1
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Laor B, Addab S, Janelle C, Hamdy RC. Pseudoarthrosis of the Distal Humerus in Pediatric Osteogenesis Imperfecta Patients: A Case Series and Literature Review. Cureus 2024; 16:e58991. [PMID: 38800212 PMCID: PMC11127615 DOI: 10.7759/cureus.58991] [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] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Osteogenesis imperfecta (OI) is a rare skeletal disorder that increases a patient's susceptibility to bone fracture. One complication commonly associated with fractures in this population is the occurrence of non-union leading to pseudoarthrosis. In this case series, three cases of non-union of the distal humerus leading to pseudoarthrosis in the pediatric OI population are presented. One case presents a successful attempt at treatment, one case presents a failed attempt at treatment, and the third case presents a patient's refusal to get treated. Furthermore, a literature review highlighting other institutions' attempts, successes, and failures at treating this clinical entity is presented. Combining the data retrieved from our institution and others, this review demonstrates that there is currently no standard for treating these patients. Additionally, based on the small case series and literature review presented in this article, definitive guidelines for the treatment of pseudoarthrosis of the distal humerus in pediatric OI patients cannot be outlined. However, our findings suggest that both non-surgical and surgical treatments could be viable options for patients with asymptomatic pseudoarthrosis of the distal humerus.
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Affiliation(s)
- Boaz Laor
- Orthopedic Surgery, Shriners Hospitals for Children, Montreal, CAN
| | - Sofia Addab
- Orthopedic Surgery, Shriners Hospitals for Children, Montreal, CAN
| | - Chantal Janelle
- Orthopedic Surgery, Shriners Hospitals for Children, Montreal, CAN
| | - Reggie C Hamdy
- Orthopedic Surgery, Shriners Hospitals for Children, Montreal, CAN
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2
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Dattagupta A, Petak S. Osteoporosis Improved by Romosozumab Therapy in a Patient With Type I Osteogenesis Imperfecta. AACE Clin Case Rep 2023; 9:209-212. [PMID: 38045794 PMCID: PMC10690408 DOI: 10.1016/j.aace.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background/Objective Osteogenesis imperfecta (OI) is a genetic disorder that affects type 1 collagen synthesis causing increased bone fragility, low bone mass, and skeletal deformity. Bisphosphonates are recommended for treatment of OI patients; however, the efficacy of sclerostin inhibitors such as romosozumab has not been determined in OI patients with osteoporosis. Case Report A 52-year-old G2P2 clinically diagnosed with OI, with a history of multiple fractures beginning in childhood presented with low bone mass. On physical examination, blue sclera was observed. She was previously treated with alendronate therapy from April 2014 to June 2015 without significant improvement in bone mineral density (BMD). After the onset of menopause, she began romosozumab 210 mg subcutaneous therapy once a month for 12 months. Repeat dual-energy X-ray absorptiometry showed an increase of 10.3% in BMD of the spine and a 5.4% increase in BMD of the right hip. The trabecular bone score increased by 5.2%. Discussion Current literature is limited regarding the use of sclerostin inhibitors in OI patients. Our patient's improvement in BMD of the spine and right hip after romosozumab therapy was significant at a 95% confidence level, compared to treatment initiation. Her trabecular bone score also improved significantly. Six months into our patient's treatment course, a case in Japan of a male with severe osteoporotic OI and recurrent fractures showed improvement in BMD after romosozumab therapy. Conclusion This case highlights our patient's significant response to romosozumab and warrants further investigation of romosozumab as a potential treatment option for OI patients with osteoporosis.
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Affiliation(s)
- Antara Dattagupta
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Houston Methodist Hospital, Houston, Texas
- Washington University School of Medicine, Department of Medicine, St. Louis, Missouri
| | - Steven Petak
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Houston Methodist Hospital, Houston, Texas
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3
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Unni P, Lee HJ. Systemic Associations with Keratoconus. Life (Basel) 2023; 13:1363. [PMID: 37374145 DOI: 10.3390/life13061363] [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: 05/06/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Keratoconus is a disease of the cornea that results in progressive steepening and thinning of the cornea and subsequent vision loss. It nearly always presents as a bilateral disease, suggesting that there is an underlying abnormality of the corneas that becomes manifest with time. However, the mechanisms underlying the development of keratoconus are largely unknown. Associations reported between keratoconus and systemic diseases are abundant in the literature, and the list of possible associations is very long. We found that atopy, Down syndrome, and various connective tissue diseases were the most frequently cited associations in our broad literature search. Additionally, Diabetes Mellitus has been increasingly studied as a possible protective factor against keratoconus. In this review, we have summarized the evidence for and against these particular systemic conditions and keratoconus and have discussed some of the implications of keratoconus patients having these conditions.
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Affiliation(s)
- Prasida Unni
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Hyunjoo Jean Lee
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
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4
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Chretien A, Mabilleau G, Lebacq J, Docquier PL, Behets C. Beneficial Effects of Zoledronic Acid on Tendons of the Osteogenesis Imperfecta Mouse (Oim). Pharmaceuticals (Basel) 2023; 16:832. [PMID: 37375779 DOI: 10.3390/ph16060832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue characterized by spontaneous fractures, bone deformities, impaired growth and posture, as well as extra-skeletal manifestations. Recent studies have underlined an impairment of the osteotendinous complex in mice models of OI. The first objective of the present work was to further investigate the properties of tendons in the osteogenesis imperfecta mouse (oim), a model characterized by a mutation in the COL1A2 gene. The second objective was to identify the possible beneficial effects of zoledronic acid on tendons. Oim received a single intravenous injection of zoledronic acid (ZA group) at 5 weeks and were euthanized at 14 weeks. Their tendons were compared with those of untreated oim (oim group) and control mice (WT group) by histology, mechanical tests, western blotting and Raman spectroscopy. The ulnar epiphysis had a significantly lower relative bone surface (BV/TV) in oim than WT mice. The tendon of the triceps brachii was also significantly less birefringent and displayed numerous chondrocytes aligned along the fibers. ZA mice showed an increase in BV/TV of the ulnar epiphysis and in tendon birefringence. The tendon of the flexor digitorum longus was significantly less viscous in oim than WT mice; in ZA-treated mice, there was an improvement of viscoelastic properties, especially in the toe region of stress-strain curve, which corresponds to collagen crimp. The tendons of both oim and ZA groups did not show any significant change in the expression of decorin or tenomodulin. Finally, Raman spectroscopy highlighted differences in material properties between ZA and WT tendons. There was also a significant increase in the rate of hydroxyproline in the tendons of ZA mice compared with oim ones. This study highlighted changes in matrix organization and an alteration of mechanical properties in oim tendons; zoledronic acid treatment had beneficial effects on these parameters. In the future, it will be interesting to better understand the underlying mechanisms which are possibly linked to a greater solicitation of the musculoskeletal system.
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Affiliation(s)
- Antoine Chretien
- Pole of Morphology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Guillaume Mabilleau
- Univ Angers, Nantes Université, Oniris, Inserm, UMR_S 1229-RMeS, REGOS, SFR ICAT, F-49000 Angers, France
- Centre Hospitalier Universitaire d'Angers, Department of Cell and Tissue Pathology, Bone Pathology Unit, F-49000 Angers, France
| | - Jean Lebacq
- Institute of NeuroScience (IoNS), Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Pierre-Louis Docquier
- Neuromusculoskeletal Lab, Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Catherine Behets
- Pole of Morphology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Brussels, Belgium
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5
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Ciancia S, Högler W, Sakkers RJB, Appelman-Dijkstra NM, Boot AM, Sas TCJ, Renes JS. Osteoporosis in children and adolescents: how to treat and monitor? Eur J Pediatr 2023; 182:501-511. [PMID: 36472650 DOI: 10.1007/s00431-022-04743-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED Osteoporosis is a condition of increased bone fragility associated with fractures. Apart from primary genetic osteoporotic conditions, secondary osteoporosis in children is being increasingly recognized. As a result, there is growing interest in its prevention and treatment. Important goals of care are to prevent fractures, increase bone mass and trabecular and cortical thickness, reshape vertebral fractures, prevent (or correct) skeletal deformities, and improve mobility, independence, and quality of life. Secondary pediatric osteoporosis is often of multifactorial origin since affected children frequently have more than one acquired factor that is detrimental to bone health. Typical conditions causing osteoporosis are leukemias, progressive muscle or neurological disorders, as well as chronic inflammatory conditions and their treatment. Management of children with osteoporosis involves a multidisciplinary team involving pediatric experts from different subspecialties. With regard to prevention and early intervention, it is important to provide optimal management of any underlying systemic conditions including avoidance, or dose-reduction, of osteotoxic medications. Basic supporting life-style measures, such as appropriate nutrition, including adequate calcium intake and vitamin D, and physical activity are recommended, where possible. When pediatric treatment criteria for osteoporosis are met, antiresorptive drugs constitute the first pharmacological line treatment. CONCLUSION This clinical review focuses on the prevention, treatment, and follow-up of children with, or at risk of developing, osteoporosis and the transition from pediatric to adult care. WHAT IS KNOWN • Osteoporosis and associated fractures can cause significant morbidity and reduce the quality of life. • The developing skeleton has huge potential for recovery and reshaping, thus early detection of fractures, assessment of recovery potential, and treatment of children with osteoporosis can prevent future fractures, deformities, and scoliosis, improve function and mobility, and reduce pain. WHAT IS NEW • Osteoporosis in children and adolescents requires a multidisciplinary approach with a thorough assessment of recovery potential, and indication for therapy should be personalized. • Although bisphosphonates still represent the drug most commonly used to increase bone mass, improve mobility, and reduce pain and recurrence of fractures, new agents are being developed and could be beneficial in children with specific conditions.
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Affiliation(s)
- Silvia Ciancia
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Wolfgang Högler
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Ralph J B Sakkers
- Department of Orthopedic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Subdivision of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke M Boot
- Department of Pediatrics, Subdivision of Endocrinology, University Medical Center Groningen, Beatrix Childrens Hospital, University of Groningen, Groningen, The Netherlands
| | - Theo C J Sas
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.,Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Judith S Renes
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands.,Dutch Growth Research Foundation, Rotterdam, The Netherlands
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6
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Erbaş İM, İlgün Gürel D, Manav Kabayeğit Z, Koç A, Ünüvar T, Abacı A, Böber E, Anık A. Clinical, genetic characteristics and treatment outcomes of children and adolescents with osteogenesis imperfecta: a two-center experience. Connect Tissue Res 2022; 63:349-358. [PMID: 34107839 DOI: 10.1080/03008207.2021.1932853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteogenesis imperfecta (OI), is a heritable, heterogeneous connective tissue disorder, characterized by fragile bones. There are conflicting results about genotype-phenotype correlations and efficiency of bisphosphonate treatment in this disorder. AIM We aimed to evaluate the clinical, genetic characteristics, and long-term follow-up results of children and adolescents with OI. MATERIALS AND METHODS A two-center retrospective study was conducted using demographic, clinical, and genetic data obtained from the medical records of the patients. RESULTS Twenty-nine patients (62% male, median age; 3.6 years) with OI diagnosis from 26 families were included in the study. Thirteen different variants (nine were novel) were described in 16 patients in COL1A1, COL1A2, and P3H1 genes. Our siblings with homozygous P3H1 variants had a severe phenotype with intrauterine and neonatal fractures. Twenty-two patients were treated with bisphosphonates (17 of them with pamidronate, five with alendronate) with a median duration of 3.0 (1.6-4.8) years. Eleven patients (50%) suffered from fractures after the treatment. Haploinsufficiency variants in COL1A1 caused a milder skeletal phenotype with less fracture count and better treatment outcomes than structural variants. When compared with the anthropometric measurements at the initial diagnosis time, height Z-scores were lower on the last clinical follow-up (p = 0.009). CONCLUSIONS We could not find an obvious genotype-phenotype correlation in Turkish OI patients with COL1A1 or COL1A2 variants. Treatment with pamidronate was effective in reducing fracture counts, without any long-term adverse effects.
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Affiliation(s)
- İbrahim Mert Erbaş
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Deniz İlgün Gürel
- Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Zehra Manav Kabayeğit
- Department of Medical Genetics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Altuğ Koç
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Tolga Ünüvar
- Division of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Ayhan Abacı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ece Böber
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Anık
- Division of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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7
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Graves LE, Wall CL, Briody JN, Bennetts B, Wong K, Onikul E, Biggin A, Munns CF. High Bone Mineral Density Osteogenesis Imperfecta in a Family with a Novel Pathogenic Variant in COL1A2. Horm Res Paediatr 2021; 93:263-271. [PMID: 32920552 DOI: 10.1159/000510463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a heterogenous group of heritable bone dysplasias characterized by bone fragility, typically low bone mass, joint laxity, easy bruising, and variable short stature. Classical OI is caused by autosomal dominant pathogenic variants in COL1A1 or COL1A2 that result in either reduced production of normal type 1 collagen or structurally abnormal collagen molecules. Pathogenic variants in these genes generally result in low bone mass. Here, we report a family that had 2 affected individuals who presented with minimal trauma fractures and were found to have elevated bone mineral density (BMD) and a previously unreported variant in COL1A2 c.3356C>T p.(Ala1119Val). We report the change in BMD using dual-energy X-ray and peripheral quantitative computed tomography over a 2.3-year period in the proband. This case report highlights the importance of BMD studies and genetic testing in the diagnostic process for brittle bone disorders.
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Affiliation(s)
- Lara E Graves
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia,
| | - Christie-Lee Wall
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Julie N Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Bruce Bennetts
- Molecular Genetics Department, Western Sydney Genetics Program, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Genomic Medicine, Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia
| | - Karen Wong
- Molecular Genetics Department, Western Sydney Genetics Program, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ella Onikul
- Department of Medical Imaging, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia
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8
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Tse MY, Porter IR, Demeter E, Behling-Kelly E, Wakshlag JJ, Miller AD. Osteogenesis Imperfecta in Two Finnish Lapphund Puppies. VETERINARY MEDICINE-RESEARCH AND REPORTS 2021; 12:177-185. [PMID: 34168973 PMCID: PMC8216744 DOI: 10.2147/vmrr.s308418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022]
Abstract
Two 8-week-old Finnish Lapphund dogs presented with pain on manipulation, abnormal long bone conformation, retrognathism, and stunted growth compared to their litter mates. Multiple long bone fractures were evident on radiographs. Clinical pathology showed an atypically normal serum alkaline phosphatase activity for dogs this age. Due to poor quality of life, the dogs were humanely euthanized and subjected to a complete necropsy. On necropsy, all bones were soft and easily broken. Histologic examination revealed that the secondary spongiosa was diminished with abnormal bony trabeculae embedded in abundant loose vascular stroma. No Haversian canals were observed and the cortices contained abundant woven bone separated by fibrovascular tissue consistent with the diagnosis of osteogenesis imperfecta (OI). Inbreeding of the sire and female offspring led to a suspicion of recessive inheritance and the particular genetic collagen disorder remains to be identified in this breed.
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Affiliation(s)
- Ming Yi Tse
- City University of Hong Kong, Jockey Club College of Veterinary Medicine and Life Sciences, Hong Kong, 999077, People's Republic of China
| | - Ian R Porter
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY, 14850, USA
| | - Elena Demeter
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Section of Anatomic Pathology, Ithaca, NY, 14853, USA
| | - Erica Behling-Kelly
- Cornell University College of Veterinary Medicine, Department of Population Medicine, Ithaca, NY, 14853, USA
| | - Joseph J Wakshlag
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY, 14850, USA
| | - Andrew D Miller
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Section of Anatomic Pathology, Ithaca, NY, 14853, USA
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9
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Zeri F, Swann PG, Naroo S. Osteogenesis imperfecta and keratoconus in an Italian family. Clin Exp Optom 2021; 101:400-403. [DOI: 10.1111/cxo.12617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fabrizio Zeri
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK,
| | - Peter G Swann
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia,
- School of Optometry, Hong Kong Polytechnic University, Hong Kong,
| | - Shehzad Naroo
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK,
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10
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Gozum G, Bogdan M, Sundaram R, Kulpa J, Narula P, Agdere L. Femur Fracture in a Premature Infant: An Unusual Association of Sickle Cell Disease with Osteogenesis Imperfecta. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926821. [PMID: 33079924 PMCID: PMC7585456 DOI: 10.12659/ajcr.926821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Female, 1-year-old Final Diagnosis: Sickle cell anaemia Symptoms: Fracture Medication: — Clinical Procedure: — Specialty: Hematology • Pediatrics and Neonatology
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Affiliation(s)
- Giselle Gozum
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Michelle Bogdan
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Revathy Sundaram
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Jolanta Kulpa
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Pramod Narula
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Levon Agdere
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
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11
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Malmgren B, Tsilingaridis G, Monsef-Johansson N, Qahtani ZHA, Dahllöf G, Åström E. Bisphosphonate Therapy and Tooth Development in Children and Adolescents with Osteogenesis Imperfecta. Calcif Tissue Int 2020; 107:143-150. [PMID: 32451573 PMCID: PMC7343730 DOI: 10.1007/s00223-020-00707-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/13/2020] [Indexed: 10/30/2022]
Abstract
Osteogenesis imperfecta (OI) is a heterogeneous connective tissue disorder characterized by repeated fractures and skeletal disorders. At present, bisphosphonate (BP) therapy is the gold standard for OI treatment. The present retrospective study evaluated the effect of BP therapy on tooth development and eruption of permanent teeth in a cohort of children receiving pamidronate. Three groups were studied: patients with OI who were treated with BPs (n = 45), patients with OI who were not treated with BPs (n = 117), and age- and gender-matched healthy controls (n = 121). Dental age, dental maturity, and tooth eruption were assessed on panoramic radiographs using the methods of Demirjian et al. (Hum Biol 45(2):211-227, 1973) and Haavikko (Suom Hammaslaak Toim 66(3):103-170, 1970) and were evaluated using the t-test, Chi-square test, and the Mann-Whitney U test. Dental age in the study group was significantly (p < 0.05) lower than chronological age compared with both control groups. Dental maturity and the eruption of permanent teeth were also significantly (p < 0.05) delayed in the study group in relation to the two control groups. The dental age was significantly lower (p < 0.001) in patients with OI type III treated with BPs compared with healthy controls and the dental maturation was significantly delayed in patients with OI type IV treated with BPs compared with those not treated. In conclusion, BP therapy in OI patients seems to lower the dental age, delay the dental maturity, and tooth eruption. BP administration before 2 years of age might be a contributing factor.
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Affiliation(s)
- Barbro Malmgren
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden.
- Center for Pediatric Oral Health Research, Stockholm, Sweden.
| | - Georgios Tsilingaridis
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Nina Monsef-Johansson
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Zaina Haif Al Qahtani
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Göran Dahllöf
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Eva Åström
- Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Neurology, Astrid Lindgren Children's Hospital at Karolinska University Hospital, Stockholm, Sweden
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12
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Bertin H, Huon JF, Guillot P, Longis J, Corre P, Bordereau S, Lebranchu P. Fibrous dysplasia of the orbital region: Series of 12 cases and review of the literature. J Fr Ophtalmol 2020; 43:467-476. [PMID: 32376037 DOI: 10.1016/j.jfo.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE Fibrous dysplasia (FD) is a benign fibro-osseous developmental disorder of growing bone, sometimes involving the craniofacial skeleton (CFD). We wish to present a patient series with CFD of the orbital region and discuss treatment modalities. METHODS Twelve patients were referred for orbital CFD in the Nantes University Hospital between 2000 and 2018 and studied according to the clinical parameters, radiological features, and modalities of treatment. RESULTS The mean age was 25.6 years. Ten patients exhibited facial asymmetry with vertical globe dystopia (75%), proptosis (58%) and facial bump (50%). The disease was monostotic in 83% of patients, involving the frontal bone (25%), the sphenoidal bone (33%), the fronto-sphenoidal complex (25%), and the skull base (17%). Unilateral radiological proptosis was found in 7 patients, with a mean protrusion 3.9mm. The optic canal was involved in 75% of patients, with no functional impairment. Three patients were treated with bisphosphonate therapy to stop progression of the disease; 6 patients were given a bone remodelling procedure with good aesthetic outcomes. CONCLUSION The orbit is a rare localization for FD causing aesthetic and functional disabilities. Medical and surgical treatment can be proposed as part of a multidisciplinary approach.
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Affiliation(s)
- H Bertin
- Service de Chirurgie maxillo-faciale, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France; Laboratoire des sarcomes osseux et remodelage des tissus calcifiés (PhyOs, UMR 1238), faculté de médecine, 1, rue Gaston-Veil, 44035 Nantes cedex, France.
| | - J-F Huon
- Service de pharmacie Clinique, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - P Guillot
- Service de rhumatologie, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - J Longis
- Service de Chirurgie maxillo-faciale, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - P Corre
- Service de Chirurgie maxillo-faciale, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - S Bordereau
- Service d'ophtalmologie, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - P Lebranchu
- Service d'ophtalmologie, Centre Hospitalier Universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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13
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Morse A, McDonald MM, Mikulec K, Schindeler A, Munns CF, Little DG. Pretreatment with Pamidronate Decreases Bone Formation but Increases Callus Bone Volume in a Rat Closed Fracture Model. Calcif Tissue Int 2020; 106:172-179. [PMID: 31578632 DOI: 10.1007/s00223-019-00615-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
Clinical concerns have been raised over prior exposure to bisphosphonates impairing fracture healing. To model this, groups of male Wistar rats were assigned to saline control or treatment groups receiving 0.15 mg/kg (low dose), 0.5 mg/kg (medium dose), and 5 mg/kg (high dose) Pamidronate (PAM) twice weekly for 4 weeks. At this point, closed fractures were made using an Einhorn apparatus, and bisphosphonate dosing was continued until the experimental endpoint. Specimens were analyzed at 2 and 6 weeks (N = 8 per group per time point). Twice weekly PAM dosing was found to have no effect on early soft callus remodeling at 2 weeks post fracture. At this time point, the highest dose PAM group gave significant increases in bone volume (+ 10%, p < 0.05), bone mineral content (+ 30%, p < 0.01), and bone mineral density (+ 10%, p < 0.01). This PAM dosing regimen showed more substantive effects on hard callus at 6 weeks post fracture, with PAM treatment groups showing + 46-79% increased bone volume. Dynamic bone labeling showed reduced calcein signal in the PAM-treated calluses (38-63%, p < 0.01) and reduced MAR (32-49%, p < 0.01), suggesting a compensatory reduction in bone anabolism. These data support the concept that bisphosphonates lead to profound decreases in bone turnover in fracture repair, however, this does not affect soft callus remodeling.
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Affiliation(s)
- Alyson Morse
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michelle M McDonald
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Bone Biology Division, The Garvan Institute for Medical Research, Sydney, Australia
| | - Kathy Mikulec
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Aaron Schindeler
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Craig F Munns
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department for Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - David G Little
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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14
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Gremminger VL, Jeong Y, Cunningham RP, Meers GM, Rector RS, Phillips CL. Compromised Exercise Capacity and Mitochondrial Dysfunction in the Osteogenesis Imperfecta Murine (oim) Mouse Model. J Bone Miner Res 2019; 34:1646-1659. [PMID: 30908713 PMCID: PMC6744299 DOI: 10.1002/jbmr.3732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/09/2022]
Abstract
Osteogenesis imperfecta (OI) is a heritable connective tissue disorder that most often arises from type I collagen-COL1A1 and COL1A2-gene defects leading to skeletal fragility, short stature, blue-gray sclera, and muscle weakness. Relative to the skeletal fragility, muscle weakness is much less understood. Recent investigations into OI muscle weakness in both patients and mouse models have revealed the presence of an inherent muscle pathology. Understanding the mechanisms responsible for OI muscle weakness is critical, particularly in light of the extensive cross-talk between muscle and bone via mechanotransduction and biochemical signaling. In the following study we initially subjected WT and oim/oim mice, modeling severe human OI type III, to either weight-bearing (voluntary wheel-running) or non-weight-bearing (swimming) exercise regimens as a modality to improve muscle strength and ultimately bone strength. The oim/oim mice ran only 35% to 42% of the distance run by age- and sex-matched WT mice and exhibited little improvement with either exercise regimen. Upon further investigation, we determined that oim/oim gastrocnemius muscle exhibited severe mitochondrial dysfunction as characterized by a 52% to 65% decrease in mitochondrial respiration rates, alterations in markers of mitochondrial biogenesis, mitophagy, and the electron transport chain components, as well as decreased mitochondrial citrate synthase activity, relative to age- and sex-matched WT gastrocnemius muscle. Thus, mitochondrial dysfunction in the oim/oim mouse likely contributes to compromised muscle function and reduced physical activity levels. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Youngjae Jeong
- Department of Biochemistry, University of Missouri, Columbia, Missouri, 65211
| | - Rory P. Cunningham
- Departments of Nutrition and Exercise Physiology and Medicine-GI, University of Missouri; Research Service-Harry S Truman Memorial VA Hospital, Columbia, MO 65201
| | - Grace M. Meers
- Departments of Nutrition and Exercise Physiology and Medicine-GI, University of Missouri; Research Service-Harry S Truman Memorial VA Hospital, Columbia, MO 65201
| | - R. Scott Rector
- Departments of Nutrition and Exercise Physiology and Medicine-GI, University of Missouri; Research Service-Harry S Truman Memorial VA Hospital, Columbia, MO 65201
| | - Charlotte L. Phillips
- Department of Biochemistry, University of Missouri, Columbia, Missouri, 65211
- Department of Child Health, University of Missouri, Columbia, Missouri, 65211
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15
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Majeed NK, Oramas D, Lindgren V, Garzon S, Wiley DE, Enakpene C, Emmadi R. A Case of Osteogenesis Imperfecta Type II With Additional Balanced Translocation t(1;20)(p13;p11.2). Fetal Pediatr Pathol 2019; 38:263-271. [PMID: 30942118 DOI: 10.1080/15513815.2019.1579877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Osteogenesis imperfect (OI) type II is a genetic disorder of bone characterized by bone fragility, multiple fractures, severe bowing and shortening of long bones, and perinatal death due to respiratory insufficiency. It is mainly caused by mutations in the COL1A1 or COL1A2 genes, inherited in an autosomal dominant manner. CASE REPORT A fetal form of this disorder that included brachydactyly, macrocephaly, frontal bossing, soft calvarium, saddle nose, micrognathia, low set ears, and narrow thoracic cavity is described. A postmortem skeletal survey revealed multiple fractures, unossified skull, and long crumpled bones. The fetal karyotype revealed a balanced translocation t(1;20)(p13;p11.2). DNA sequencing detected a c.3065G > T transversion in exon 42 of the COL1A1 gene, a mutation associated with OI type II. CONCLUSION Although the balanced translocation t(1:20)(p13;p11.2) appears to be incidental in our case, identification of the specific mutation and translocation is important for estimation of genetic risk for another afflicted child.
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Affiliation(s)
- Nasma K Majeed
- a Pathology Department , University of Illinois at Chicago , Chicago , IL , USA
| | - Diana Oramas
- a Pathology Department , University of Illinois at Chicago , Chicago , IL , USA
| | - Valerie Lindgren
- a Pathology Department , University of Illinois at Chicago , Chicago , IL , USA
| | - Steven Garzon
- a Pathology Department , University of Illinois at Chicago , Chicago , IL , USA
| | - Dr Elizabeth Wiley
- a Pathology Department , University of Illinois at Chicago , Chicago , IL , USA
| | | | - Rajyasree Emmadi
- a Pathology Department , University of Illinois at Chicago , Chicago , IL , USA
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16
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Rehberg M, Winzenrieth R, Hoyer-Kuhn H, Duran I, Schoenau E, Semler O. TBS as a Tool to Differentiate the Impact of Antiresorptives onCortical and Trabecular Bone in Children With OsteogenesisImperfecta. J Clin Densitom 2019; 22:229-235. [PMID: 30309730 DOI: 10.1016/j.jocd.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/22/2018] [Accepted: 09/04/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION/BACKGROUND Osteogenesis imperfecta is a hereditary connective tissue disorder, resulting in low bone mass and high bone fragility. Dual-energy X-ray absorptiometry (DXA) and in adulthood also the trabecular bone score (TBS) are well established to assess bone health and fracture risk. The purpose of this investigation was to assess the usefulness of TBS in respect to different treatment regimes in children with osteogenesis imperfecta. Changes of areal bone mineral density (aBMD) and TBS using DXA scans of children treated with antiresorptive therapies were evaluated. METHODOLOGY DXA scans (aBMD, TBS) of 8 children with OI were evaluated. The scans were taken during a 1 yr period of treatment with bisphosphonates and during 1 yr pilot trial using denosumab. Changes of aBMD and TBS during both treatment regimens were compared. RESULTS During bisphosphonate treatment aBMD increased about 6.2%, while TBS increased about 2.1%. The difference between aBMD and TBS before and after bisphosphonate treatment was not significant (p = 0.25). During denosumab treatment aBMD increased around 25.1%, while TBS increased 6.7%. The change of aBMD was significant (p = 0.007), as was the difference between aBMD and TBS (p < 0.001). CONCLUSIONS Denosumab had a significant effect on both aBMD and TBS but was significantly more pronounced in aBMD. These results suggest a stronger effect of denosumab on cortical bone and the growth plate in comparison to bisphosphonates. Beside the lack of paediatric reference data and the small sample size, the results suggest TBS to be a useful tool for monitoring skeletal changes during development, growth, and antiresorptive therapy in children with OI.
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Affiliation(s)
- Mirko Rehberg
- Children's Hospital, University Hospital Cologne, Cologne, Germany.
| | | | - Heike Hoyer-Kuhn
- Children's Hospital, University Hospital Cologne, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University Hospital Cologne, Cologne, Germany
| | - Eckhard Schoenau
- Children's Hospital, University Hospital Cologne, Cologne, Germany; Center of Prevention and Rehabilitation, University Hospital Cologne, Cologne, Germany
| | - Oliver Semler
- Children's Hospital, University Hospital Cologne, Cologne, Germany; Cologne Centre for Rare Skeletal Dysplasia in Childhood, University Hospital Cologne, Cologne, Germany
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17
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O'Donnell C, Bloch N, Michael N, Erickson M, Garg S. Management of Scoliosis in Children with Osteogenesis Imperfecta. JBJS Rev 2019; 5:e8. [PMID: 28742716 DOI: 10.2106/jbjs.rvw.16.00063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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18
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Bains JS, Carter EM, Citron KP, Boskey AL, Shapiro JR, Steiner RD, Smith PA, Bober MB, Hart T, Cuthbertson D, Krischer J, Byers PH, Pepin M, Durigova M, Glorieux FH, Rauch F, Sliepka JM, Sutton VR, Lee B, Nagamani SC, Raggio CL. A Multicenter Observational Cohort Study to Evaluate the Effects of Bisphosphonate Exposure on Bone Mineral Density and Other Health Outcomes in Osteogenesis Imperfecta. JBMR Plus 2019; 3:e10118. [PMID: 31131341 PMCID: PMC6524673 DOI: 10.1002/jbm4.10118] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/22/2018] [Accepted: 09/15/2018] [Indexed: 01/01/2023] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by low bone mass and bone fragility. Using data from a large cohort of individuals with OI from the Osteogenesis Imperfecta Foundation's linked clinical research centers, we examined the association between exposure to bisphosphonate (BPN) treatment (past or present) and lumbar spine (LS) areal bone mineral density (aBMD), fractures, scoliosis, and mobility. From 466 individuals, we obtained 1394 participant‐age LS aBMD data points. Though all OI subtypes were examined, primary analyses were restricted to type I OI (OI‐1). Using linear regression, we constructed expected OI‐1 LS aBMD‐for‐age curves from the data from individuals who had never received BPN. LS aBMD in those who had been exposed to BPN was then compared with the computed expected aBMD. BPN exposure in preadolescent years (age <14 years) was associated with a LS aBMD that was 9% more than the expected computed values in BPN‐naïve individuals (p < 0.01); however, such association was not observed across all ages. Exposure to i.v. BPN and treatment duration >2 years correlated with LS aBMD in preadolescent individuals. BPN exposure also had a significant association with non‐aBMD clinical outcome variables. Logistic regression modeling predicted that with BPN exposure, a 1‐year increase in age would be associated with an 8.2% decrease in fracture probability for preadolescent individuals with OI‐1, compared with no decrease in individuals who had never received any BPN (p < 0.05). In preadolescent individuals with OI‐1, a 0.1 g/cm2 increase in LS aBMD was associated with a 10.6% decrease in scoliosis probability, compared with a 46.8% increase in the BPN‐naïve group (p < 0.01). For the same changes in age and LS aBMD in preadolescent individuals, BPN exposure was also associated with higher mobility scores (p < 0.01), demonstrating that BPN treatment may be associated with daily function. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jaskaran S Bains
- Hospital for Special Surgery Dept of Orthopedic Surgery New York NY USA
| | - Erin M Carter
- Hospital for Special Surgery Dept of Orthopedic Surgery New York NY USA
| | - Kate P Citron
- Hospital for Special Surgery Dept of Orthopedic Surgery New York NY USA
| | - Adele L Boskey
- Hospital for Special Surgery Dept of Orthopedic Surgery New York NY USA
| | - Jay R Shapiro
- Department of Bone and Osteogenesis Imperfecta Kennedy Krieger Institute Baltimore MD USA
| | - Robert D Steiner
- Departments of Pediatrics and Molecular and Medical Genetics Oregon Health & Science University Portland OR USA.,University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Michael B Bober
- Division of Medical Genetics Alfred I. DuPont Hospital for Children Wilmington DE USA
| | - Tracy Hart
- Osteogenesis Imperfecta Foundation Gaithersburg MD USA
| | - David Cuthbertson
- College of Medicine University of South Florida, Biostatistics Tampa FL USA
| | - Jeff Krischer
- College of Medicine University of South Florida, Biostatistics Tampa FL USA
| | - Peter H Byers
- Departments of Medicine and Pathology Division of Medical Genetics University of Washington Seattle WA USA
| | - Melanie Pepin
- Departments of Medicine and Pathology Division of Medical Genetics University of Washington Seattle WA USA
| | - Michaela Durigova
- Shriners Hospital for Children-Canada and McGill University, Division of Endocrinology Montreal QC Canada
| | - Francis H Glorieux
- Shriners Hospital for Children-Canada and McGill University, Division of Endocrinology Montreal QC Canada
| | - Frank Rauch
- Shriners Hospital for Children-Canada and McGill University, Division of Endocrinology Montreal QC Canada
| | - Joseph M Sliepka
- Department of Molecular and Human Genetics Baylor College of Medicine Houston TX USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics Baylor College of Medicine Houston TX USA.,Texas Children's Hospital, Human Genetics Houston TX USA
| | - Brendan Lee
- Department of Molecular and Human Genetics Baylor College of Medicine Houston TX USA.,Texas Children's Hospital, Human Genetics Houston TX USA
| | | | - Sandesh Cs Nagamani
- Department of Molecular and Human Genetics Baylor College of Medicine Houston TX USA.,Texas Children's Hospital, Human Genetics Houston TX USA
| | - Cathleen L Raggio
- Hospital for Special Surgery Dept of Orthopedic Surgery New York NY USA
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19
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Fiedler IAK, Schmidt FN, Wölfel EM, Plumeyer C, Milovanovic P, Gioia R, Tonelli F, Bale HA, Jähn K, Besio R, Forlino A, Busse B. Severely Impaired Bone Material Quality in Chihuahua Zebrafish Resembles Classical Dominant Human Osteogenesis Imperfecta. J Bone Miner Res 2018; 33:1489-1499. [PMID: 29665086 DOI: 10.1002/jbmr.3445] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/02/2018] [Accepted: 04/07/2018] [Indexed: 12/12/2022]
Abstract
Excessive skeletal deformations and brittle fractures in the vast majority of patients suffering from osteogenesis imperfecta (OI) are a result of substantially reduced bone quality. Because the mechanical competence of bone is dependent on the tissue characteristics at small length scales, it is of crucial importance to assess how OI manifests at the micro- and nanoscale of bone. In this context, the Chihuahua (Chi/+) zebrafish, carrying a heterozygous glycine substitution in the α1 chain of collagen type I, has recently been proposed as a suitable animal model of classical dominant OI, showing skeletal deformities, altered mineralization patterns, and a smaller body size. This study assessed the bone quality properties of Chi/+ at multiple length scales using micro-computed tomography (micro-CT), histomorphometry, quantitative back-scattered electron imaging, Fourier-transform infrared spectroscopy, nanoindentation, and X-ray microscopy. At the skeletal level, the Chi/+ displays smaller body size, deformities, and fracture calli in the ribs. Morphological changes at the whole bone level showed that the vertebrae in Chi/+ had a smaller size, smaller thickness, and distorted shape. At the tissue level, Chi/+ displayed a higher degree of mineralization, lower collagen maturity, lower mineral maturity, altered osteoblast morphology, and lower osteocyte lacunar density compared to wild-type zebrafish. The alterations in the cellular, compositional, and structural properties of Chi/+ bones bear an explanation for the impaired local mechanical properties, which promote an increase in overall bone fragility in Chi/+. The quantitative assessment of bone quality in Chi/+ thus further validates this mutant as an important model reflecting osseous characteristics associated with human classical dominant OI. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Imke A K Fiedler
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva M Wölfel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Plumeyer
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petar Milovanovic
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roberta Gioia
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | - Francesca Tonelli
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | | | - Katharina Jähn
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roberta Besio
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | - Antonella Forlino
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Rush ET. Childhood hypophosphatasia: to treat or not to treat. Orphanet J Rare Dis 2018; 13:116. [PMID: 30012160 PMCID: PMC6048713 DOI: 10.1186/s13023-018-0866-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
Background Hypophosphatasia (HPP) is a rare inborn error of metabolism that results from dysfunction of the tissue non-specific alkaline phosphatase enzyme. Its manifestations are extremely variable, ranging from early lethality to disease limited to the dentition. The disease is life-threatening when manifesting within the first six months of life, excepting the extremely rare benign perinatal hypophosphatasia. Childhood hypophosphatasia, defined as onset of symptoms between six months and eighteen years, can manifest as rickets, pain, decreased mobility, deficits of growth, and fractures. Historical treatment has generally involved a combination of dietary and rehabilitative interventions. Main document Asfotase alfa (Strensiq™), is a first-in-class bone-targeted recombinant tissue nonspecific alkaline phosphatase which has shown significant improvements in morbidity and mortality in patients with perinatal and infantile hypophosphatasia. Subsequent research has also shown improvements in morbidity for patients with childhood hypophosphatasia as measured by improvement in rickets, growth, strength, mobility, and quality of life. This enzyme replacement therapy has generally been well-tolerated, with most adverse reactions being mild-to-moderate in nature. The author shares their approach to decisions on commencement of ERT based from experience of managing approximately fifteen patients across the age spectrum. This approach focuses on assessing the severity of five key manifestations of childhood HPP: decreased mobility, pain, rickets, deficits of growth, and fractures.
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Affiliation(s)
- Eric T Rush
- Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,Division of Endocrinology, Metabolism, and Genetics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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21
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Galvis A, Shoo A, Shedlock AR. Case 3: Skull Depression in a 9-month-old Girl. Pediatr Rev 2018; 39:366-369. [PMID: 29967082 DOI: 10.1542/pir.2016-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alvaro Galvis
- Department of Pediatrics, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Anthony Shoo
- Department of Pediatrics, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Aaron R Shedlock
- Department of Pediatrics, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
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22
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Simm PJ, Biggin A, Zacharin MR, Rodda CP, Tham E, Siafarikas A, Jefferies C, Hofman PL, Jensen DE, Woodhead H, Brown J, Wheeler BJ, Brookes D, Lafferty A, Munns CF. Consensus guidelines on the use of bisphosphonate therapy in children and adolescents. J Paediatr Child Health 2018; 54:223-233. [PMID: 29504223 DOI: 10.1111/jpc.13768] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/28/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022]
Abstract
Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.
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Affiliation(s)
- Peter J Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Margaret R Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine P Rodda
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Research, Sunshine Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Elaine Tham
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Aris Siafarikas
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Craig Jefferies
- Department of Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Diane E Jensen
- Children's Health Queensland, Hospital and Health Services District, South Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Helen Woodhead
- Department of Endocrinology and Diabetes, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Justin Brown
- Department of Paediatric Endocrinology, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J Wheeler
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Denise Brookes
- Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Antony Lafferty
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Department of Paediatrics and Child Health, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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Rosemberg DL, Goiano EO, Akkari M, Santili C. Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur. J Child Orthop 2018; 12:97-103. [PMID: 29456761 PMCID: PMC5813132 DOI: 10.1302/1863-2548.12.170009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To introduce a new model of telescopic intramedullary rod (TIR), evaluate its effects on treating patients presenting with moderate and severe osteogenesis imperfecta (OI) and to compare the findings with those of other telescopic rods. METHODS A total of 21 patients (nine girls and 12 boys; mean age at first operation, 6.6 years, 1.52 to 13.18) who underwent 52 femoral operations were monitored during a mean of 9.96 years (3.39 to 14.54). Patient characteristics, telescoping rod capability and its complications were examined. RESULTS According to the Sillence classification, we investigated one patient with type I, nine with type III and 11 with type IV OI. Revision rates at up to five years (36%) were inferior to those found for the Fassier-Duval rod (46%). The main cause of revision was fracture (15 patients), followed by rod migration (nine), and infection (two). The rod exhibited higher telescopic capacity in boys than girls. Type III most commonly required an operation; the age group with the highest number of procedures was five to ten years. Male migration was the main cause of rod migration. CONCLUSION The TIR has a satisfactory cost-benefit ratio with less complication rates and low production costs. The TIR is a feasible alternative to the commonly used Fassier-Duval rod. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D. L. Rosemberg
- Santa Casa de Sao Paulo School of Medical Sciences, School of Medicine, São Paulo, SP, Brazil,Correspondence should be sent to D. L. Rosemberg, Santa Casa de Sao Paulo School of Medical Sciences, School of Medicine, R. Dr. Gabriel dos Santos, 559, ap 201, São Paulo, SP, Brazil. E-mail:
| | - E. O. Goiano
- Santa Casa de Sao Paulo School of Medical Sciences, Dpto. De Ortopedia, Vila Buarque, São Paulo, SP, Brazil
| | - M. Akkari
- Santa Casa de Sao Paulo School of Medical Sciences, Dpto. De Ortopedia, Vila Buarque, São Paulo, SP, Brazil
| | - C. Santili
- Santa Casa de Sao Paulo School of Medical Sciences, Dpto. De Ortopedia, Vila Buarque, São Paulo, SP, Brazil
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Abstract
PURPOSE OF REVIEW Osteogenesis imperfecta (OI) is a genetic bone disorder resulting in bone fragility. It has a heterogeneous phenotype which typically includes reduced bone mass, multiple fractures, deformity, and chronic disability. Bisphosphonate treatment remains the first-line medical management, but there is still debate on aspects of its effectiveness. This review summarizes current knowledge about long-term bisphosphonate use in OI with recommendations on clinical application. RECENT FINDINGS Bisphosphonates increase bone mineral density, most notably of the vertebrae, and reduce fracture risk in the pediatric OI population. Gains in strength and mobility, together with the permissive effect on orthopedic surgery (e.g., in combination with intramedullary rodding) and physiotherapy, have resulted in improved quality of life for those with OI. As experience in its use continues, the risks and benefits of long-term bisphosphonate treatment in OI are slowly emerging. Patient registries containing data on genotype, phenotype, fractures, bisphosphonate treatment, orthopedic intervention, and functional outcomes are essential for systematic evaluation given the lack of large multi-centered randomized control trials.
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Affiliation(s)
- A Biggin
- Institute of Endocrinology & Diabetes, Children's Hospital Westmead, Westmead, NSW, Australia.
- Discipline of Child & Adolescent Health, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - C F Munns
- Institute of Endocrinology & Diabetes, Children's Hospital Westmead, Westmead, NSW, Australia
- Discipline of Child & Adolescent Health, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
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Abstract
Skeletal deformity and bone fragility are the hallmarks of the brittle bone dysplasia osteogenesis imperfecta. The diagnosis of osteogenesis imperfecta usually depends on family history and clinical presentation characterized by a fracture (or fractures) during the prenatal period, at birth or in early childhood; genetic tests can confirm diagnosis. Osteogenesis imperfecta is caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2) in about 85% of individuals, affecting collagen quantity or structure. In the past decade, (mostly) recessive, dominant and X-linked defects in a wide variety of genes encoding proteins involved in type I collagen synthesis, processing, secretion and post-translational modification, as well as in proteins that regulate the differentiation and activity of bone-forming cells have been shown to cause osteogenesis imperfecta. The large number of causative genes has complicated the classic classification of the disease, and although a new genetic classification system is widely used, it is still debated. Phenotypic manifestations in many organs, in addition to bone, are reported, such as abnormalities in the cardiovascular and pulmonary systems, skin fragility, muscle weakness, hearing loss and dentinogenesis imperfecta. Management involves surgical and medical treatment of skeletal abnormalities, and treatment of other complications. More innovative approaches based on gene and cell therapy, and signalling pathway alterations, are under investigation.
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Santos MCD, Pires AF, Soares K, Barros L. Family experience with osteogenesis imperfecta type 1: the most distressing situations. Disabil Rehabil 2017; 40:2281-2287. [DOI: 10.1080/09638288.2017.1334236] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Margarida Custódio dos Santos
- Faculdade de Psicologia, Universidade de Lisboa, Lisbao, Portugal
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbao, Portugal
| | - Ana Filipa Pires
- Faculdade de Psicologia, Universidade de Lisboa, Lisbao, Portugal
| | - Kelly Soares
- Faculdade de Psicologia, Universidade de Lisboa, Lisbao, Portugal
| | - Luísa Barros
- Faculdade de Psicologia, Universidade de Lisboa, Lisbao, Portugal
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Marr C, Seasman A, Bishop N. Managing the patient with osteogenesis imperfecta: a multidisciplinary approach. J Multidiscip Healthc 2017; 10:145-155. [PMID: 28435282 PMCID: PMC5388361 DOI: 10.2147/jmdh.s113483] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a heterogeneous heritable connective tissue disorder characterized by low bone density. The type and severity of OI are variable. The primary manifestations are fractures, bone deformity, and bone pain, resulting in reduced mobility and function to complete everyday tasks. OI affects not only the physical but also the social and emotional well-being of children, young people, and their families. As such, medical, surgical, and allied health professionals’ assessments all play a role in the management of these children. The multidisciplinary approach to the treatment of children and young people living with OI seeks to provide well-coordinated, comprehensive assessments, and interventions that place the child and family at the very center of their care. The coordinated efforts of a multidisciplinary team can support children with OI to fulfill their potential, maximizing function, independence, and well-being.
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Affiliation(s)
| | | | - Nick Bishop
- Academic Unit of Child Health, Department of Human Metabolism, University of Sheffield, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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29
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Sá-Caputo DC, Dionello CDF, Frederico ÉHFF, Paineiras-Domingos LL, Sousa-Gonçalves CR, Morel DS, Moreira-Marconi E, Unger M, Bernardo-Filho M. WHOLE-BODY VIBRATION EXERCISE IMPROVES FUNCTIONAL PARAMETERS IN PATIENTS WITH OSTEOGENESIS IMPERFECTA: A SYSTEMATIC REVIEW WITH A SUITABLE APPROACH. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES : AJTCAM 2017; 14:199-208. [PMID: 28480432 PMCID: PMC5412226 DOI: 10.21010/ajtcam.v14i3.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with osteogenesis imperfecta (OI) have abnormal bone modelling and resorption. The bone tissue adaptation and responsivity to dynamic and mechanical loading may be of therapeutic use under controlled circumstances. Improvements due to the wholebody vibration (WBV) exercises have been reported in strength, motion, gait, balance, posture and bone density in several osteopenic individuals, as in post-menopausal women or children with disabling conditions, as patients with OI. The aim of this investigation was to systematically analyse the current available literature to determine the effect of WBV exercises on functional parameters of OI patients. MATERIALS AND METHODS Three reviewers independently accessed bibliographical databases. Searches were performed in the PubMed, Scopus, Science Direct and PEDro databases using keywords related to possible interventions (including WBV) used in the management of patients with osteogenesis imperfecta. RESULTS Three eligible studies were identified by searches in the analysed databases. CONCLUSION It was concluded that WBV exercises could be an important option in the management of OI patients improving the mobility and functional parameters. However, further studies are necessary for establishing suitable protocols for these patients.
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Affiliation(s)
- Danubia C Sá-Caputo
- Programa de Pâs-graduaçâo em Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carla da F Dionello
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Programa de Pâs-graduaçâo em Ciencias Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Éric Heleno F. F Frederico
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Laisa L Paineiras-Domingos
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Programa de Pâs-graduaçâo em Ciencias Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cintia Renata Sousa-Gonçalves
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Danielle S Morel
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Programa de Pâs-graduaçâo em Ciencias Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eloá Moreira-Marconi
- Programa de Pâs-graduaçâo em Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marianne Unger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Mario Bernardo-Filho
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Trejo P, Rauch F. Osteogenesis imperfecta in children and adolescents-new developments in diagnosis and treatment. Osteoporos Int 2016; 27:3427-3437. [PMID: 27492436 DOI: 10.1007/s00198-016-3723-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/25/2016] [Indexed: 12/13/2022]
Abstract
Osteogenesis imperfecta (OI) is the most prevalent heritable bone fragility disorder in children. It has been known for three decades that the majority of individuals with OI have mutations in COL1A1 or COL1A2, the two genes coding for collagen type I alpha chains, but in the past 10 years defects in at least 17 other genes have been linked to OI. Almost all individuals with a typical OI phenotype have a mutation in one of the currently known genes. Regarding medical treatment, intravenous bisphosphonate therapy is the most widely used medical approach. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures, but there is little effect of bisphosphonate therapy on the development of scoliosis. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. Newer medications with anti-resorptive and bone anabolic action are being investigated in an attempt to improve on the efficacy of bisphosphonates but the safety and efficacy of these new approaches in children with OI is not yet established.
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Affiliation(s)
- P Trejo
- Shriners Hospital for Children, 1003 Decarie, Montreal, Quebec, Canada, H4A 0A9
- McGill University, Montreal, Quebec, Canada
| | - F Rauch
- Shriners Hospital for Children, 1003 Decarie, Montreal, Quebec, Canada, H4A 0A9.
- McGill University, Montreal, Quebec, Canada.
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Malmgren B, Andersson K, Lindahl K, Kindmark A, Grigelioniene G, Zachariadis V, Dahllöf G, Åström E. Tooth agenesis in osteogenesis imperfecta related to mutations in the collagen type I genes. Oral Dis 2016; 23:42-49. [DOI: 10.1111/odi.12568] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/25/2016] [Accepted: 08/05/2016] [Indexed: 02/03/2023]
Affiliation(s)
- B Malmgren
- Division of Pediatric Dentistry; Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - K Andersson
- Division of Pediatric Dentistry; Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - K Lindahl
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - A Kindmark
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - G Grigelioniene
- Department of Clinical Genetics; Karolinska University Hospital; Stockholm Sweden
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
| | - V Zachariadis
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
| | - G Dahllöf
- Division of Pediatric Dentistry; Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - E Åström
- Neuropediatric unit; Karolinska University Hospital; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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Hosiasson S, Hosiasson J. MICHEL PETRUCCIANI: EL GENIO Y LA ADVERSIDAD DE LOS GENES. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vasanwala RF, Sanghrajka A, Bishop NJ, Högler W. Recurrent Proximal Femur Fractures in a Teenager With Osteogenesis Imperfecta on Continuous Bisphosphonate Therapy: Are We Overtreating? J Bone Miner Res 2016; 31:1449-54. [PMID: 26845496 DOI: 10.1002/jbmr.2805] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/22/2016] [Accepted: 02/02/2016] [Indexed: 12/12/2022]
Abstract
Long-term bisphosphonate (BP) therapy in adults with osteoporosis is associated with atypical femoral fractures, caused by increased material bone density and prolonged suppression of bone remodeling which may reduce fracture toughness. In children with osteogenesis imperfecta (OI), long-term intravenous BP therapy improves bone structure and mass without further increasing the already hypermineralized bone matrix, and is generally regarded as safe. Here we report a teenage girl with OI type IV, who was started on cyclical intravenous pamidronate therapy at age 6 years because of recurrent fractures. Transiliac bone biopsy revealed classical structural features of OI but unusually low bone resorption surfaces. She made substantial improvements in functional ability, bone mass, and fracture rate. However, after 5 years of pamidronate therapy she started to develop recurrent, bilateral, nontraumatic, and proximal femur fractures, which satisfied the case definition for atypical femur fractures. Some fractures were preceded by periosteal reactions and prodromal pain. Pamidronate was discontinued after 7 years of therapy, following which she sustained two further nontraumatic femur fractures, and continued to show delayed tibial osteotomy healing. Despite rodding surgery, and very much in contrast to her affected, untreated, and normally mobile mother, she remains wheelchair-dependent. The case of this girl raises questions about the long-term safety of BP therapy in some children, in particular about the risk of oversuppressed bone remodeling with the potential for microcrack accumulation, delayed healing, and increased stiffness. The principal concern is whether there is point at which benefit from BP therapy could turn into harm, where fracture risk increases again. This case should stimulate debate whether current adult atypical femoral fracture guidance should apply to children, and whether low-frequency, low-dose cyclical, intermittent, or oral treatment maintenance regimens should be considered on a case-by-case basis. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Rashida F Vasanwala
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK.,Department of Endocrinology and Diabetes, KK Women's and Children's Hospital, Singapore
| | - Anish Sanghrajka
- Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK
| | - Nicholas J Bishop
- Department of Human Metabolism, Sheffield Children's Hospital, Sheffield, UK
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Metwally T, Burke A, Tsai JY, Collins MT, Boyce AM. Fibrous Dysplasia and Medication-Related Osteonecrosis of the Jaw. J Oral Maxillofac Surg 2016; 74:1983-99. [PMID: 27137436 DOI: 10.1016/j.joms.2016.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Osteonecrosis of the jaw (ONJ) is an established side effect of intravenous bisphosphonates and other antiresorptive medications. Although bisphosphonates are frequently prescribed for patients with the skeletal disorder fibrous dysplasia (FD), there are no reports of ONJ in this population. This has led some to conclude that patients with FD are at low risk for the development of bisphosphonate-related ONJ. PATIENTS AND METHODS Patients were evaluated as part of a longstanding FD natural history study at the National Institutes of Health. RESULTS Of 76 patients with FD who were treated with bisphosphonates, 4 developed ONJ (5.4%). Three patients developed ONJ in areas of FD-affected bone and 1 in an area of normal bone. All 4 patients had features known to be associated with ONJ in the general population, including long-term high-dose intravenous bisphosphonate treatment, periodontal and endodontic infections, and dentoalveolar surgical procedures. CONCLUSIONS These cases establish ONJ as a potential complication of bisphosphonate treatment in patients with FD. The presence of established risk factors for ONJ in this group of patients with FD suggests that high-risk patients could be identified before the development of ONJ. Clinicians should use caution in prescribing bisphosphonates to patients with FD and should do so only for established indications.
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Affiliation(s)
- Tarek Metwally
- Medical Research Scholar, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Dental Student, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Andrea Burke
- Clinical Research Fellow, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Jeffrey Y Tsai
- Resident, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY
| | - Michael T Collins
- Chief, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Alison M Boyce
- Attending Physician, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Adjunct Assistant Professor, Division of Endocrinology and Diabetes, and Attending Physician, Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Health System, Washington, DC.
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Biggin A, Zheng L, Briody JN, Coorey CP, Munns CF. The long-term effects of switching from active intravenous bisphosphonate treatment to low-dose maintenance therapy in children with osteogenesis imperfecta. Horm Res Paediatr 2016; 83:183-9. [PMID: 25676713 DOI: 10.1159/000369582] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Intravenous bisphosphonate therapy is the first-line treatment in moderate-to-severe osteogenesis imperfecta (OI), but there are varied treatment protocols with little data on long-term efficacy. This study evaluates the clinical outcomes when transitioning from active bisphosphonate treatment to maintenance therapy. METHODS A retrospective review was conducted on 17 patients before treatment, following active treatment (zoledronate 0.05 mg/kg 6-monthly or pamidronate 6-9 mg/kg/year) and after establishment on maintenance treatment for more than 2 years (zoledronate 0.025 mg/kg 6-monthly or pamidronate <4 mg/kg/year). RESULTS There was a significant reduction in mean fracture rate from 1.5 ± 1.1 fractures/year at baseline to 0.7 ± 0.7 fractures/year on active treatment. Z-scores for lumbar spine bone mineral density, bone mineral content, volumetric bone mineral density and bone mineral content for lean tissue mass increased during active treatment. These improvements were maintained during the period of maintenance treatment. Vertebral height improved in fractured thoracic vertebrae from pre-treatment to active therapy and improved further during maintenance treatment. Metacarpal cortical thickness and relative cortical area also increased over the treatment periods. CONCLUSION Maintenance intravenous bisphosphonate therapy preserved the beneficial effects of active treatment at the doses stated above. Further studies are required to determine the optimal bisphosphonate treatment regimen in the management of children with OI.
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Affiliation(s)
- Andrew Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Westmead, N.S.W., Australia
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Saraff V, Högler W. ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management. Eur J Endocrinol 2015; 173:R185-97. [PMID: 26041077 DOI: 10.1530/eje-14-0865] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 06/03/2015] [Indexed: 01/21/2023]
Abstract
Osteoporosis in children can be primary or secondary due to chronic disease. Awareness among paediatricians is vital to identify patients at risk of developing osteoporosis. Previous fractures and backaches are clinical predictors, and low cortical thickness and low bone density are radiological predictors of fractures. Osteogenesis Imperfecta (OI) is a rare disease and should be managed in tertiary paediatric units with the necessary multidisciplinary expertise. Modern OI management focuses on functional outcomes rather than just improving bone mineral density. While therapy for OI has improved tremendously over the last few decades, this chronic genetic condition has some unpreventable, poorly treatable and disabling complications. In children at risk of secondary osteoporosis, a high degree of suspicion needs to be exercised. In affected children, further weakening of bone should be avoided by minimising exposure to osteotoxic medication and optimising nutrition including calcium and vitamin D. Early intervention is paramount. However, it is important to identify patient groups in whom spontaneous vertebral reshaping and resolution of symptoms occur to avoid unnecessary treatment. Bisphosphonate therapy remains the pharmacological treatment of choice in both primary and secondary osteoporosis in children, despite limited evidence for its use in the latter. The duration and intensity of treatment remain a concern for long-term safety. Various new potent antiresorptive agents are being studied, but more urgently required are studies using anabolic medications that stimulate bone formation. More research is required to bridge the gaps in the evidence for management of paediatric osteoporosis.
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Affiliation(s)
- Vrinda Saraff
- Department of Endocrinology and DiabetesBirmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Wolfgang Högler
- Department of Endocrinology and DiabetesBirmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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37
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Abstract
Osteogenesis imperfecta (OI) is an uncommon genetic bone disease associated with brittle bones and fractures in children and adults. Although OI is most commonly associated with mutations of the genes for type I collagen, many other genes (some associated with type I collagen processing) have now been identified. The genetics of OI and advances in our understanding of the biomechanical properties of OI bone are reviewed in this article. Treatment includes physiotherapy, fall prevention, and sometimes orthopedic procedures. In this brief review, we will also discuss current understanding of pharmacologic therapies for treatment of OI.
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Affiliation(s)
- Joseph L Shaker
- Endocrinology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carolyne Albert
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA ; Shriners Hospitals for Children, Chicago, IL, USA
| | - Jessica Fritz
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gerald Harris
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA ; Shriners Hospitals for Children, Chicago, IL, USA
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39
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Yuan J, Li S, Xu Y, Cong L. Clinical application of antenatal genetic diagnosis of osteogenesis imperfecta type IV. Med Sci Monit 2015; 21:964-9. [PMID: 25835785 PMCID: PMC4395019 DOI: 10.12659/msm.892786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Clinical analysis and genetic testing of a family with osteogenesis imperfecta type IV were conducted, aiming to discuss antenatal genetic diagnosis of osteogenesis imperfecta type IV. Material/Methods Preliminary genotyping was performed based on clinical characteristics of the family members and then high-throughput sequencing was applied to rapidly and accurately detect the changes in candidate genes. Results Genetic testing of the III5 fetus and other family members revealed missense mutation in c.2746G>A, pGly916Arg in COL1A2 gene coding region and missense and synonymous mutation in COL1A1 gene coding region. Conclusions Application of antenatal genetic diagnosis provides fast and accurate genetic counseling and eugenics suggestions for patients with osteogenesis imperfecta type IV and their families.
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Affiliation(s)
- Jing Yuan
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Song Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - YeYe Xu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lin Cong
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
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