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Yamashita S, Takahashi Y, Hashimoto J, Murakami A, Nakamura R, Katsuno M, Izumi R, Suzuki N, Warita H, Aoki M. Nationwide survey of patients with multisystem proteinopathy in Japan. Ann Clin Transl Neurol 2024; 11:938-945. [PMID: 38287512 PMCID: PMC11021623 DOI: 10.1002/acn3.52011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE Multisystem proteinopathy (MSP) is an inherited disorder in which protein aggregates with TAR DNA-binding protein of 43 kDa form in multiple organs. Mutations in VCP, HNRNPA2B1, HNRNPA1, SQSTM1, MATR3, and ANXA11 are causative for MSP. This study aimed to conduct a nationwide epidemiological survey based on the diagnostic criteria established by the Japan MSP study group. METHODS We conducted a nationwide epidemiological survey by administering primary and secondary questionnaires among 6235 specialists of the Japanese Society of Neurology. RESULTS In the primary survey, 47 patients with MSP were identified. In the secondary survey of 27 patients, inclusion body myopathy was the most common initial symptom (74.1%), followed by motor neuron disease (11.1%), frontotemporal dementia (FTD, 7.4%), and Paget's disease of bone (PDB, 7.4%), with no cases of parkinsonism. Inclusion body myopathy occurred most frequently during the entire course of the disease (81.5%), followed by motor neuron disease (25.9%), PDB (18.5%), FTD (14.8%), and parkinsonism (3.7%). Laboratory findings showed a high frequency of elevated serum creatine kinase levels and abnormalities on needle electromyography, muscle histology, brain magnetic resonance imaging, and perfusion single-photon emission computed tomography. INTERPRETATION The low frequency of FTD and PDB may suggest that FTD and PDB may be widely underdiagnosed and undertreated in clinical practice.
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Affiliation(s)
- Satoshi Yamashita
- Department of NeurologyGraduate School of Medical Sciences, Kumamoto UniversityKumamotoJapan
- Department of NeurologyInternational University of Health and Welfare Narita HospitalNaritaJapan
| | - Yuji Takahashi
- Department of NeurologyNational Center Hospital, National Center of Neurology and PsychiatryTokyoJapan
| | - Jun Hashimoto
- Department of Orthopaedic SurgeryNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Ayuka Murakami
- Department of NeurologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Ryoichi Nakamura
- Department of NeurologyNagoya University Graduate School of MedicineNagoyaJapan
- Department of NeurologyAichi Medical University School of MedicineNagakuteAichiJapan
| | - Masahisa Katsuno
- Department of NeurologyNagoya University Graduate School of MedicineNagoyaJapan
- Department of Clinical Research EducationNagoya University Graduate School of MedicineNagoyaJapan
| | - Rumiko Izumi
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
| | - Naoki Suzuki
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
| | - Hitoshi Warita
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
| | - Masashi Aoki
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
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Hashimoto J, Arai Y, Kurosu S, Ikezaki T. Safety and effectiveness of risedronate in Paget's disease of bone: postmarketing surveillance study in Japan. J Bone Miner Metab 2024; 42:122-133. [PMID: 38197974 DOI: 10.1007/s00774-023-01486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/05/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION We conducted an all-case postmarketing surveillance study between 2008 and 2017 to evaluate the safety and effectiveness of risedronate for Paget's disease of bone (PDB) in Japan. MATERIAL AND METHODS This study registered all patients who received once-daily risedronate 17.5 mg for the treatment of PDB and collected data over a 48-week follow-up period per treatment cycle for each patient. RESULTS The safety analysis set included 184 patients (mean age, 63.7 years), 81 (44.0%) of whom previously received a bisphosphonate. Of them, 41 (22.3%) experienced 72 adverse drug reactions (ADRs), and 8 (4.3%) experienced 14 serious ADRs. Common ADRs included gastrointestinal disorders (20 patients, 10.9%) and hypocalcemia (6 patients, 3.3%). The effectiveness analysis set included 182 patients, 124 of whom completed only one treatment cycle and 58 of whom completed multiple treatment cycles. The proportions of patients who normalized serum alkaline phosphatase (ALP) concentration were 71.1% (113/159 patients) and 67.3% (33/49 patients) for the first and second treatment cycles, respectively. The relapse rate according to ALP levels after the end of treatment for the first cycle was 5.0% (95% confidence interval [CI] = 2.1-11.5) at 24 weeks and 12.9% (95% CI = 7.5-21.7) at 40 weeks. Regarding pain relief, the achievement rates were 70.0% (49/70 patients) and 30.8% (4/13 patients) for the first and second treatment cycles, respectively. CONCLUSION To conclude, risedronate 17.5 mg/day is safe and effective for treating patients with PDB in daily practice.
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Affiliation(s)
- Jun Hashimoto
- National Hospital Organization Osaka Minami Medical Center, 2-1, Kido Higashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Yuki Arai
- Medical Department, EA Pharma Co., Ltd., 2-1-1, Irifune, Chuo-ku, Tokyo, 104-0042, Japan.
| | - Shinsuke Kurosu
- Data Science Group, Clinical Development Department, EA Pharma Co., Ltd., 2-1-1, Irifune, Chuo-ku, Tokyo, 104-0042, Japan
| | - Toshimi Ikezaki
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., 4-6-10, Koishikawa, Bunkyo-ku, Tokyo, 112-8088, Japan
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Paget’s disease of bone involving the mandible may causes temporomandibular joint ankylosis: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Aiba H, Nakazato T, Matsuo H, Kimura H, Saito S, Sakai T, Murakami H, Kawai J, Kawasaki S, Imamura Y. Bone Metastases from Gastric Cancer Resembling Paget's Disease: A Case Report. J Clin Med 2022; 11:jcm11247306. [PMID: 36555923 PMCID: PMC9784664 DOI: 10.3390/jcm11247306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Systemic osteosclerotic lesions are frequently caused by multiple bone metastases or systemic metabolic disorders. However, bone metastasis from gastric cancer is rare. Herein, we describe such a case, with radiographic and clinical findings resembling Paget's disease. The patient was an 80-year-old Japanese woman with a history of early gastric cancer, treated by partial gastrectomy 2 years prior. The patient sought medical care for chronic low back pain. On imaging, systemic sclerotic lesions were observed throughout the spine and pelvis, with an increase in bone mineral density from 0.86 g/cm3 (2 years prior) to 1.38g/cm3 (current visit) in the lumbar spine. Elevated serum levels of osteoblastic and osteolytic markers were identified. A bone biopsy was used to confirm the diagnosis of metastatic gastric cancer. The patient was treated with TS-1 and denosumab, with normalization of abnormal metabolic markers and alleviation of the back pain. Bone metastasis is reported in only 10% of cases of gastric cancer and, thus, is relatively rare. Therefore, our case of gastric cancer recurrence presenting with mixed osteoblastic and osteolytic bone lesions similar to Paget's disease is relevant to the report. Bone biopsy is necessary for an accurate diagnosis.
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Affiliation(s)
- Hisaki Aiba
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
- Correspondence: ; Tel.: +81-52-853-8236
| | - Tomoharu Nakazato
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Hideo Matsuo
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Hiroaki Kimura
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shiro Saito
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takao Sakai
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Jun Kawai
- Department of Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Shingo Kawasaki
- Department of Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Yasuhiro Imamura
- Department of Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
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Abstract
Paget's disease of the bone is a prevalent bone disease characterized by disorganized bone remodeling; however, it is comparatively uncommon in East Asian countries, including China, Japan, and Korea. The exact cause still remains unknown. In genetically susceptible individuals, environmental triggers such as paramyxoviral infections are likely to cause the disease. Increased osteoclast activity results in increased bone resorption, which attracts osteoblasts and generates new bone matrix. Fast bone resorption and formation lead to the development of disorganized bone tissue. Increasing serum alkaline phosphatase or unique radiographic lesions may serve as the diagnostic indicators. Common symptoms include bone pain, bowing of the long bones, an enlarged skull, and hearing loss. The diagnosis is frequently confirmed by radiographic and nuclear scintigraphy of the bone. Further, bisphosphonates such as zoledronic acid and pamidronate are effective for its treatment. Moreover, biochemical monitoring is superior to the symptoms as a recurrence indicator. This article discusses the updates of Paget's disease of bone with a clinical case.
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Affiliation(s)
- Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Corresponding author: Yoon-Sok Chung. Department Endocrinology and Metabolism, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5127, Fax: +82-31-219-4497, E-mail:
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Affiliation(s)
- Yoshiyuki Nakatsuji
- Department of Gastroenterology and Internal Medicine, Marunouchi Hospital, Japan
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Tao X, Liu L, Yang X, Wei Z, Chen Z, Zhang G, Zhang Z, Yue H. Clinical Characteristics and Pathogenic Gene Identification in Chinese Patients With Paget's Disease of Bone. Front Endocrinol (Lausanne) 2022; 13:850462. [PMID: 35355568 PMCID: PMC8959906 DOI: 10.3389/fendo.2022.850462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the clinical features of sporadic Paget's disease of bone (PDB) in China and further explore the underlying genetic abnormalities of the disease. METHODS Clinical characteristics, biochemical indices, bone turnover markers and radiographic examinations of the patients were collected. Genomic DNA was extracted from peripheral blood and whole-exome sequencing was carried out to identify the potential pathogenic genes. The pathogenicity of the variants was thereafter investigated by bioinformatics analysis. RESULTS A total of 50 patients (57.20 ± 15.52 years, male/female: 1.63: 1) with PDB were included and the mean onset age was 48.34 years (48.34 ± 17.24 years). 94.0% of the patients exhibited symptomatic patterns described as bone pain (86.0%), elevated skin temperature at the lesion site (26.0%), bone deformity (22.0%) and local swelling (18.0%). The most frequently involved lesion sites were pelvis (52.0%), femur (42.0%), tibia (28.0%), skull (28.0%) and spine (18.0%), respectively. Additionally, 40.0% of them accompanied with osteoarthritis, 14.0% with pathological fractures, and the misdiagnosis rate of PDB was as high as 36.0%. Serum level of alkaline phosphatase was significantly increased, with the mean value of 284.00 U/L (quartiles, 177.00-595.00 U/L). Two heterozygous missense mutations of SQSTM1 gene (c.1211T>C, M404T) and one novel heterozygous missense mutation in HNRNPA2B1 gene (c.989C>T, p. P330L) were identified in our study. Moreover, several potential disease-causing genes were detected and markedly enriched in the pathways of neurodegeneration (including WNT16, RYR3 and RYR1 genes) and amyotrophic lateral sclerosis (ALS, including NUP205, CAPN2, and NUP214 genes). CONCLUSION In contrast to Western patients, Chinese patients have an earlier onset age, more severe symptoms, and lower frequency of SQSTM1 gene mutation (4.0%). Moreover, a novel heterozygous missense mutation in HNRNPA2B1 gene was identified in one male patient with isolated bone phenotype. As for other genetic factors, it was indicated that WNT16, RYR3, RYR1, NUP205, CAPN2 and NUP214 genes may be potential pathogenic genes, pathways of neurodegeneration and ALS may play a vital role in the pathogenesis of PDB.
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Affiliation(s)
- Xiaohui Tao
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Li Liu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xingguang Yang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhe Wei
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhongzhong Chen
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ge Zhang
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
- *Correspondence: Zhenlin Zhang, ; Ge Zhang, ; Hua Yue,
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Zhenlin Zhang, ; Ge Zhang, ; Hua Yue,
| | - Hua Yue
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Zhenlin Zhang, ; Ge Zhang, ; Hua Yue,
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Nakamura T, Kawarabayashi T, Koh K, Takiyama Y, Ikeda Y, Shoji M. Spastic Paraplegia with Paget's Disease of Bone due to a VCP Gene Mutation. Intern Med 2021; 60:141-144. [PMID: 32893227 PMCID: PMC7835475 DOI: 10.2169/internalmedicine.4617-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hereditary spastic paraplegia (HSP) is a neurodegenerative disorder clinically characterized by slowly progressing spastic paraparesis. We herein report a 50-year-old Japanese woman who presented with slowly progressing spastic paraplegia and a history of Paget's disease of bone (PDB). Genetic testing revealed a mutation of the Valosin-containing protein (VCP) gene (p.Arg155Cys; c.436C>T). This mutation has not been reported to cause HSP with PDB.
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Affiliation(s)
- Takumi Nakamura
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | | | - Kishin Koh
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Japan
| | - Yoshihisa Takiyama
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Mikio Shoji
- Dementia Center, Geriatrics Research Institute Hospital, Japan
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Wang QY, Fu SJ, Ding N, Liu SY, Chen R, Wen ZX, Fu S, Sheng ZF, Ou YN. Clinical features, diagnosis and treatment of Paget's disease of bone in mainland China: A systematic review. Rev Endocr Metab Disord 2020; 21:645-655. [PMID: 32115673 DOI: 10.1007/s11154-020-09544-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Paget's disease of bone (PDB) is a metabolic bone disease with distinct geographical and ethnic differences in its pathogenesis. In this study, we aimed to retrospectively analyze the clinical features and the status of diagnosis and treatment of PDB in mainland China to improve the clinician's understanding of this disease. For this purpose, we conducted a systematic review of 118 articles, including a total of 332 patients with PDB. The results showed that the onset age of PDB in mainland China was 46-60 years. The number of male patients in most age groups was slightly higher than that of female patients, but there was no statistical difference (p > 0.05). The gender ratio (male to female) of PDB in mainland China was significantly different from that in Japan (p < 0.05), but not from that in the USA (p > 0.05). The clinical manifestations of PDB patients in mainland China mainly included ostealgia, bone malformation, hearing loss, and fracture, and bisphosphonate was used as the main treatment drug. These findings were similar to those in Japan, UK, and USA. Total alkaline phosphatase (TALP) level was elevated in about 89.7% of patients, and no correlation between TALP level and ostealgia was observed (p > 0.05). In addition, no difference in TALP level between males and females in each group was observed (p > 0.05).
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Affiliation(s)
- Qin-Yi Wang
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Shan-Jiang Fu
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Department of Metabolism & Endocrinology, Sanya Central Hospital, 1146 Jiefang 4th Road, Sanya, Hainan, 572000, People's Republic of China
| | - Na Ding
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Shu-Ying Liu
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Rong Chen
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Department of Metabolism & Endocrinology, Zhuzhou Central Hospital, Central South University, Zhuzhou, Hunan, 412000, People's Republic of China
| | - Zhang-Xin Wen
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Department of Metabolism & Endocrinology, Zhuzhou Central Hospital, Central South University, Zhuzhou, Hunan, 412000, People's Republic of China
| | - Sang Fu
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
- Health Management Center, Xiangtan Central Hospital, 120 Heping Road, Xiangtan, Hunan, 411100, People's Republic of China
| | - Zhi-Feng Sheng
- Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
- Hunan Key Laboratory for Metabolic Bone Diseases, Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
| | - Yang-Na Ou
- Hospital Infection Control Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
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Maatallah K, Rahmouni S, Miladi S, Rouached L, Ferjeni H, Fazaa A, Laatar A, Kaffel D, Hamdi W. Paget's Disease of Bone in Tunisia: A Study of 69 Patients. Indian J Endocrinol Metab 2020; 24:422-427. [PMID: 33489848 PMCID: PMC7810052 DOI: 10.4103/ijem.ijem_239_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/25/2020] [Accepted: 07/25/2020] [Indexed: 11/25/2022] Open
Abstract
CONTEXT Paget's disease of bone is a common bone disease with a striking variation in its incidence and characteristics in different parts of the world. It is uncommonly reported in African patients. AIMS Given the lack of studies describing the characteristics of patients with Paget's disease of bone in North Africa, we aimed to describe demographic, clinical, biochemical, and imaging characteristics, as well as treatment outcomes of Tunisian patients with Paget's disease of bone. SUBJECTS AND METHODS This bicentric and retrospective study included patients with Paget's disease of bone. Clinical, laboratory, radiological profile, and response to treatment were analyzed. RESULTS Sixty-nine patients were identified. The mean age was 64.9 ± 11.6 years and 52.2% were women. One patient reported a positive family history. Seven patients were asymptomatic. Bone pain was the most common presenting symptom. Eight patients had a history of malignancy. In three patients, Paget's disease of bone was diagnosed as part of a metastatic workup. Monostotic disease was found in half of the cases. The most commonly involved sites were pelvis (43.5%), femur (21.7%), and spine (21.7%). The mean serum alkaline phosphatase level at presentation was 591 U/L (68-8380). Two patients received salmon calcitonin (2.8%) and 47 patients (68.1%) received bisphosphonates. After a mean follow-up of 55 months (2-240 months), bone pain improved in 43.1% of patients and the serum alkaline phosphate levels had normalized in 22 of them (43.1%). During follow-up, there was no malignant transformation. CONCLUSIONS In this series of Tunisian patients, Paget's disease of bone had a female predominance and was usually monostotic. The clinical and radiological presentations were similar to the European series.
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Affiliation(s)
- Kaouther Maatallah
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Research Unit UR 17SP04, Faculty of Medicine of Tunis, Tunisia
| | - Safa Rahmouni
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Research Unit UR 17SP04, Faculty of Medicine of Tunis, Tunisia
| | - Saoussen Miladi
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Leila Rouached
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Hanen Ferjeni
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Research Unit UR 17SP04, Faculty of Medicine of Tunis, Tunisia
| | - Alia Fazaa
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Ahmed Laatar
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Research Unit UR 17SP04, Faculty of Medicine of Tunis, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Research Unit UR 17SP04, Faculty of Medicine of Tunis, Tunisia
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Omar AT, Sandoval MAS, Pascual JLR, Khu KJO. Management of Hydrocephalus in Paget's Disease of Bone: Systematic Review and Illustrative Case. World Neurosurg 2019; 135:e640-e649. [PMID: 31881339 DOI: 10.1016/j.wneu.2019.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Paget's disease of the bone (PDB) is a focal bone disorder characterized by excessive resorption and deposition of pathologic bone. It can involve the skull and cause neurologic dysfunction. Hydrocephalus occurring as a complication has also been reported. However, owing to its rarity, the optimal treatment has not yet been determined. METHODS We report the case of a 60-year-old woman with a diagnosis of PDB who had presented with symptomatic hydrocephalus and was successfully treated with ventriculoperitoneal shunt insertion. We also performed a systematic review of the Scopus and PubMed databases for case reports and series documenting patients with PDB complicated by hydrocephalus and discussed the clinical features and therapeutic strategies used. RESULTS We found 28 cases of PDB complicated by hydrocephalus in reported studies, including the present case. The median age was 67 years (range, 48-85 years; interquartile range, 7 years), with a female sex predilection. The most common neurologic manifestations were cognitive impairment, gait unsteadiness, urinary incontinence, hearing loss, and headache. Surgery had been performed in 73% of the 28 cases. The most common operation was insertion of a ventriculoperitoneal shunt (63.2%). Cerebrospinal fluid diversion resulted in significant or complete neurologic recovery in 78.9% of the 28 patients. Posterior fossa decompression was performed in 15.8% of operative cases but did not significantly alter the clinical course. CONCLUSION Patients with hydrocephalus occurring as a complication of PDB will most commonly present with cognitive impairment, gait unsteadiness, and urinary incontinence. Surgery plays an important role in the treatment, with CSF diversion procedures resulting in significant neurologic recovery in most cases.
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Affiliation(s)
- Abdelsimar T Omar
- Section of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mark Anthony S Sandoval
- Department of Physiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose Leonard R Pascual
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Kathleen Joy O Khu
- Section of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
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Michou L, Orcel P. Has Paget's bone disease become rare? Joint Bone Spine 2019; 86:538-541. [DOI: 10.1016/j.jbspin.2019.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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13
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Horino T, Ichii O, Terada Y. Cotton Wool Sign in Paget Disease of Bone. Intern Med 2019; 58:1809-1810. [PMID: 30799354 PMCID: PMC6630133 DOI: 10.2169/internalmedicine.2120-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Taro Horino
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Japan
| | - Osamu Ichii
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Japan
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14
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Sugiyama H, Omonishi K, Yonehara S, Ozasa K, Kajihara H, Tsuya T, Takeshima Y. Characteristics of Benign and Malignant Bone Tumors Registered in the Hiroshima Tumor Tissue Registry, 1973-2012. JB JS Open Access 2018; 3:e0064. [PMID: 30280138 PMCID: PMC6145567 DOI: 10.2106/jbjs.oa.17.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reported information on the characteristics of benign bone tumors is disjointed, and the long-term trends in the occurrence of malignant bone tumors by histological type have not been reported in Japan. Our aim was to describe the characteristics of both benign and malignant bone tumors as described in cases registered in the Hiroshima Tumor Tissue Registry from 1973 to 2012. METHODS Cases were identified with the International Classification of Diseases for Oncology (ICD-O-3) topography code C40-C41 (bones, joints, and articular cartilage), and histological types were classified according to the World Health Organization 2013 system. We described the distribution of the cases by behavior, sex, skeletal site of tumor occurrence, histological type, period at diagnosis (in 10-year groups), and age at diagnosis (in 10-year groups). RESULTS We observed 2,542 benign bone tumors, 272 intermediate bone tumors, and 506 malignant bone tumors. We confirmed that 81.6% of benign bone tumors were chondrogenic, consisting primarily of osteochondromas and enchondromas. Giant cell tumor of bone was the most dominant type of intermediate tumor, whereas osteogenic tumors and chondrogenic tumors were the most dominant types of malignant tumors. Among malignant bone tumors, 41.7% of tumors occurred in the long bones of the lower limb, and there were different peaks of age at the time of diagnosis for osteogenic tumors and chondrogenic tumors. A similar distribution of histological types was seen throughout the 40-year observation period. CONCLUSIONS Osteochondroma and enchondroma differed in terms of the age of the patient at the time of diagnosis and the skeletal sites where the tumors most frequently occurred. Giant cell tumor had a large impact on occurrence as a common type of intermediate bone tumor. CLINICAL RELEVANCE The results of the present study, based on pathological tissue registry data, provide knowledge about the epidemiological and pathological features of bone tumors in Japan.
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Affiliation(s)
- Hiromi Sugiyama
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Hiroshima, Japan
| | - Kunihiro Omonishi
- Department of Pathology, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Shuji Yonehara
- Department of Pathology and Research Laboratory, Welfare Association Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Hiroshima, Japan
| | - Hiroki Kajihara
- Hiroshima Prefecture Medical Association, Hiroshima, Hiroshima, Japan
| | - Takafumi Tsuya
- Hiroshima Prefecture Medical Association, Hiroshima, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Institute of Biomedical and Health Sciences, Graduate School of Hiroshima University, Hiroshima, Hiroshima, Japan
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Alaya R, Alaya Z, Nang M, Bouajina E. [Paget's disease of bone: Diagnostic and therapeutic updates]. Rev Med Interne 2017; 39:185-191. [PMID: 28690091 DOI: 10.1016/j.revmed.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 03/09/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022]
Abstract
Paget's disease of bone is the second most common metabolic bone disease after osteoporosis. Its pathogenesis is not yet clearly understood. Geographic distribution and epidemiological variations suggest a role of genetic and environmental factors in its pathophysiology. The frequency of the Paget's disease of bone increases with age. Its discovery can be fortuitous. Prognosis mainly depends on the occurrence of complications involving bones and joints, neurological, cardiovascular or metabolic systems. Treatment of symptomatic forms currently relies on bisphosphonates that have transformed its prognosis.
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Affiliation(s)
- R Alaya
- Service de rhumatologie, centre hospitalier Sud Francilien, 91100 Corbeil-Essonnes, France
| | - Z Alaya
- Service de rhumatologie, hôpital Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie.
| | - M Nang
- Service de rhumatologie, centre hospitalier Sud Francilien, 91100 Corbeil-Essonnes, France
| | - E Bouajina
- Service de rhumatologie, hôpital Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
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16
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A FKBP5 mutation is associated with Paget's disease of bone and enhances osteoclastogenesis. Exp Mol Med 2017; 49:e336. [PMID: 28524179 PMCID: PMC5454451 DOI: 10.1038/emm.2017.64] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023] Open
Abstract
Paget's disease of bone (PDB) is a common metabolic bone disease that is characterized by aberrant focal bone remodeling, which is caused by excessive osteoclastic bone resorption followed by disorganized osteoblastic bone formation. Genetic factors are a critical determinant of PDB pathogenesis, and several susceptibility genes and loci have been reported, including SQSTM1, TNFSF11A, TNFRSF11B, VCP, OPTN, CSF1 and DCSTAMP. Herein, we report a case of Chinese familial PDB without mutations in known genes and identify a novel c.163G>C (p.Val55Leu) mutation in FKBP5 (encodes FK506-binding protein 51, FKBP51) associated with PDB using whole-exome sequencing. Mutant FKBP51 enhanced the Akt phosphorylation and kinase activity in cells. A study of osteoclast function using FKBP51V55L KI transgenic mice proved that osteoclast precursors from FKBP51V55L mice were hyperresponsive to RANKL, and osteoclasts derived from FKBP51V55L mice displayed more intensive bone resorbing activity than did FKBP51WT controls. The osteoclast-specific molecules tartrate-resistant acid phosphatase, osteoclast-associated receptor and transcription factor NFATC1 were increased in bone marrow-derived monocyte/macrophage cells (BMMs) from FKBP51V55L mice during osteoclast differentiation. However, c-fos expression showed no significant difference in the wild-type and mutant groups. Akt phosphorylation in FKBP51V55L BMMs was elevated in response to RANKL. In contrast, IκB degradation, ERK phosphorylation and LC3II expression showed no difference in wild-type and mutant BMMs. Micro-CT analysis revealed an intensive trabecular bone resorption pattern in FKBP51V55L mice, and suspicious osteolytic bone lesions were noted in three-dimensional reconstruction of distal femurs from mutant mice. These results demonstrate that the mutant FKBP51V55L promotes osteoclastogenesis and function, which could subsequently participate in PDB development.
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Nagano S, Nakamura S, Shimada H, Yokouchi M, Setoguchi T, Ishidou Y, Sasaki H, Komiya S. Computer-assisted quantitative evaluation of bisphosphonate treatment for Paget's disease of bone using the bone scan index. Exp Ther Med 2017; 12:3830-3836. [PMID: 28105116 PMCID: PMC5228493 DOI: 10.3892/etm.2016.3899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/27/2016] [Indexed: 11/21/2022] Open
Abstract
The purpose of the present study was to analyze the effect of treatment of Paget's disease of bone (PDB) with bone scintigraphy using a computer-assisted diagnosis system (BONENAVI) that quantitatively evaluates bone metabolism. Seven patients with PDB (three male, four female; average age, 60 years; age range, 33–80 years) underwent bone scintigraphy and measurement of serum alkaline phosphatase (ALP), bone-specific ALP (BAP), serum cross-linked N-telopeptide (NTx) of type I collagen, urinary NTx, and deoxypyridinoline (DPD) before and after bisphosphonate treatment. Bone scan index (BSI), artificial neural network (ANN) value, and hotspot number (HSn) were calculated using BONENAVI software. Mean follow-up period was 22 months (range, 11–35 months). Among three BONENAVI parameters (ANN, BSI, and HSn), only BSI was significantly lower after bisphosphonate treatment as compared with before. All bone metabolic markers excluding DPD were significantly lower following bisphosphonate treatment than before. Bone formation markers (ALP and BAP) were significantly lower than bone resorption markers (U-NTx and S-NTx). The correlation of BONENAVI parameters with four bone metabolic markers was analyzed before and after bisphosphonate treatment. Before treatment, the majority of the four markers did not correlate with the BONENAVI parameters. In contrast, post-treatment ALP, BAP, and U-NTx were significantly correlated with BSI and HSn. To the best of our knowledge, this is the first study to evaluate the treatment of PDB by bone scintigraphy using a computer-assisted diagnosis system that quantitatively evaluates bone metabolism. The findings demonstrated that, using BONENAVI software, bone scintigraphy is able to quantitatively and spatially evaluate the bisphosphonate treatment effect, particularly in patients with polyostotic PDB.
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Affiliation(s)
- Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Shunsuke Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hirofumi Shimada
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Masahiro Yokouchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yasuhiro Ishidou
- Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiromi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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18
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Michou L, Orcel P. The changing countenance of Paget's Disease of bone. Joint Bone Spine 2016; 83:650-655. [DOI: 10.1016/j.jbspin.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 12/31/2022]
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19
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Ohara M, Imanishi Y, Nagata Y, Ishii A, Kobayashi I, Mori K, Ito M, Miki T, Nishizawa Y, Inaba M. Clinical efficacy of oral risedronate therapy in Japanese patients with Paget's disease of bone. J Bone Miner Metab 2015; 33:584-90. [PMID: 25319558 DOI: 10.1007/s00774-014-0623-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/10/2014] [Indexed: 11/29/2022]
Abstract
Paget's disease of bone (PDB) is a chronic disorder characterized by localized bone regions with excessive bone turnover. Although oral risedronate (17.5 mg daily for 8 weeks) was recently approved in Japan, its efficacy is not well understood. We retrospectively examined the efficacy of oral risedronate in PDB patients in a clinical setting. Eleven patients whose serum alkaline phosphatase (ALP) level exceeded the upper limit of the normal range were treated. Patients whose ALP levels normalized and remained so for 12 months after therapy initiation were defined as responders. Treatment was repeated if bone pain recurred or if serum ALP levels increased at least 25% above the nadir. Six patients (55%) were responsive to the therapy. A higher prevalence of skull lesions, higher serum calcium levels at treatment initiation and antecedent treatments of bisphosphonates were predictors of resistance against the therapy. Fresh frozen serum samples obtained from some treatment sessions were evaluated for metabolic bone markers such as bone-specific ALP (BAP), type I procollagen N-terminal pro-peptide (PINP), N-treminal crosslinking telopeptide of type I collagen and C-treminal crosslinking telopeptide of type I collagen (CTX). A significant reduction of P1NP preceded that of serum ALP levels in the responders, which was followed by a similar occurrence for BAP and osteocalcin (BGP) levels. A temporary decrease in CTX levels was noted. No significant changes in markers (including ALP level) were observed in non-responder and repeat-treatment groups. P1NP levels may be more useful than ALP levels in assessing treatment efficacy. Repeat treatment effectiveness for the repeat-treatment group was limited.
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Affiliation(s)
- Masaya Ohara
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-Ku, Osaka, 545-8585, Japan
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20
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Griz L, Fontan D, Mesquita P, Lazaretti-Castro M, Borba VZC, Borges JLC, Fontenele T, Maia J, Bandeira F. Diagnosis and management of Paget's disease of bone. ACTA ACUST UNITED AC 2015; 58:587-99. [PMID: 25211441 DOI: 10.1590/0004-2730000002941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 03/18/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To conduct a literature review on the diagnosis and management of Paget's disease of bone. MATERIALS AND METHODS This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society of Endocrinology and Metabolism (SBEM) as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D", are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. CONCLUSION We present a scientific statement on Paget's disease of bone providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment.
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Affiliation(s)
- Luiz Griz
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Daniele Fontan
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Patricia Mesquita
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Thyciara Fontenele
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Juliana Maia
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Francisco Bandeira
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
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Tan A, Ralston SH. Clinical presentation of Paget's disease: evaluation of a contemporary cohort and systematic review. Calcif Tissue Int 2014; 95:385-92. [PMID: 25160936 DOI: 10.1007/s00223-014-9904-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
Paget's disease of bone (PDB) has become less common over recent decades but it is unclear if this has impacted on clinical presentation. Here we evaluated the presenting features of PDB in a contemporary cohort of UK patients and conducted a systematic review of studies in which the presenting features had been reported. The case series comprised 88 patients referred to a specialist clinic between 2005 and 2013. Bone pain was the most common presenting feature occurring in 73.8% of patients. Others included bone deformity (18.1%), deafness (7.9%) and pathological fracture (5.7%). The disease was asymptomatic in 22% of cases. Antiresorptive treatment was given for pain in 34 cases and 61.7% of patients responded. Patients with a shorter disease duration were more likely to respond (p = 0.047). In the systematic review, bone pain was the most common presenting feature (52.2% of cases) followed by deformity (21.5%), deafness (8.9%) and fracture (8.5%). Time trend analysis in subjects of European descent showed that fracture was less common in studies performed during the past 25 years as compared with older studies (5.5 vs. 10.8% p < 0.001) whereas pain was more common (54.3 vs. 48.3%, p = 0.003). While changes in the mode of presentation of PDB have occurred over recent years, many patients present with complications such as fracture and deformity. Further research is required to determine if early detection and therapeutic intervention might be of value in preventing the morbidity associated with this common disease.
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Affiliation(s)
- Adrian Tan
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, EH4 2XU, UK
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Nagano S, Yokouchi M, Nagayoshi R, Sasaki H, Shimada H, Setoguchi T, Ijiri K, Komiya S. Paget disease of bone in Japanese patients: a report of three cases. J Orthop Surg (Hong Kong) 2013; 21:375-9. [PMID: 24366804 DOI: 10.1177/230949901302100323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Paget disease of bone (PDB) is a bone metabolic disorder causing pain, fractures, and deformity. Its incidence is estimated to be 1 to 2% in Caucasians older than 55 years, but in Asian populations the incidence is rare. We report on 2 female and one male Japanese patients aged 46 to 73 years with PDB. One patient had monostotic disease with pain around the shoulder and the other 2 were asymptomatic. All patients had elevated alkaline phosphatase (ALP) levels (range, 629-957 U/L). Two patients responded to oral bisphosphonate treatment and achieved normalised ALP levels and pain relief. One patient with polyostotic disease did not show any change in ALP levels. The diagnosis of the disease and the indications for bisphosphonate treatment are discussed.
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Affiliation(s)
- Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Corral-Gudino L, Borao-Cengotita-Bengoa M, Del Pino-Montes J, Ralston S. Epidemiology of Paget's disease of bone: a systematic review and meta-analysis of secular changes. Bone 2013; 55:347-52. [PMID: 23643679 DOI: 10.1016/j.bone.2013.04.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 01/23/2023]
Abstract
CONTEXT Several studies have suggested that the prevalence and severity of PDB have fallen in recent years. The magnitude of this trend and its globalization have not been well established. OBJECTIVE The objective of this study is to estimate the pooled magnitude of the changes in the prevalence of PDB and as a secondary objective, to make up a world atlas of PDB prevalence. METHODS A systematic review of English and non-English articles using MEDLINE (1946 to 2013) and EMBASE (1980 to 2013) was the method used. Search terms included epidemiology, incidence, prevalence, cohort studies, osteitis deformans or Paget's disease of bone. Studies with incidence and/or prevalence rate for PDB were included. Two authors independently extracted the data using predefined data fields and quality assessment. A pooled analysis based on random-effects models was carried out for secular trends. RESULTS Twenty-eight articles documented the prevalence of PDB; four articles the incidence and two articles the rate of new referrals. The prevalence of PDB varied greatly between the different countries, from 0.00028% in Japan to 5.4% in the UK. There were available data on changes in prevalence from two different surveys over two different time frames in Europe and New Zealand. In all but one city (Turin), a drop in the prevalence of PDB was recorded (pooled OR 0.64; 95% CI 0.45-0.91). CONCLUSION The incidence and prevalence rates of PDB vary widely between populations but both have decreased in most regions over recent years. The changes are heterogeneous however and within countries, the largest changes have been in areas that previously had a high prevalence. The reasons for these changes remain unclear at present but are likely to be due to an interaction between genetic factors and environmental triggers which may differ in different regions.
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Affiliation(s)
- Luis Corral-Gudino
- Servicio de Medicina Interna, Hospital El Bierzo, Ponferrada, Leon, Spain.
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Ferraz-de-Souza B, Martin RM, Correa PHS. Symptomatic intracranial hypertension and prolonged hypocalcemia following treatment of Paget's disease of the skull with zoledronic acid. J Bone Miner Metab 2013; 31:360-5. [PMID: 23076294 DOI: 10.1007/s00774-012-0395-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/17/2012] [Indexed: 11/29/2022]
Abstract
Skull involvement in Paget's disease of bone can lead to neurological symptoms, prompting treatment. Intravenous zoledronic acid (ZA) has emerged as an effective and safe treatment option for patients with Paget's, leading to sustained remission and improved quality of life. A previously untreated 61-year-old female presented with 2-year history of facial asymmetry with progressive hearing impairment. Serum calcium levels were normal with upper normal levels of PTH and low 25OHD levels. Serum alkaline phosphatase was markedly increased and bone scan showed extensive pagetic involvement of the skull. Head CT and MRI revealed hydrocephalus with cerebellar tonsillar herniation, platybasia and basilar invagination. In the absence of clinical signs or symptoms of intracranial hypertension, she was treated with intravenous ZA after 15-day supplementation with calcium and vitamin D. Twelve hours after the infusion, the patient became confused, agitated and disoriented and developed urinary incontinence; cortical sulci became effaced on CT indicating increased intracranial pressure. Over the following days, she developed frank hypocalcemia requiring intravenous calcium infusion and calcitriol. Neurological status returned to normal within 24 h of onset, except for urinary incontinence. Nine months later she remained incontinent and still required calcitriol to maintain normocalcemia. Zoledronic acid is a first-line option for the treatment of Paget's disease, yet there can be complications in particular clinical scenarios such as pagetic hydrocephalus, as seen in this case. Plentiful supplementation of calcium and vitamin D before bisphosphonate therapy is paramount in order to minimize the risk of prolonged post-treatment hypocalcemia.
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Affiliation(s)
- Bruno Ferraz-de-Souza
- Unidade de Doenças Osteometabólicas, Serviço de Endocrinologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Gu JM, Zhang ZL, Zhang H, Hu WW, Wang C, Yue H, Ke YH, He JW, Hu YQ, Li M, Liu YJ, Fu WZ. Thirteen Chinese patients with sporadic Paget's disease of bone: clinical features, SQSTM1 mutation identification, and functional analysis. J Bone Miner Metab 2012; 30:525-33. [PMID: 22491873 DOI: 10.1007/s00774-012-0352-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/23/2012] [Indexed: 12/18/2022]
Abstract
To increase awareness of the rarity of Paget's disease of bone (PDB) in the Chinese population, we characterized the clinical manifestations and features of 13 Chinese sporadic PDB patients. The clinical features of our Chinese PDB patients show similarities with cases reported in Western countries. The most common lesion sites were the pelvis, femur, and tibia; the next most common lesion sites were the spine and skull. Most patients had a higher serum alkaline phosphatase (ALP) level. Treatment with bisphosphonates was effective. In addition, we screened for PDB-causing mutations and performed a functional analysis in an attempt to elucidate the molecular pathogenesis of PDB. A total of 216 persons, including 13 sporadic PDB patients, three unaffected relatives of 1 patient, and 200 healthy donors, were recruited. All eight exons and exon-intron boundaries of the SQSTM1 gene were amplified by polymerase chain reaction (PCR) and directly sequenced. We identified a 53-year-old man who harbored a heterozygous T-to-C transversion at position 1250 in exon 8 (1250T > C), which resulted in a methionine-to-threonine (ATG > ACG) substitution at codon 404 (M404T). The M404T mutant SQSTM1 protein exhibited increased NF-κB activation and drove a significantly increased number of osteoclast-like cells (OLCs) that formed in response to RANKL and an increased number of OLC nuclei. This is the first report of an SQSTM1 genetic mutation that contributes to the pathogenesis of PDB in Chinese patients. These results may partially explain the mechanism by which this SQSTM1 mutation contributes to the pathogenesis of sporadic PDB in Chinese patients.
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Affiliation(s)
- Jie-Mei Gu
- Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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Chung PYJ, Van Hul W. Paget's Disease of Bone: Evidence for Complex Pathogenetic Interactions. Semin Arthritis Rheum 2012; 41:619-41. [DOI: 10.1016/j.semarthrit.2011.07.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/25/2011] [Accepted: 07/08/2011] [Indexed: 11/28/2022]
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Sankaran S, Naot D, Grey A, Cundy T. Paget's disease in patients of Asian descent in New Zealand. J Bone Miner Res 2012; 27:223-6. [PMID: 21932347 DOI: 10.1002/jbmr.507] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 08/16/2011] [Accepted: 08/29/2011] [Indexed: 11/11/2022]
Abstract
Paget's disease is considered to be uncommon in Asian people, but we have noted a recent increase in the number of Asian patients referred to our clinic, on a background of an apparently decreasing prevalence in the population of European descent. In this article, we report clinical and epidemiological features of patients of Asian descent with Paget's disease, referred between 1973 and 2010 to the Auckland Paget's disease clinic. No Asian patients were referred before 1993, but 14 have presented between 1993 and 2010, with a median of 8 years between arrival into New Zealand and time of diagnosis. The patients were predominantly of south Asian origin. None of the 8 patients tested carried a mutation in exon 8 of the sequestosome 1 (SQSTM1) gene. The number of new Paget's disease referrals expressed as a proportion of the potentially at-risk Asian population in the Auckland region (derived from census data) was 1/10(4) in 2006 to 2011. Amongst Europeans, the corresponding value decreased from 10/10(4) in 1986 to 1991 to 2/10(4) in 2006 to 2010. The increased number of people of Asian descent diagnosed with Paget's disease in the Auckland region has paralleled the increasing size of the local Asian population. The continuing decline of Paget's disease in the European population, in conjunction with the emergence of the disease in the Asian population, supports the view that an environmental determinant to the disease exists and that Asians are not genetically protected. It also implies that the apparent reduction in Paget's disease prevalence in western cities is unlikely to be explicable by the rising Asian population of these cities.
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Affiliation(s)
- Shyam Sankaran
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Aukland, New Zealand
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Shimoyama Y, Kusano M, Shimoda Y, Ishihara S, Toyomasu Y, Ohno T, Mochiki E, Sano T, Hirato J, Mori M. Paget's disease of bone resembling bone metastasis from gastric cancer. Clin J Gastroenterol 2011; 4:207-211. [PMID: 26189521 DOI: 10.1007/s12328-011-0230-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 04/25/2011] [Indexed: 11/28/2022]
Abstract
A 74-year-old man had an endoscopic type 0'-IIc tumor in the upper gastric body on the greater curvature and biopsy showed the tumor to be a well-differentiated adenocarcinoma (Group 5). He was referred to us for endoscopic submucosal dissection (ESD). Endoscopy revealed fold convergency, fold swelling, and fusion of the fold, indicating tumor invasion into the submucosa, which was outside the indications for ESD. In addition, there was an increase of serum bone-type alkaline phosphatase (ALP-III and ALP-IV) and urinary cross-linked N-terminal telopeptide of type I collagen (a bone metabolism marker), while (18)F-fluorodeoxyglucose positron emission tomography showed increased uptake in the left pelvis and Th10, suggesting bone metastases. We first diagnosed gastric cancer with bone metastases; however, the symptoms suggested pathological bone fracture and no bone pain. Therefore, a computed tomography-guided aspiration bone biopsy was performed to exclude the possibility of Paget's disease of bone. Biopsy specimens revealed no tumor and a mosaic pattern. No increased uptake of (18)F-FAMT (L-[3-(18)F] α-methyltyrosine) supported a diagnosis of no bone metastases from gastric cancer. We finally diagnosed gastric cancer accompanied by Paget's disease of bone and performed a laparoscopy-assisted proximal gastrectomy. The pathological diagnosis was U less 0-IIb, and U post 0-IIc ypT1a (M) N0H0P0M0 yp stage IA. In gastric cancer patients with suspected bone metastasis, we also need to consider Paget's disease of bone.
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Affiliation(s)
- Yasuyuki Shimoyama
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.
| | - Motoyasu Kusano
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Japan
| | - Yoko Shimoda
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Shingo Ishihara
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshitaka Toyomasu
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsuro Ohno
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Erito Mochiki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takaaki Sano
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junko Hirato
- Department of Pathology, Gunma University Hospital, Maebashi, Japan
| | - Masatomo Mori
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
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Richardson RB. Stem cell niches and other factors that influence the sensitivity of bone marrow to radiation-induced bone cancer and leukaemia in children and adults. Int J Radiat Biol 2011; 87:343-59. [PMID: 21204614 PMCID: PMC3072695 DOI: 10.3109/09553002.2010.537430] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 09/08/2010] [Accepted: 10/26/2010] [Indexed: 01/10/2023]
Abstract
PURPOSE This paper reviews and reassesses the internationally accepted niches or 'targets' in bone marrow that are sensitive to the induction of leukaemia and primary bone cancer by radiation. CONCLUSIONS The hypoxic conditions of the 10 μm thick endosteal/osteoblastic niche where preleukemic stem cells and hematopoietic stem cells (HSC) reside provides a radioprotective microenvironment that is 2- to 3-fold less radiosensitive than vascular niches. This supports partitioning the whole marrow target between the low haematological cancer risk of irradiating HSC in the endosteum and the vascular niches within central marrow. There is a greater risk of induced bone cancer when irradiating a 50 μm thick peripheral marrow adjacent to the remodelling/reforming portion of the trabecular bone surface, rather than marrow next to the quiescent bone surface. This choice of partitioned bone cancer target is substantiated by the greater radiosensitivity of: (i) Bone with high remodelling rates, (ii) the young, (iii) individuals with hypermetabolic benign diseases of bone, and (iv) the epidemiology of alpha-emitting exposures. Evidence is given to show that the absence of excess bone-cancer in atomic-bomb survivors may be partially related to the extremely low prevalence among Japanese of Paget's disease of bone. Radiation-induced fibrosis and the wound healing response may be implicated in not only radiogenic bone cancers but also leukaemia. A novel biological mechanism for adaptive response, and possibility of dynamic targets, is advocated whereby stem cells migrate from vascular niches to stress-mitigated, hypoxic niches.
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Affiliation(s)
- Richard B Richardson
- Radiological Protection Research and Instrumentation Branch, Atomic Energy of Canada Limited, Chalk River Laboratories, Chalk River, Ontario, Canada.
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Yoh K, Takata S, Yoshimura N, Hashimoto J. Efficacy, tolerability, and safety of risedronate in Japanese patients with Paget's disease of bone. J Bone Miner Metab 2010; 28:468-76. [PMID: 20179977 DOI: 10.1007/s00774-009-0152-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 12/20/2009] [Indexed: 10/19/2022]
Abstract
This study evaluated the clinical efficacy of treatment with oral risedronate (17.5 mg once daily) for 8 weeks in 11 Japanese patients with Paget's disease of bone (PDB). Risedronate suppressed the excessive bone turnover associated with PDB and improved several biochemical markers, including serum alkaline phosphatase (ALP), serum bone-specific ALP (BALP), urinary deoxypyridinoline (DPD), and urinary cross-linked N-telopeptide of type 1 collagen (NTX). These markers began to decrease within about 2 weeks after the initiation of treatment in most patients, and the response persisted for up to 40 weeks after the cessation of treatment. Risedronate reduced pain by week 24 in most patients. According to quantitative bone scintigraphy, the lesion with the highest radioisotope (RI) uptake showed a decrease of uptake from 12.7 +/- 6.8 to 6.0 +/- 2.3 (mean +/- SD) in week 24, although each lesion of patients with polyostotic disease had a different scintigraphic response. Overall, risedronate at a dose of 17.5 mg once daily was well tolerated by patients with PDB, even though the dosage was seven times higher than that approved for the treatment of osteoporosis in Japan (2.5 mg once daily). In conclusion, treatment with high-dose risedronate for 8 weeks resulted in clinically significant and sustained improvement of biochemical markers of bone turnover for 48 weeks in patients with PDB, and this improvement was associated with a decrease of RI uptake by Paget's bone lesions and with reduced pain.
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Affiliation(s)
- Kousei Yoh
- Department of Orthopedic Surgery, Sasayama Hospital, Hyogo Medical College, 75 Yamauchi-cho, Sasayama 669-2337, Japan.
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WOO JH, KIM S, CHOI SJ, LEE YH, JI JD, SONG GG. Diagnosis of Paget’s disease of the pelvis using F-18 FDG PET/CT. Int J Rheum Dis 2010; 13:e51-4. [DOI: 10.1111/j.1756-185x.2010.01538.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Five-year follow-up of Japanese patients with Paget's disease of the bone after treatment with low-dose oral alendronate: a case series. J Med Case Rep 2010; 4:166. [PMID: 20509976 PMCID: PMC2887900 DOI: 10.1186/1752-1947-4-166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 05/31/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Paget's disease of the bone is characterized by focal abnormalities of increased bone turnover affecting one or more sites throughout the skeleton. Although this disease is rare in Japan, it is common in western and southern Europe, and among British migrants in Australia and New Zealand. Bisphosphonates have been widely used for the treatment of Paget's disease of the bone and are considered to be the treatment of choice. However, there have been few reports on the long-term follow-up examination of patients after their treatment with bisphosphonates. CASE PRESENTATION We report the treatment with a low dose of oral alendronate (5 mg per day) which was effective in reducing bone turnover and pain over the five-year follow-up period in two Japanese patients, a 66-year-old man and a 68-year-old woman, with Paget's disease of the bone. Furthermore, in one patient, no clinical symptoms, such as bone pain or increases in serum total alkaline phosphatase and urinary N-terminal telopeptide of type I collagen as markers of bone turnover, were observed over the patient's five-year follow-up period. CONCLUSIONS To the best of our knowledge, this is the first report of a long-term follow-up of patients with Paget's disease of the bone after a six-month treatment with low-dose oral alendronate (5 mg per day).
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Takigami I, Ohara A, Matsumoto K, Fukuta M, Shimizu K. Functional bracing for delayed union of a femur fracture associated with Paget's disease of the bone in an Asian patient: a case report. J Orthop Surg Res 2010; 5:33. [PMID: 20459871 PMCID: PMC2881078 DOI: 10.1186/1749-799x-5-33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 05/12/2010] [Indexed: 11/13/2022] Open
Abstract
Paget's disease of the bone is a common metabolic bone disease in most European countries, Australia, New Zealand, and North America. Conversely, this disease is rare in Scandinavia, Asia, and Africa. In Japan, it is extremely rare, with a prevalence of 0.15/100000. Paget's disease is a localized disorder of bone remodeling. Excessive bone resorption and abnormal bone formation result in biomechanically weakened bone and predispose patients to fracture. Delayed union and non-union of fractures have been reported in patients with Paget's disease. Therefore, open reduction and internal fixation of fractures has been recommended to prevent such complications. Here we report an unusual case of a 63-year-old Asian woman with delayed union of a femur fracture secondary to Paget's disease, which was treated successfully by functional bracing.
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Affiliation(s)
- Iori Takigami
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
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Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol 2008; 2:177-202. [PMID: 20614314 PMCID: PMC2807558 DOI: 10.1007/s12105-008-0057-2] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
Abstract
Benign fibro-osseous lesions of the craniofacial complex are represented by a variety of disease processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes. The definitive diagnosis can rarely be rendered on the basis of histopathologic features alone; rather, procurement of a final diagnosis is usually dependent upon assessment of microscopic, clinical and imaging features together. Fibrous dysplasia and osteitis deformans constitute two dysplastic lesions in which mutations have been uncovered. Other dysplastic bone diseases of the craniofacial complex include florid osseous dysplasia, focal cemento-osseous dysplasia and periapical cemental dysplasia, all showing a predilection for African descent individuals; although no specific genetic alterations in DNA coding have yet to be uncovered and most studies have been derived from predominant high African descent populations. Ossifying fibromas are neoplastic lesions with four subtypes varying with regard to behavior and propensity for recurrence after surgical excision. The clinicopathologic and molecular features of this unique yet heterogeneous group of diseases are reviewed.
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Affiliation(s)
- Roy Eversole
- Department of Pathology and Medicine, Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA.
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Morissette J, Laurin N, Brown JP. Sequestosome 1: mutation frequencies, haplotypes, and phenotypes in familial Paget's disease of bone. J Bone Miner Res 2006; 21 Suppl 2:P38-44. [PMID: 17229007 DOI: 10.1359/jbmr.06s207] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Mutations of the SQSTM1/p62 gene are commonly observed in PDB. Screening an updated sample from Quebec and using previously published data from other populations, we compared frequency estimates for SQSTM1/p62 mutations and haplotype distribution. The P392L mutation was the most prevalent, embedded in two different haplotypes, possibly shared by other populations. We also examined the phenotype and penetrance of P392L. INTRODUCTION There is accumulating evidence that supports a contribution of genetic factors in the etiology of Paget's disease of bone (PDB), and several genetic loci have been suggested for the disorder. The sequestosome1/p62 (SQSTM1/p62) gene was the first gene identified to have a role in PDB, with 14 mutations reported to date. MATERIAL AND METHODS To evaluate the importance of the SQSTM1/p62 mutations in PDB, we recruited, sequenced, and genotyped a total of 123 carriers from 20 families in addition to 214 unrelated PDB patients. We compared the frequency of SQSTM1/p62 mutations in familial and unrelated cases among different populations. Finally, we examined the phenotypic expression and penetrance of the P392L mutation in the Quebecois families. RESULTS AND CONCLUSIONS The 14 mutations reported in SQSTM1/p62 all affect the ubiquitin-associated domain of the protein. The P392L mutation is the most commonly observed mutation in PDB patients and was consistently found in unrelated and familial PDB cases in the populations tested. Analysis of adjacent polymorphisms suggests that P392L is associated with two different haplotypes in the Quebecois patients, similar to what has been observed in European populations. In Quebec, both haplotypes had similar frequencies in unrelated P392L carriers, whereas one haplotype was predominant in the other populations studied. These data suggest that these two haplotypes, possibly introduced by European founders in the Quebecois population, were equally distributed in the succeeding generations. Finally, the P392L mutation is transmitted as an autosomal dominant trait in the Quebecois families, with a high but incomplete penetrance peaking after age 60. The large phenotypic variability and similarity between unrelated and familial cases, respectively, remain unexplained and require further research.
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Affiliation(s)
- Jean Morissette
- Centre de Recherche en Endocrinologie Moléculaire et Oncologique, Centre de Recherche du Centre Hospitalier de l'Université Laval, Quebec, Quebec, Canada
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