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Parker BM. Calcium Alkali Syndrome Treated With Hemodialysis. Cureus 2021; 13:e13749. [PMID: 33842126 PMCID: PMC8022897 DOI: 10.7759/cureus.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 11/05/2022] Open
Abstract
Malignancy, primary hyperparathyroidism, and vitamin D intoxication are the most common causes of hypercalcemia. Symptoms of hypercalcemia are nonspecific and require a plasma calcium level to diagnose. Undiagnosed hypercalcemia can cause renal failure long-term. Here, we describe a unique case of hypercalcemia resulting in acute kidney injury (AKI) secondary to overconsumption of calcium carbonate (Tums).
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Affiliation(s)
- Barbara M Parker
- Clinical Pharmacy, AdventHealth Orlando, Orlando, USA
- Clinical Pharmacy, Rockledge Regional Medical Center, Rockledge, USA
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2
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Çağlar A, Tuğçe Çağlar H. Vitamin D intoxication due to misuse: 5-year experience. Arch Pediatr 2021; 28:222-225. [PMID: 33483193 DOI: 10.1016/j.arcped.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Vitamin D intoxication (VDI) is a well-known cause of hypercalcemia in children and leads to serious kidney, heart, and neurological problems. In the treatment of VDI, the goal is to correct hypercalcemia. Our aim was to evaluate the clinical features of patients with VDI, identify the causes of VDI in our region, and help guide precautions and treatment of VDI. MATERIALS AND METHODS The medical records of patients with VDI presenting between January 2015 and December 2019 were retrospectively analyzed. RESULTS In total, 38 patients aged 0.3-4 years including 20 males (52.6%) were included in the study. Vomiting (65.8%), loss of appetite (47.4%), and constipation (31.6%) were the most common symptoms. The cause of intoxication was prescribed D3 vials in 23 patients, non-prescribed D3 vials in nine patients, and incorrectly produced fish oil supplement in six patients. Admission serum calcium and 25 (OH) D levels were 3.75±0.5mmol/L and 396±110ng/mL, respectively. A statistically significant correlation was found between the serum calcium levels at the time of diagnosis and the dose of vitamin D received, serum 25 (OH) D, phosphorus, and parathyroid (PTH) levels. Nephrocalcinosis was present in 15 (39.5%) patients. The mean time to achieve normocalcemia was 6.18±2 days. The mean time to achieve normocalcemia in patients treated with pamidronate was 5.94±0.7 days. CONCLUSION Stoss therapy should not be administered for children of families with problems of adherence to treatment. It should be noted that VDI may develop as a result of improperly produced nutritional supplements. General practitioners and pediatricians must be aware of VDI risks and explain them to parents. Pamidronate is effective for treating VDI in children.
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Affiliation(s)
- A Çağlar
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey.
| | - H Tuğçe Çağlar
- Department of Pediatrics, Aksaray University Training and Research Hospital, Aksaray, Turkey
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Brun VH, Knutsen E, Stenvold H, Halvorsen H. Severe hypercalcemia caused by parathyroid hormone in a rectal cancer metastasis: a case report. BMC Endocr Disord 2021; 21:4. [PMID: 33413267 PMCID: PMC7792014 DOI: 10.1186/s12902-020-00664-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypercalcemia of malignancy is relatively common in several cancers. However, in colorectal cancer, paraneoplastic phenomena that cause hypercalcemia is uncommon. In the few cases that are reported, secretion of parathyroid hormone-related peptide mediates the effect. We describe the first case of severe hypercalcemia mediated by intact parathyroid hormone secretion from a bone metastasis of colorectal origin. This was a diagnostic and therapeutic challenge. CASE PRESENTATION A 68-year-old male treated for rectal adenocarcinoma 10 years earlier developed a bone metastasis. After initial treatment of the metastasis with surgery and irradiation, he developed a relapse with severe hypercalcemia and corresponding elevated parathyroid hormone levels. The workup showed no signs of parathyroid adenomas, but the metastasis produced intact parathyroid hormone. The hypercalcemia was successfully treated by irradiation and osteoclast inhibitor, and the patient received chemotherapy. Survival was 24 months from the onset of hypercalcemia. CONCLUSIONS Proper diagnosis of the uncommon endocrine disturbance allowed targeted therapy and avoidance of neck exploration for wrongly suspecting primary hyperparathyroidism. Intact parathyroid hormone should be measured in cases of malignant hypercalcemia.
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Affiliation(s)
- Vegard Heimly Brun
- Department of Breast- and Endocrine Surgery, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway.
- UiT The Arctic University of Norway, Faculty of Health Sciences, Hansine Hansens veg 18, 9019, Tromsø, Norway.
| | - Erik Knutsen
- UiT The Arctic University of Norway, Faculty of Health Sciences, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Helge Stenvold
- Department of Oncology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
| | - Hanne Halvorsen
- Department of Clinical Pathology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
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4
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Encefalopatie metaboliche e tossiche non farmacologiche. Neurologia 2016. [DOI: 10.1016/s1634-7072(16)78793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Yang Z, Chen W, Xia Z, Liu Y, Peggrem S, Geng T, Yang Z, Li H, Xu B, Zhang C, Triffitt JT, Zhang Y. Local application of ibandronate/gelatin sponge improves osteotomy healing in rabbits. PLoS One 2015; 10:e0125807. [PMID: 25951178 PMCID: PMC4423918 DOI: 10.1371/journal.pone.0125807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/24/2015] [Indexed: 11/18/2022] Open
Abstract
Delayed healing or non-union of skeletal fractures are common clinical complications. Ibandronate is a highly potent anti-catabolic reagent used for treatment of osteopenia and fracture prevention. We hypothesized that local application of ibandronate after fracture fixation may improve and sustain callus formation and therefore prevent delayed healing or non-union. This study tested the effect of local application of an ibandronate/gelatin sponge composite on osteotomy healing. A right-side distal-femoral osteotomy was created surgically, with fixation using a k-wire, in forty adult male rabbits. The animals were divided into four groups of ten animals and treated by: (i) intravenous injection of normal saline (Control); (ii) local implantation of absorbable gelatin sponge (GS); (iii) local implantation of absorbable GS containing ibandronate (IB+GS), and (iv) intravenous injection of ibandronate (IB i.v.). At two and four weeks the affected femora were harvested for X-ray photography, computed tomography (CT), biomechanical testing and histopathology. At both time-points the results showed that the calluses in both the ibandronate-treated groups, but especially in the IB+GS group, were significantly larger than in the control and GS groups. At four weeks the cross sectional area (CSA) and mechanical test results of ultimate load and energy in the IB+GS group were significantly higher than in other groups. Histological procedures showed a significant reduction in osteoclast numbers in the IB+GS and IB i.v. groups at day 14. The results indicate that local application of an ibandronate/gelatin sponge biomaterial improved early osteotomy healing after surgical fixation and suggest that such treatment may be a valuable local therapy to enhance fracture repair and potentially prevent delayed or non-union.
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Affiliation(s)
- Zongyou Yang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Wei Chen
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Zhidao Xia
- Centre for Nanohealth, College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, United Kingdom
| | - Yueju Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Shaun Peggrem
- Centre for Nanohealth, College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, United Kingdom
| | - Tao Geng
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Zhaoxu Yang
- Department of Orthopaedic Surgery, Hebei General Hospital, Shijiazhuang, 050051, P.R. China
| | - Han Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Bin Xu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Chi Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - James T. Triffitt
- Botnar Research Centre, Nuffield Orthopaedic Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom OX37LD
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
- * E-mail:
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Ahmad S, Kuraganti G, Steenkamp D. Hypercalcemic crisis: a clinical review. Am J Med 2015; 128:239-45. [PMID: 25447624 DOI: 10.1016/j.amjmed.2014.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 02/01/2023]
Abstract
Hypercalcemia is a common metabolic perturbation. However, hypercalcemic crisis is an unusual endocrine emergency, with little clinical scientific data to support therapeutic strategy. We review the relevant scientific English literature on the topic and review current management strategies after conducting a PubMed, MEDLINE, and Google Scholar search for articles published between 1930 and June 2014 using specific keywords: "hypercalcemic crisis," "hyperparathyroid crisis," "parathyroid storm," "severe primary hyperparathyroidism," "acute hyperparathyroidism," and "severe hypercalcemia" for articles pertaining to the diagnosis, epidemiology, clinical presentation, and treatment strategies. Despite extensive clinical experience, large and well-designed clinical studies to direct appropriate clinical care are lacking. Nonetheless, morbidity and mortality rates have substantially decreased since early series reported almost universal fatality. Improved outcomes can be attributed to modern diagnostic capabilities, leading to earlier diagnosis, along with the recognition that primary hyperparathyroidism is the most common etiology for hypercalcemic crisis. Hypercalcemic crisis is an unusual endocrine emergency that portends excellent outcomes if rapid diagnosis, medical treatment, and definitive surgical treatment are expedited.
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Affiliation(s)
- Shazia Ahmad
- Department of Medicine, Boston Medical Center, Boston, Mass
| | | | - Devin Steenkamp
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, Mass.
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Rordorf T, Hassan AA, Azim H, Alexandru E, Er O, Gokmen E, Güral Z, Mardiak J, Minchev V, Peintinger F, Szendroi M, Takac I, Tesarova P, Vorobiof D, Vrbanec D, Yildiz R, Yücel S, Zekri J, Oyan B. Bone health in breast cancer patients: a comprehensive statement by CECOG/SAKK Intergroup. Breast 2014; 23:511-25. [PMID: 24986766 DOI: 10.1016/j.breast.2014.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/16/2014] [Accepted: 05/15/2014] [Indexed: 01/07/2023] Open
Abstract
Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision- making in clinical practice.
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Affiliation(s)
- Tamara Rordorf
- Department of Oncology, University Hospital, Zürich, Switzerland.
| | | | - Hamdy Azim
- Department of Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eniu Alexandru
- Institute of Oncology "Prof. Dr. Ion Chiricuta" (IOCN), Cluj-Napoca, Romania
| | - Ozlem Er
- Acibadem University, Acibadem Maslak Hospital, Istanbul, Turkey
| | | | - Zeynep Güral
- I.T.F. Radyasyon Onkolojisi Anabilim Dalı, Istanbul, Turkey
| | | | - Velko Minchev
- University Multiprofile Hospital for Active Treatment and Emergency Medicine, Plovdiv, Bulgaria
| | | | | | - Itzok Takac
- Maribor Teaching Hospital, Maribor, Slovenia
| | | | | | | | | | - Serap Yücel
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Jamal Zekri
- Jeddah King Faisal Specialist Hospital & Research Centre, Khaldia, Saudi Arabia
| | - Basak Oyan
- Yeditepe University Hospital, Istanbul, Turkey
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Sener I, Bereket C, Kosker H, Turer A, Tek M, Kaplan S. The Effects of Zoledronic Acid on Mandibular Fracture Healing in an Osteoporotic Model. J Craniofac Surg 2013; 24:1221-4. [DOI: 10.1097/scs.0b013e3182997816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Abstract
Both injectable and nasal spray calcitonins have been utilized in the treatment of postmenopausal osteoporosis for over 25 years. More widespread use of calcitonin in the treatment of osteoporosis has been hampered in part due to poor patient acceptability and compliance and the inability of patients to take this medication as an oral pill. In recent years, an oral preparation of calcitonin has been developed that combines the active peptide hormone with a caprylic acid derivative to enhance bioavailability. Clinical trials with oral calcitonin in patients with osteoarthritis are currently being conducted. A recent phase 3 study failed to demonstrate significant vertebral fracture reduction, and as a result the clinical program for oral calcitonin in osteoporosis is under review for further consideration.
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Affiliation(s)
- Michael J Maricic
- Catalina Pointe Rheumatology, 7520 North Oracle Road, Suite 100, Tucson, AZ 85704, USA.
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10
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Idris AI, Greig IR, Bassonga-Landao E, Ralston SH, van 't Hof RJ. Identification of novel biphenyl carboxylic acid derivatives as novel antiresorptive agents that do not impair parathyroid hormone-induced bone formation. Endocrinology 2009; 150:5-13. [PMID: 18772231 DOI: 10.1210/en.2008-0998] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bisphosphonates are widely used in the treatment of osteoporosis, but they inhibit bone formation and blunt the anabolic effect of PTH. Here we describe a novel series of compounds that have potent antiresorptive effects in vitro and in vivo that do not adversely affect osteoblast function. The effects of the compounds on osteoclast formation and survival were studied on mouse osteoclasts generated from bone marrow macrophages and on osteoblast function using primary mouse calvarial osteoblast cultures and bone nodule cultures. Studies were performed in vivo using sham-operated or ovariectomized mice. The most potent compound tested was ABD350, a halogen-substituted derivative of the parent compound ABD56 in which the labile ester bond was replaced by a reduced ketone link, with IC50 osteoclast formation at a concentration of 1.3 microm. All compounds inhibited receptor activator of nuclear factor-kappaB ligand-induced inhibitor of nuclear factor kappaB phosphorylation and caused osteoclast apoptosis but no inhibitory effects on osteoblast function were observed at concentrations of up to 20 microm. ABD350 prevented ovariectomy-induced bone loss when given ip (5 mg/kg.d), whereas ABD56 was only partially effective at this dose. In contrast to the bisphosphonate alendronate, ABD350 had no inhibitory effect on PTH-induced bone formation in ovariectomized mice. In conclusion, the biphenyl carboxylic acid derivatives like ABD350 represent a new class of antiresorptive drugs that inhibit osteoclast activity but have no significant inhibitory effects on osteoblast activity in vitro or PTH-induced bone formation in vivo.
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Affiliation(s)
- Aymen I Idris
- Rheumatic Diseases Unit, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
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Chesnut CH, Azria M, Silverman S, Engelhardt M, Olson M, Mindeholm L. Salmon calcitonin: a review of current and future therapeutic indications. Osteoporos Int 2008; 19:479-91. [PMID: 18071651 DOI: 10.1007/s00198-007-0490-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 07/31/2007] [Indexed: 02/07/2023]
Abstract
Salmon calcitonin, available as a therapeutic agent for more than 30 years, demonstrates clinical utility in the treatment of such metabolic bone diseases as osteoporosis and Paget's disease, and potentially in the treatment of osteoarthritis. This review considers the physiology and pharmacology of salmon calcitonin, the evidence based research demonstrating efficacy and safety of this medication in postmenopausal osteoporosis with potentially an effect on bone quality to explain its abilities to reduce the risk of spine fracture, the development of an oral salmon calcitonin preparation, and the therapeutic rationale for this preparation's chondroprotective effect in osteoarthritis.
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Affiliation(s)
- C H Chesnut
- Osteoporosis Research Group, University of Washington, Seattle, WA, USA.
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Onizawa K, Yoshida H. Administration of bisphosphonate for hypercalcemia associated with oral cancer. Head Face Med 2006; 2:9. [PMID: 16603094 PMCID: PMC1459855 DOI: 10.1186/1746-160x-2-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 04/10/2006] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The efficacy of treating hypercalcemia with bisphosphonate (BP) in patients with advanced oral cancer has not been fully investigated. This retrospective study evaluated the clinical course of hypercalcemic patients with and without BP treatment. METHODS Sixteen hypercalcemic patients, most of whom had uncontrollable locoregional lesions and lung metastases, were studied. Nine patients had been given BP, and the rest had not. RESULTS There were significant differences in age and serum ALT between the BP-treated and -untreated groups. The first administration of BP effectively and safely decreased the serum calcium level, but repeated administrations were less effective. Although the patients treated with BP survived significantly longer than the untreated subjects, the difference of the median was only about 2 weeks. CONCLUSION The occurrence of hypercalcemia in oral cancer patients apparently implies an extremely poor prognosis, and long-term survival cannot be expected, even with BP treatment.
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Affiliation(s)
- Kojiro Onizawa
- Oral and Maxillofacial Surgery, Doctoral Program in Functional and Regulatory Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Hiroshi Yoshida
- Oral and Maxillofacial Surgery, Doctoral Program in Functional and Regulatory Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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Välimäki VV, Moritz N, Yrjans JJ, Vuorio E, Aro HT. Effect of zoledronic acid on incorporation of a bioceramic bone graft substitute. Bone 2006; 38:432-43. [PMID: 16338190 DOI: 10.1016/j.bone.2005.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Revised: 09/09/2005] [Accepted: 09/09/2005] [Indexed: 11/25/2022]
Abstract
Many osteoporotic fracture patients are candidates for concurrent treatment with bisphosphonates and bioceramic bone graft substitutes. Osteopromotive silica-based bioactive glasses are known to induce accelerated local bone turnover and adjunct antiresorptive agents, such as zoledronic acid, may affect the process. The current study examined the effect of adjunct zoledronic acid therapy on bioactive glass incorporation. In Harlan Sprague-Dawley rats (n = 80), a standardized region of the proximal tibia was subjected to ablation of local bone marrow and filled with bioactive glass (BG) microspheres. Experimental animals received zoledronic acid (1.5 mug/kg, s.c., once a week, started 1 week before surgery) or doxycycline (a metalloproteinase inhibitor) (33 mg/kg, daily gavage) as a control agent. BG incorporation and geometric bone properties were followed by sequential pQCT imaging. The final outcome at 8 weeks was analyzed by digital radiography, histomorphometry, BEI-SEM, EDXA and muCT. The mRNA levels of markers for bone resorption (cathepsin K, TRACP, MMP-9, MMP-13) and synthesis (type I, II, III collagens, osteocalcin, osteonectin, osteopontin) were measured for determination of local bone turnover. Bones filled with BG microspheres produced 2.5-fold more intramedullary new bone than controls with bone marrow ablation only, but the BG filling delayed the recovery of pQCT strength strain index (SSI) of the bones. Adjunct therapy with zoledronic acid enhanced new bone formation on BG microspheres and particularly improved the SSI values of the BG-filled bones (P < 0.05). The zoledronic acid therapy alone (without BG filling) produced the highest amount of intramedullary new bone (6-fold more than in unfilled controls, P < 0.001) but did not show a similar benefit in SSI. The analyses of mRNA expression confirmed high local bone turnover in all bones with BG filling. At the 9th week of zoledronic acid treatment, bones with and without BG filling showed increased mRNA levels of bone resorption markers and decreased mRNA levels of markers for synthesis, indicating that a corrective resorption process was already in progress in response to massive accumulation of medullary new bone at earlier stages of the therapy. Adjunct antiresorptive therapy seems to be beneficial for incorporation of bioactive glass microspheres and does not block local natural remodeling processes. In the current model, the therapy even resulted in favorable remodeling of the tubular bone structure.
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Affiliation(s)
- Ville-Valtteri Välimäki
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland
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14
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Abstract
The anthropological record indicates that we are exposed to considerably less ultraviolet radiation (required for the synthesis of vitamin D) and consume considerably less calcium than did our early ancestors. Most U.S. citizens have calcium intakes and serum levels of vitamin D far below recommended values. This is despite there having been extensive evidence that optimal calcium and vitamin D intakes not only benefit our postcranial bone health but also have many other health benefits. Numerous articles indicate that vitamin D and calcium deficiencies result in bone loss and increased inflammation, which are well recognized symptoms of periodontal disease. For more than 40 years, investigators have suggested that calcium intake may be associated with alveolar bone resorption, and more recently there have been a number of studies in which investigators have suggested that calcium and vitamin D may benefit periodontal health, and it has been suggested that calcium deficiency may be a risk factor for periodontal disease. There has not, however, been a vitamin-D-calcium-periodontitis clinical trial in which randomization and masking were carefully controlled, the periodontal disease status of patients known, periodontal disease measures were the primary outcomes, and levels of intake optimized to produce maximal effects. Such research might demonstrate that calcium and vitamin D are important adjuncts to standard treatments for preventing and treating periodontal disease.
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Affiliation(s)
- Charles F Hildebolt
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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15
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Van 't Hof RJ, Idris AI, Ridge SA, Dunford J, Greig IR, Ralston SH. Identification of biphenylcarboxylic acid derivatives as a novel class of bone resorption inhibitors. J Bone Miner Res 2004; 19:1651-60. [PMID: 15355560 DOI: 10.1359/jbmr.2004.19.10.1651] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 04/15/2004] [Accepted: 05/21/2004] [Indexed: 11/18/2022]
Abstract
UNLABELLED A novel class of biphenylcarboxylic acid derivatives are described that inhibit osteoclastic bone resorption in vitro by promoting osteoclast apoptosis and that prevent ovariectomy-induced bone loss in vivo. The compounds act by a novel mechanism that seems to be distinct from existing antiresorptive drugs. INTRODUCTION Many common bone diseases such as osteoporosis, Paget's disease, and cancer-associated bone disease are characterized by excessive bone loss caused by increased osteoclastic activity. Successful treatment of these diseases is based on osteoclast inhibition. The osteoclast inhibitory drugs that are currently available fall into relatively few mechanistic classes, indicating the need to identify novel antiresorptives. Here we describe a series of biphenylcarboxylic acid derivatives that have potent inhibitory effects on osteoclastic bone resorption in vitro and on ovariectomy-induced bone loss in vivo. MATERIALS AND METHODS Compounds were tested for inhibitory effects on bone resorption in vitro using mouse osteoblast-bone marrow co-cultures, isolated rabbit osteoclasts, and mouse osteoclasts generated from bone marrow. Some experiments were also performed on human osteoclasts generated from peripheral blood mononuclear cells. We also investigated the effects of specific compounds on ovariectomy-induced bone loss in vivo in mice. RESULTS One of the most potent compounds identified was the butanediol ester of biphenyl carboxylic acid (ABD056), which inhibited osteoclast formation in mouse osteoblast-bone marrow co-cultures by 50% (IC50) at a concentration of 26 microM and in macrophage-colony stimulating factor (M-CSF)- and RANKL-stimulated mouse bone marrow cultures with an IC50 of 8 microM. Mechanistic studies showed that ABD056 caused osteoclast apoptosis and inhibited TNFalpha-induced NF-kappaB activation. No inhibitory effects on osteoblast growth or differentiation were observed at concentrations of up to 100 microM. When administered to mice at doses of 5 and 10 mg/kg/day, ABD056 prevented ovariectomy-induced bone loss. CONCLUSIONS Butanediol biphenylcarboxylic acid derivatives represent a new class of antiresorptive drug that might be of therapeutic value in the prevention and treatment of diseases characterized by osteoclast activation such as osteoporosis, cancer-associated bone disease, and Paget's disease of bone.
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Affiliation(s)
- Rob J Van 't Hof
- Bone Research Group, Department of Medicine and Therapeutics, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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