Av. Maipú 1660, Vicente López, 1602, Buenos Aires, Argentina
| | - Claudio Silva
- Diagnóstico Maipú, Av. Maipú 1660, Vicente López, 1602, Buenos Aires, Argentina
| | - Paula Rozenfeld
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biologicas, Calle 47 y 115-La Plata, 1900, Buenos Aires, Argentina
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Herrera S, Pérez-López J, Moltó-Abad M, Güerri-Fernández R, Cabezudo E, Novelli S, Esteve J, Hernández A, Roig I, Solanich X, Prieto-Alhambra D, Nogués X, Díez-Pérez A. Assessment of Bone Health in Patients With Type 1 Gaucher Disease Using Impact Microindentation. J Bone Miner Res 2017; 32:1575-1581. [PMID: 28263001 DOI: 10.1002/jbmr.3121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 11/09/2022]
Abstract
Gaucher disease (GD), one of the most common lysosomal disorders (a global population incidence of 1:50,000), is characterized by beta-glucocerebrosidase deficiency. Some studies have demonstrated bone infiltration in up to 80% of patients, even if asymptomatic. Bone disorder remains the main cause of morbidity in these patients, along with osteoporosis, avascular necrosis, and bone infarcts. Enzyme replacement therapy (ERT) has been shown to improve these symptoms. This cross-sectional study included patients with type 1 Gaucher disease (GD1) selected from the Catalan Study Group on GD. Clinical data were collected and a general laboratory workup was performed. Bone mineral density (BMD) was measured at the lumbar spine and hip using dual-energy X-ray absorptiometry (DXA). Patients with bone infarcts or any other focal lesion in the area of indentation visible on imaging were excluded. Bone Material Strength index (BMSi) was measured by bone impact microindentation using an Osteoprobe instrument. Analysis of covariance (ANCOVA) models were fitted to adjust for age, sex, weight, and height. Sixteen patients with GD1 and 29 age- and sex-matched controls were included. GD1 was associated with significantly lower BMSi (adjusted beta -9.30; 95% CI, -15.18 to -3.42; p = 0.004) and reduced lumbar BMD (adjusted beta -0.14; 95% CI, -0.22 to -0.06; p = 0.002) and total hip BMD (adjusted beta -0.09; 95% CI, -0.15 to -0.03; p = 0.006), compared to GD1-free controls. Chitotriosidase levels were negatively correlated with BMSi (linear R2 = 51.6%, p = 0.004). Bone tissue mechanical characteristics were deteriorated in patients with GD1. BMSi was correlated with chitotriosidase, the marker of GD activity. Bone disorder requires special consideration in this group of patients, and microindentation could be an appropriate tool for assessing and managing their bone health. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sabina Herrera
- Internal Medicine Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and CIBERFES, Barcelona, Spain
| | - Jordi Pérez-López
- Inborn Errors of Metabolism in Adults, Unit of Rare Diseases, Hospital Valle de Hebron, Barcelona, Spain
| | - Marc Moltó-Abad
- Inborn Errors of Metabolism in Adults, Unit of Rare Diseases, Hospital Valle de Hebron, Barcelona, Spain
| | - Roberto Güerri-Fernández
- Internal Medicine Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and CIBERFES, Barcelona, Spain
| | - Elena Cabezudo
- Hematology Department, Sant Joan de Deu, Barcelona, Spain
| | - Silvana Novelli
- Haematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Esteve
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Albert Hernández
- Internal Medicine, Hospital Comarcal Sant Jaume de Calella, Barcelona, Spain
| | - Inmaculada Roig
- Department of Hematology and Hemotherapy, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Xavier Solanich
- Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- National Institute for Health Research (NIHR) Biomedical Research Unit, University of Oxford, Oxford, UK.,GREMPAL, CIBERFES, Barcelona, Spain
| | - Xavier Nogués
- Internal Medicine Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and CIBERFES, Barcelona, Spain
| | - Adolfo Díez-Pérez
- Internal Medicine Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and CIBERFES, Barcelona, Spain
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