1
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Ward LM. A practical guide to the diagnosis and management of osteoporosis in childhood and adolescence. Front Endocrinol (Lausanne) 2024; 14:1266986. [PMID: 38374961 PMCID: PMC10875302 DOI: 10.3389/fendo.2023.1266986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 02/21/2024] Open
Abstract
Osteoporosis in childhood distinguishes itself from adulthood in four important ways: 1) challenges in distinguishing otherwise healthy children who have experienced fractures due to non-accidental injury or misfortunate during sports and play from those with an underlying bone fragility condition; 2) a preponderance of monogenic "early onset" osteoporotic conditions that unveil themselves during the pediatric years; 3) the unique potential, in those with residual growth and transient bone health threats, to reclaim bone density, structure, and strength without bone-targeted therapy; and 4) the need to benchmark bone health metrics to constantly evolving "normal targets", given the changes in bone size, shape, and metabolism that take place from birth through late adolescence. On this background, the pediatric osteoporosis field has evolved considerably over the last few decades, giving rise to a deeper understanding of the discrete genes implicated in childhood-onset osteoporosis, the natural history of bone fragility in the chronic illness setting and associated risk factors, effective diagnostic and monitoring pathways in different disease contexts, the importance of timely identification of candidates for osteoporosis treatment, and the benefits of early (during growth) rather than late (post-epiphyseal fusion) treatment. While there has been considerable progress, a number of unmet needs remain, the most urgent of which is to move beyond the monotherapeutic anti-resorptive landscape to the study and application of anabolic agents that are anticipated to not only improve bone mineral density but also increase long bone cross-sectional diameter (periosteal circumference). The purpose of this review is to provide a practical guide to the diagnosis and management of osteoporosis in children presenting to the clinic with fragility fractures, one that serves as a step-by-step "how to" reference for clinicians in their routine clinical journey. The article also provides a sightline to the future, emphasizing the clinical scenarios with the most urgent need for an expanded toolbox of effective osteoporosis agents in childhood.
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Affiliation(s)
- Leanne M. Ward
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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2
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Muñoz-Garcia J, Heymann D, Giurgea I, Legendre M, Amselem S, Castañeda B, Lézot F, William Vargas-Franco J. Pharmacological options in the treatment of osteogenesis imperfecta: A comprehensive review of clinical and potential alternatives. Biochem Pharmacol 2023; 213:115584. [PMID: 37148979 DOI: 10.1016/j.bcp.2023.115584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Abstract
Osteogenesis imperfecta (OI) is a genetically heterogeneous connective tissue disorder characterized by bone fragility and different extra-skeletal manifestations. The severity of these manifestations makes it possible to classify OI into different subtypes based on the main clinical features. This review aims to outline and describe the current pharmacological alternatives for treating OI, grounded on clinical and preclinical reports, such as antiresorptive agents, anabolic agents, growth hormone, and anti-TGFβ antibody, among other less used agents. The different options and their pharmacokinetic and pharmacodynamic properties will be reviewed and discussed, focusing on the variability of their response and the molecular mechanisms involved to attain the main clinical goals, which include decreasing fracture incidence, improving pain, and promoting growth, mobility, and functional independence.
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Affiliation(s)
- Javier Muñoz-Garcia
- Institut de Cancérologie de l'Ouest, Saint-Herblain, F-44805, France; Nantes Université, CNRS, US2B, UMR 6286, Nantes F-44322, France
| | - Dominique Heymann
- Institut de Cancérologie de l'Ouest, Saint-Herblain, F-44805, France; Nantes Université, CNRS, US2B, UMR 6286, Nantes F-44322, France; Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Irina Giurgea
- Sorbonne Université, INSERM UMR933, Hôpital Trousseau (AP-HP), Paris F-75012, France
| | - Marie Legendre
- Sorbonne Université, INSERM UMR933, Hôpital Trousseau (AP-HP), Paris F-75012, France
| | - Serge Amselem
- Sorbonne Université, INSERM UMR933, Hôpital Trousseau (AP-HP), Paris F-75012, France
| | - Beatriz Castañeda
- Service d'Orthopédie Dento-Facial, Département d'Odontologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris F75013, France
| | - Frédéric Lézot
- Sorbonne Université, INSERM UMR933, Hôpital Trousseau (AP-HP), Paris F-75012, France.
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3
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Chang B, Keating S, Mikhael M, Lim J. Osteogenesis Imperfecta: Multidisciplinary and Goal-Centered Care. AJP Rep 2022; 12:e144-e147. [PMID: 36187198 PMCID: PMC9522483 DOI: 10.1055/s-0042-1757481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
We describe a case of osteogenesis imperfecta (OI) in a late preterm female of 35-week gestation. The mother did have a history of substance abuse, poor prenatal care, and hypertension. On the day of delivery, an ultrasound revealed skeletal dysplasia and breech with nonreassuring fetal tracing, leading to an emergency cesarean. The clinical exam was concerning for OI, and postnatal care was focused on optimizing respiratory status and minimizing pain and discomfort during routine care. Genetics, endocrine, orthopaedics, and palliative care were all involved to diagnose and educate the family. Support and education were needed for bedside staff to minimize angst at performing routine care, given the high risk of fractures. While initially stable on minimal oxygen, once the diagnosis of type III OI was made, a progressively deforming condition with respiratory status decompensation, the family wished to minimize suffering, limited aggressive medical care, and focused on comfort. The infant eventually died from respiratory failure in the neonatal intensive care unit. We present this case to demonstrate the need for an interdisciplinary team approach to support both family and staff in cases of OI.
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Affiliation(s)
- Bryston Chang
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California
| | - Sarah Keating
- Department of Palliative Care, Children's Hospital of Orange County, Orange, California
| | - Michel Mikhael
- Department of Neonatal-Perinatal Medicine, Orange, California
| | - Jina Lim
- Department of Neonatology, Children's Hospital of Orange County, Orange, California
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4
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Chang B, Keating S, Mikhael M, Lim J. Osteogenesis Imperfecta: Multidisciplinary and Goal-Centered Care. AJP Rep 2022; 12:e144-e147. [PMID: 36187200 PMCID: PMC9525185 DOI: 10.1055/a-1911-3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022] Open
Abstract
We describe a case of osteogenesis imperfecta (OI) in a late preterm female of 35-week gestation. The mother did have a history of substance abuse, poor prenatal care, and hypertension. On the day of delivery, an ultrasound revealed skeletal dysplasia and breech with nonreassuring fetal tracing, leading to an emergency cesarean. The clinical exam was concerning for OI, and postnatal care was focused on optimizing respiratory status and minimizing pain and discomfort during routine care. Genetics, endocrine, orthopaedics, and palliative care were all involved to diagnose and educate the family. Support and education were needed for bedside staff to minimize angst at performing routine care, given the high risk of fractures. While initially stable on minimal oxygen, once the diagnosis of type III OI was made, a progressively deforming condition with respiratory status decompensation, the family wished to minimize suffering, limited aggressive medical care, and focused on comfort. The infant eventually died from respiratory failure in the neonatal intensive care unit. We present this case to demonstrate the need for an interdisciplinary team approach to support both family and staff in cases of OI.
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Affiliation(s)
- Bryston Chang
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California
| | - Sarah Keating
- Department of Palliative Care, Children's Hospital of Orange County, Orange, California
| | - Michel Mikhael
- Department of Neonatal-Perinatal Medicine, Orange, California
| | - Jina Lim
- Department of Neonatology, Children's Hospital of Orange County, Orange, California
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The Rationale for Using Neridronate in Musculoskeletal Disorders: From Metabolic Bone Diseases to Musculoskeletal Pain. Int J Mol Sci 2022; 23:ijms23136921. [PMID: 35805927 PMCID: PMC9267106 DOI: 10.3390/ijms23136921] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Neridronate or ((6-amino-1-hydroxy-1-phosphonohexyl) phosphonic acid) is an amino-bisphosphonate (BP) synthetized in Italy in 1986. Bisphosphonates are molecules with a P-C-P bond in their structure that allows strong and selectively binding to hydroxyapatite (HAP) as well as osteoclasts inhibition through different mechanisms of action. Neridronate was initially used to treat Paget disease of the bone, demonstrating effectiveness in reducing bone turnover markers as well as pain. The interesting molecular properties of neridronate foster its wide use in several other conditions, such as osteogenesis imperfecta, and osteoporosis. Thanks to the unique safety and efficacy profile, neridronate has been used in secondary osteoporosis due to genetic, rheumatic, and oncological diseases, including in pediatric patients. In the last decade, this drug has also been studied in chronic musculoskeletal pain conditions, such as algodystrophy, demonstrating effectiveness in improving extraskeletal outcomes. This review highlights historical and clinical insights about the use of neridronate for metabolic bone disorders and musculoskeletal pain conditions.
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Nguyen EB, Kim EY, Malwane MI, Trejo S, Cucalón-Calderón JR. Delayed Diagnosis of Osteogenesis Imperfecta: A Differential Diagnosis Guided by Competing Ocular Findings and a Lack of Family History. Cureus 2022; 14:e25822. [PMID: 35822142 PMCID: PMC9271314 DOI: 10.7759/cureus.25822] [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] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Osteogenesis imperfecta (OI) is an inherited connective tissue disorder with variable clinical manifestations involving many structures and organ systems, leading to characteristic presentations such as low bone mineral density (BMD), vertebral compression fractures, hearing loss, and blue sclerae. Even within the same family, individuals with the same inherited genotype may have differential presentations due to variable expressivity. Early diagnosis of OI in the pediatric population may allow for earlier treatment and interprofessional interventions. This case describes a minority female infant who initially presented with bilateral complexion-associated melanosis (CAM) inclusions in her eyes. The appearance of her inclusions was reminiscent of the blue sclera seen in OI; however, there was no clinical suspicion for OI on birth, developmental, and family histories. Her growth and development were unremarkable at all well-child checks until her three-year well-child check. It was then discovered that she suffered multiple long bone fractures due to low trauma, vertebral compression fractures, and kyphoscoliosis. Due to the occurrence of these fragility fractures, she was given a clinical diagnosis of osteoporosis with pending genetic testing for osteogenesis imperfecta. It was later discovered that there was, in fact, an extensive history of recurrent childhood fractures in the patient’s brother, mother, and numerous maternal relatives. Our case demonstrates the greater need for certified medical interpretation services to obtain clear past medical and family history, especially in the face of language barriers and low health literacy, in conjunction with clinical findings, i.e., CAM, to guide the differential diagnosis and subsequent management appropriately.
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Carroll RS, Donenfeld P, McGreal C, Franzone JM, Kruse RW, Preedy C, Costa J, Dirnberger DR, Bober MB. Comprehensive pain management strategy for infants with moderate to severe osteogenesis imperfecta in the perinatal period. PAEDIATRIC AND NEONATAL PAIN 2021; 3:156-162. [PMID: 35548555 PMCID: PMC8975205 DOI: 10.1002/pne2.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/15/2022]
Abstract
Osteogenesis imperfecta (OI) is a rare genetic heterogeneous disorder that causes increased bone fragility and recurrent fractures. For infants with OI and diffuse fractures, pain management, which is nuanced and specific for this population, is of the utmost importance to their neonatal care. Through experience at our center, we have developed a standard approach that has been successful in optimizing survival for these infants during this tenuous period. In this paper, we outline our multidisciplinary approach to pain management for infants with moderate to severe OI during the neonatal period, with emphasis on promotion of fracture healing and adequate pain control.
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Affiliation(s)
- Ricki S. Carroll
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Division of Palliative Medicine Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
- Division of Orthogenetics Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Perri Donenfeld
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Division of Palliative Medicine Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Cristina McGreal
- Division of Orthogenetics Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Jeanne M. Franzone
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Neonatal‐Perinatal Medicine Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Richard W. Kruse
- Neonatal‐Perinatal Medicine Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Catherine Preedy
- Department of Orthopaedic Surgery Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Joanna Costa
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Department of Orthopaedic Surgery Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Daniel R. Dirnberger
- Department of Orthopaedic Surgery Nemours Children’s Hospital Delaware Wilmington Delaware USA
| | - Michael B. Bober
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Division of Orthogenetics Department of Pediatrics Nemours Children’s Hospital Delaware Wilmington Delaware USA
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Devin CL, Sagalow E, Penikis A, McGreal CM, Bober MB, Berman L. Long-term vascular access for infants with moderate to severe osteogenesis imperfecta. Pediatr Surg Int 2021; 37:1621-1625. [PMID: 34374819 DOI: 10.1007/s00383-021-04975-2] [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] [Accepted: 08/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Osteogenesis imperfecta (OI) is a genetic disorder that causes skeletal fragility. For the most fragile infants and young children with OI, intravenous (IV) bisphosphonate administration is essential, but IV access attempts often cause fractures. Port-a-caths help prevent these events, but some surgeons are hesitant to insert these devices in these infants due to lack of data on their safety. METHODS Retrospective study of pediatric patients with OI who underwent port-a-cath placement from 1999 to 2018; incidence of complications such as infection and thrombosis and need for reoperation or replacement are described. RESULTS Port-a-caths were placed in 17 patients with OI (median age, 8 mos [5-23 mos]; median weight, 5.8 kg [3.96-9.08 kg]) and remained in place for a median of 53.5 mos (10-127 mos). One port-a-cath was replaced because of thrombosis. Two port-a-caths were removed because of malfunction, one for skin erosion, and one for infection. In these five cases, replacement was not needed because patients could safely tolerate IV access. Two patients have their port-a-cath in place and the remaining ten patients had theirs removed electively as it was no longer needed. CONCLUSION Port-a-cath placement in pediatric patients with OI is safe and efficacious for durable central access, enabling reliable IV bisphosphonate delivery and reducing iatrogenic trauma.
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Affiliation(s)
- Courtney L Devin
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Emily Sagalow
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Annalise Penikis
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Cristina M McGreal
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Michael B Bober
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Loren Berman
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA. .,Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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Langston SJ, Krakow D, Chu A. Revisiting Skeletal Dysplasias in the Newborn. Neoreviews 2021; 22:e216-e229. [PMID: 33795397 DOI: 10.1542/neo.22-4-e216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
With over 400 reported disorders, the skeletal dysplasias represent a myriad of molecularly-based skeletal abnormalities. Arising from errors in skeletal development, the clinical spectrum of disease evolves through an affected individual's life. The naming and grouping of these disorders are ever-changing, but the fundamentals of diagnosis remain the same and are accomplished through a combination of prenatal ultrasonography and postnatal physical examination, radiography, and genetic analysis. Although some disorders are lethal in the perinatal and neonatal periods, other disorders allow survival into infancy, childhood, and even adulthood with relatively normal lives. The foundation of management for an affected individual is multidisciplinary care. Medical advances have offered new insights into reducing common morbidities through pharmacologic means. This review summarizes the normal skeletal development and discusses the 3 most common skeletal dysplasias that can affect the newborn.
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Affiliation(s)
- Seth J Langston
- Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Deborah Krakow
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA
| | - Alison Chu
- Division of Neonatology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
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Barbosa JS, Almeida Paz FA, Braga SS. Bisphosphonates, Old Friends of Bones and New Trends in Clinics. J Med Chem 2021; 64:1260-1282. [PMID: 33522236 DOI: 10.1021/acs.jmedchem.0c01292] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bisphosphonates, used for a long time in osteoporosis management, are currently the target of intensive research, from pre-formulation studies to more advanced stages of clinical practice. This review presents an overview of the contributions of this family of compounds to human health, starting with the chemistry and clinical uses of bisphosphonates. Following this, their pharmacology is described, highlighting administration-borne handicaps and undesirable effects. The last three sections of the review describe the research efforts that seek to curb delivery-related issues and expand bisphosphonate use. Innovative routes and strategies of administration, such as nano-encapsulation for oral intake or injectable cements for local or in-bone delivery are presented, as well as the latest results of case studies or preclinical studies proposing new therapeutic indications for the clinically approved bisphosphonates. Finally, a selection of anti-infectious bisphosphonate new drug candidates is shown, with focus on the molecules reported in the last two decades.
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Affiliation(s)
- Jéssica S Barbosa
- CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal.,LAQV-Requimte, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Filipe A Almeida Paz
- CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Susana Santos Braga
- LAQV-Requimte, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
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Abstract
Glucocorticoids (GC) are an important risk factor for bone fragility in children with serious illnesses, largely due to their direct adverse effects on skeletal metabolism. To better appreciate the natural history of fractures in this setting, over a decade ago the Canadian STeroid-associated Osteoporosis in the Pediatric Population ("STOPP") Consortium launched a 6 year, multi-center observational cohort study in GC-treated children. This study unveiled numerous key clinical-biological principles about GC-induced osteoporosis (GIO), many of which are unique to the growing skeleton. This was important, because most GIO recommendations to date have been guided by adult studies, and therefore do not acknowledge the pediatric-specific principles that inform monitoring, diagnosis and treatment strategies in the young. Some of the most informative observations from the STOPP study were that vertebral fractures are the hallmark of pediatric GIO, they occur early in the GC treatment course, and they are frequently asymptomatic (thereby undetected in the absence of routine monitoring). At the same time, some children have the unique, growth-mediated ability to restore normal vertebral body dimensions following vertebral fractures. This is an important index of recovery, since spontaneous vertebral body reshaping may preclude the need for osteoporosis therapy. Furthermore, we now better understand that children with poor growth, older children with less residual growth potential, and children with ongoing bone health threats have less potential for vertebral body reshaping following spine fractures, which can result in permanent vertebral deformity if treatment is not initiated in a timely fashion. Therefore, pediatric GIO management is now predicated upon early identification of vertebral fractures in those at risk, and timely intervention when there is limited potential for spontaneous recovery. A single, low-trauma long bone fracture can also signal an osteoporotic event, and a need for treatment. Intravenous bisphosphonates are currently the recommended therapy for pediatric GC-induced bone fragility, typically prescribed to children with limited potential for medication-unassisted recovery. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of intravenous bisphosphonate therapy, may not completely rescue the osteoporosis in those with the most aggressive forms, opening the door to novel strategies.
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Affiliation(s)
- Leanne M. Ward
- The Ottawa Pediatric Bone Health Research Group, The Children's Hospital of Eastern Ontario Genetic and Metabolic Bone Disease Clinic, University of Ottawa, Ottawa, ON, Canada
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Ramaroli DA, Cavarzere P, Cheli M, Provenzi M, Barillari M, Rodella G, Gaudino R, Antoniazzi F. A Child with Early-Onset Gorham-Stout Disease Complicated by Chylothorax: Near-Complete Regression of Bone Lesions with Interferon and Bisphosphonate Treatment. Horm Res Paediatr 2020; 91:406-410. [PMID: 30630178 DOI: 10.1159/000495364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/10/2018] [Indexed: 11/19/2022] Open
Abstract
We report a case of Gorham-Stout disease (GSD) complicated by chylothorax and treated with a combination therapy with interferon and bisphosphonates. This treatment may be helpful in improving the usually unfavorable prognosis of GSD beginning with a chylothorax before 1 year of age, and in reducing bone lesions. Moreover, the use of bisphosphonates appears to be useful in treating pain.
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Affiliation(s)
| | - Paolo Cavarzere
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, Verona, Italy,
| | - Maurizio Cheli
- Pediatric Surgery, Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marco Barillari
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giulia Rodella
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rossella Gaudino
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Center for the Diagnosis and Treatment of Pediatric Bone Rare Diseases, Verona, Italy
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13
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Ma J, Siminoski K, Wang P, Alos N, Cummings EA, Feber J, Halton J, Ho J, Houghton K, Lang B, Miettunen PM, Scuccimarri R, Jaremko JL, Koujok K, Lentle B, Matzinger MA, Shenouda N, Rauch F, Ward LM. The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches. J Bone Miner Res 2020; 35:460-468. [PMID: 31742768 DOI: 10.1002/jbmr.3922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
Abstract
Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform spine radiographs in most conditions that predispose to vertebral fracture (VF). In this study we examined the accuracy of two clinical predictors, back pain and lumbar spine bone mineral density (LS BMD), to derive four case-finding paradigms for detection of prevalent VF (PVF). Subjects were 400 children at risk for PVF (leukemia 186, rheumatic disorders 135, nephrotic syndrome 79). Back pain was assessed by patient report, LS BMD was measured by dual-energy X-ray absorptiometry, and PVF were quantified on spine radiographs using the modified Genant semiquantitative method. Forty-four patients (11.0%) had PVF. Logistic regression analysis between LS BMD and PVF produced an odds ratio (OR) of 1.9 (95% confidence interval [CI], 1.5 to 2.5) per reduction in Z-score unit, an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60 to 0.79), and an optimal BMD Z-score cutoff of -1.6. Case identification using either low BMD alone (Z-score < -1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD plus back pain produced lower sensitivity (32%), higher specificity (96%), higher PPV (47%), and similar NPV (92%). The approach using low BMD or back pain had the highest sensitivity (75%), lowest specificity (64%), lowest PPV (20%), and highest NPV (95%). All paradigms had increased sensitivities for higher fracture grades. Our results show that BMD and back pain history can be used to identify children with the highest risk of PVF so that radiography can be used judiciously. The specific paradigm to be applied will depend on the expected PVF rate and the clinical approach to the use of radiography. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging and Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peiyao Wang
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Nathalie Alos
- Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada
| | | | - Janusz Feber
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Paivi M Miettunen
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | | | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Khaldoun Koujok
- Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Brian Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Nazih Shenouda
- Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Frank Rauch
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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- Canadian Pediatric Bone Health Working Group, Ottawa, ON, Canada
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Abstract
New therapeutic approaches have been established in the field of rare skeletal diseases (e.g., for osteogenesis imperfecta, achondroplasia, hypophosphatemic rickets, hypophosphatasia, and fibrodysplasia ossificans progressiva). After elucidation of the underlying genotypes and pathophysiologic alterations of these diseases, new treatment options have been designed. Most drugs are based on an interaction with the disease-specific cascade of enzymes and proteins involved in the disease. Thereby an approved treatment is available for children with severe forms of hypophosphatasia and hypophosphatemic rickets (asfotase alfa, burosumab). Additionally, there are different phase 3 trials ongoing assessing the efficacy and safety of drugs for osteogenesis imperfecta, achondroplasia, and fibrodysplasia ossificans progressiva (denosumab, vosoritide, palovarotene).Because all these diseases are rare, the number of investigated patients in the trials is small, and the knowledge about rare side effects and long-term outcome is limited. Therefore it is recommended to treat the patients in specialized centers where the effects of the drugs can be evaluated and data about safety, side effects, and efficacy can be collected.Based on the fact that most drugs for rare diseases are highly expensive clear indications for start of a treatment, evaluation of the therapy and recommendations how long a treatment has to be administrated are urgently needed.
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Affiliation(s)
- Heike Hoyer-Kuhn
- Faculty of Medicine, University of Cologne, Cologne, Germany.
- Department of Paediatrics, University Hospital Cologne, Cologne, Germany.
| | - Eckhard Schönau
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Paediatrics, University Hospital Cologne, Cologne, Germany
- Center for Prevention and Rehabilitation, Unireha, University of Cologne, Cologne, Germany
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15
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Pinheiro B, Zambrano MB, Vanz AP, Brizola E, Souza LTD, Félix TM. Cyclic pamidronate treatment for osteogenesis imperfecta: Report from a Brazilian reference center. Genet Mol Biol 2019; 42:252-260. [PMID: 31067290 PMCID: PMC6687341 DOI: 10.1590/1678-4685-gmb-2018-0097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022] Open
Abstract
Treatment of moderate and severe forms of osteogenesis imperfecta (OI) with
cyclic pamidronate at the Reference Center for OI Treatment in Southern Brazil
was studied. A retrospective cohort study was conducted from 2002 to 2012. Data
were obtained during inpatient (drug infusion) and outpatient care. Clinical
data, including the presence of blue sclerae, dentinogenesis imperfecta, history
and site of the fractures, biochemical data, including calcium, phosphorus, and
alkaline phosphatase levels, were systematically collected. Bone mineral density
(BMD) was measured using dual energy X-ray absorptiometry (DXA). Forty-five
patients (26 females) were included in the study, and the age of the patients at
the time of diagnosis ranged from 1 to 144 months, with a median age (p25-p75)
of 38 (5-96) months. Most cases presented OI-4 (51.1%), and the median age of
the patients at the start of treatment was 3.3 years (25-75 percentiles: 0.5 -
8.7 years). Twenty-four patients (54.5%) had some adverse events or
intercurrences during treatment, and the treatment compliance mean was 92.3% (±
10.7). The treatment with intravenous pamidronate has shown to be safe,
well-tolerated, and effective in regard to the improvement of BMD and the
reduction of the number of fractures in children and adolescents with OI.
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Affiliation(s)
- Bruna Pinheiro
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marina B Zambrano
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Paula Vanz
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Evelise Brizola
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Liliane Todeschini de Souza
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Têmis Maria Félix
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
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16
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Semler O, Rehberg M, Mehdiani N, Jackels M, Hoyer-Kuhn H. Current and Emerging Therapeutic Options for the Management of Rare Skeletal Diseases. Paediatr Drugs 2019; 21:95-106. [PMID: 30941653 DOI: 10.1007/s40272-019-00330-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasing knowledge in the field of rare diseases has led to new therapeutic approaches in the last decade. Treatment strategies have been developed after elucidation of the underlying genetic alterations and pathophysiology of certain diseases (e.g., in osteogenesis imperfecta, achondroplasia, hypophosphatemic rickets, hypophosphatasia and fibrodysplasia ossificans progressiva). Most of the drugs developed are specifically designed agents interacting with the disease-specific cascade of enzymes and proteins involved. While some are approved (asfotase alfa, burosumab), others are currently being investigated in phase III trials (denosumab, vosoritide, palovarotene). To offer a multi-disciplinary therapeutic approach, it is recommended that patients with rare skeletal disorders are treated and monitored in highly specialized centers. This guarantees the greatest safety for the individual patient and offers the possibility of collecting data to further improve treatment strategies for these rare conditions. Additionally, new therapeutic options could be achieved through increased awareness, not only in the field of pediatrics but also in prenatal and obstetric specialties. Presenting new therapeutic options might influence families in their decision of whether or not to terminate a pregnancy with a child with a skeletal disease.
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Affiliation(s)
- Oliver Semler
- Centre for Rare Skeletal Diseases in childhood, Children's Hospital, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany. .,Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.
| | - Mirko Rehberg
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
| | - Nava Mehdiani
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
| | - Miriam Jackels
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Centre for Prevention and Rehabilitation, Unireha, University of Cologne, Cologne, Germany
| | - Heike Hoyer-Kuhn
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
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17
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Wirth T. The orthopaedic management of long bone deformities in genetically and acquired generalized bone weakening conditions. J Child Orthop 2019; 13:12-21. [PMID: 30838071 PMCID: PMC6376434 DOI: 10.1302/1863-2548.13.180184] [Citation(s) in RCA: 11] [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 Diseases such as osteogenesis imperfecta, fibrous dysplasia, hypophosphataemic rickets and others lead to soft and weak bones and long bone deformity in affected patients. As a consequence, these patients lose their walking capacity and functional abilities of the upper extremities as well. METHODS In combination with bisphosphonate treatment and physical rehabilitation programmes surgical interventions are being applied to correct and stabilize the deformed and less mechanically resistant long bones. Intramedullary devices, ideally with an elongating telescopic mechanism, have proven to be the most suitable implants. RESULTS The surgical correction and stabilization of deformed bones in weak bone diseases is very beneficial to the patients. Pain restriction, reduction of fracture events, minimization of consequences of traumatic events and falls have resulted in a significant functional improvement. The patients live on a better activity level with a much-improved individual independence. Despite a high complication and revision rate of the intramedullary rods the gain of quality of life outweighs these negative aspects by far. CONCLUSION Orthopaedic surgical treatment for deformed bones in patients with weak bone diseases has changed the life of the patients and plays a very important role in the disease management protocols.This paper was written under the guidance of the Study Group Genetics and Metabolic Diseases of the European Paediatric Orthopaedic Society.
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Affiliation(s)
- T. Wirth
- Department of Orthopaedics, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany, Correspondence should be sent to T. Wirth, MD, PhD, Department of Orthopaedics, Klinikum Stuttgart, Olgahospital, Kriegsbergstraße 62, D-70176 Stuttgart, Germany. E-mail:
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18
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Ward LM, Weber DR. Growth, pubertal development, and skeletal health in boys with Duchenne Muscular Dystrophy. Curr Opin Endocrinol Diabetes Obes 2019; 26:39-48. [PMID: 30507696 PMCID: PMC6402320 DOI: 10.1097/med.0000000000000456] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Glucocorticoid therapy is currently the most widely used treatment for Duchenne muscular dystrophy (DMD), having consistently shown to prolong ambulation by 2 years, reduce the frequency of scoliosis, and improve cardiorespiratory function. Among the most frequent side effects of glucocorticoids are fractures due to osteoporosis, linear growth retardation or arrest, and pubertal delay, the subjects of this review. RECENT FINDINGS The diagnosis of osteoporosis has shifted in recent years away from a bone mineral density-centric to a fracture-focused approach, with particular emphasis on early vertebral fracture identification (one of the key triggers for osteoporosis intervention). Delayed puberty should be addressed in an age-appropriate manner, with numerous options available for sex steroid replacement. Growth impairment, however, is a more challenging complication of glucocorticoid-treated DMD, one that is most likely best addressed through growth-sparing therapies that target the dystrophinopathy. SUMMARY With glucocorticoid prescription an increasingly prevalent component of DMD care, early attention to management of osteoporosis and delayed puberty are important components of multidisciplinary and anticipatory care. The treatment of short stature remains controversial, with no accepted therapy currently available to over-ride the toxic effects of glucocorticoids on the growth axis.
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Affiliation(s)
- Leanne M. Ward
- Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - David R. Weber
- Division of Endocrinology and Diabetes, Golisano Children’s Hospital, University of Rochester Medical Centre, Rochester, New York, USA
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19
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Wong SC, Straub V, Ward LM, Quinlivan R. 236th ENMC International Workshop Bone protective therapy in Duchenne muscular dystrophy: Determining the feasibility and standards of clinical trials Hoofddorp, The Netherlands, 1-3 June 2018. Neuromuscul Disord 2019; 29:251-259. [PMID: 30803852 DOI: 10.1016/j.nmd.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Sze Choong Wong
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, UK.
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of East Ontario, University of Ottawa, Ottawa, Canada
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Disease and Division of Neuropathology, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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20
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Ward LM, Hadjiyannakis S, McMillan HJ, Noritz G, Weber DR. Bone Health and Osteoporosis Management of the Patient With Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S34-S42. [PMID: 30275247 PMCID: PMC6442478 DOI: 10.1542/peds.2018-0333e] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/29/2022] Open
Abstract
Duchenne muscular dystrophy is associated with an increased risk of bone fragility due to the adverse effects of prolonged glucocorticoid therapy and progressive muscle weakness on bone strength. Osteoporosis manifests clinically as low-trauma long-bone and vertebral fractures (VFs), with VFs frequent, particularly in those treated with glucocorticoid therapy. It is increasingly recognized that bone pain, medical complications of osteoporosis (such as fat embolism syndrome), and the potential for permanent, fracture-induced loss of ambulation can be mitigated with timely bone health surveillance and management. This includes periodic spine radiographs for VF detection because VFs can be asymptomatic in their early phases and thereby go undetected in the absence of monitoring. With this article, we provide a comprehensive review of the following 4 phases of bone health management: (1) bone health monitoring, which is used to identify early signs of compromised bone health; (2) osteoporosis stabilization, which is aimed to mitigate back pain and interrupt the fracture-refracture cycle through bone-targeted therapy; (3) bone health maintenance, which has the goal to preserve the clinical gains realized during the stabilization phase through ongoing bone-targeted therapy; and (4) osteoporosis therapy discontinuation, which places those who are eligible for discontinuation of osteoporosis treatment back on a health monitoring program. In the course of reviewing these 4 phases of management, we will discuss the criteria for diagnosing osteoporosis, along with detailed recommendations for osteoporosis intervention including specific drugs, dose, length of therapy, contraindications, and monitoring of treatment efficacy and safety.
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Affiliation(s)
- Leanne M. Ward
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Stasia Hadjiyannakis
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Hugh J. McMillan
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Garey Noritz
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - David R. Weber
- Golisano Children’s Hospital, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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21
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Birnkrant DJ, Bushby K, Bann CM, Alman BA, Apkon SD, Blackwell A, Case LE, Cripe L, Hadjiyannakis S, Olson AK, Sheehan DW, Bolen J, Weber DR, Ward LM. Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management. Lancet Neurol 2018; 17:347-361. [PMID: 29395990 DOI: 10.1016/s1474-4422(18)30025-5] [Citation(s) in RCA: 572] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/30/2017] [Accepted: 01/12/2018] [Indexed: 02/07/2023]
Abstract
A coordinated, multidisciplinary approach to care is essential for optimum management of the primary manifestations and secondary complications of Duchenne muscular dystrophy (DMD). Contemporary care has been shaped by the availability of more sensitive diagnostic techniques and the earlier use of therapeutic interventions, which have the potential to improve patients' duration and quality of life. In part 2 of this update of the DMD care considerations, we present the latest recommendations for respiratory, cardiac, bone health and osteoporosis, and orthopaedic and surgical management for boys and men with DMD. Additionally, we provide guidance on cardiac management for female carriers of a disease-causing mutation. The new care considerations acknowledge the effects of long-term glucocorticoid use on the natural history of DMD, and the need for care guidance across the lifespan as patients live longer. The management of DMD looks set to change substantially as new genetic and molecular therapies become available.
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Affiliation(s)
- David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Katharine Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | - Benjamin A Alman
- Department of Orthopaedic Surgery, Duke University School of Medicine and Health System, Durham, NC, USA
| | - Susan D Apkon
- Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Laura E Case
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA
| | - Linda Cripe
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Stasia Hadjiyannakis
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
| | - Aaron K Olson
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Daniel W Sheehan
- John R Oishei Children's Hospital, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Julie Bolen
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David R Weber
- Division of Endocrinology and Diabetes, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
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22
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Leali PT, Balsano M, Maestretti G, Brusoni M, Amorese V, Ciurlia E, Andreozzi M, Caggiari G, Doria C. Efficacy of teriparatide vs neridronate in adults with osteogenesis imperfecta type I: a prospective randomized international clinical study. ACTA ACUST UNITED AC 2017; 14:153-156. [PMID: 29263724 DOI: 10.11138/ccmbm/2017.14.1.153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Osteogenesis imperfecta (OI) is an hereditary disease characterized by low bone mass, increased bone fragility, short stature, and skeletal deformities, few treatment options are currently available. Neridronate is an amino-bisphosphonate, licensed in Italy for the treatment of OI and Paget's disease of bone. A characteristic property of neridronate is that it can be administered both intravenously and intramuscularly, providing an useful system for administration in homecare. Neridronate appears to increase Bone Mineral Density (BMD) in adults with OI and reduces bone resorption by inhibition of osteoclastic activity. Teriparatide (recombinant 1-34 N terminal sequence of human parathyroid hormone) is the first anabolic agent approved for the treatment of patients with osteoporosis and has been reported to increase bone formation by stimulating osteoblast differentiation, osteoblast function, and survival. The results of this study showed a promising role of teriparatide in the therapy of OI type I.
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Affiliation(s)
| | - Massimo Balsano
- Orthopaedic Department, Santorso Hospital, Santorso (VI), Italy
| | | | - Matteo Brusoni
- Orthopaedic Department, University of Sassari, Sassari, Italy
| | | | | | | | | | - Carlo Doria
- Orthopaedic Department, University of Sassari, Sassari, Italy
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23
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Papanna MC, Tafazal S, Bell MJ, Giles SN, Fernandes JA. Femoral neck fractures in osteogenesis imperfecta treated with bisphosphonates. J Child Orthop 2017; 11:191-194. [PMID: 28828062 PMCID: PMC5548034 DOI: 10.1302/1863-2548.11.160212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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 Osteogenesis imperfecta (OI) is a condition characterised by bone fragility and multiple fractures, which cause considerable morbidity in the affected patients. Most cases are associated with mutations in one of the type I collagen genes. Recently, bisphosponates have been used widely to reduce pain and the incidence of fragility fractures in OI in children, even though there have been concerns raised regarding the long-term complications of it due to their effect on the bone. The fragility fractures involving the neck of the femur in children with intramedullary rods in the femoral shaft are very difficult to treat. Although these fractures are frequently un-displaced, they require optimal internal fixation to achieve fracture union. The aim of this study was to assess the clinical and radiological outcomes of OI patients with intracapsular femoral neck fracture treated with headless compression screws. METHOD AND RESULTS At our institute, we identified seven patients (11 hips) with OI who underwent internal fixation with headless compression screws for a neck of femur fracture between June 2010 and Dec 2012. The time to fractures healing was on average 14 weeks (12 to 16). All patients gained their pre-injury ambulatory status. CONCLUSION It is very challenging and technically demanding for orthopaedic surgeons when treating the fragility fracture of the neck of femur in patients with intramedullary rod in the femoral shaft. The published data regarding the management of these complex conditions are very limited. We describe our experience with the technique of percutaneous headless compression screw fixation for treating the femoral neck fractures in OI patients.
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Affiliation(s)
- M. C. Papanna
- Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, S5 7AU, UK,Correspondence should be sent to: Mr M.C. Papanna, Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, S5 7AU, UK. E-mail:
| | - S. Tafazal
- Department of Trauma and Orthopaedics, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK
| | - M. J. Bell
- Department of Trauma and Orthopaedics, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK
| | - S. N. Giles
- Department of Trauma and Orthopaedics, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK
| | - J. A. Fernandes
- Department of Trauma and Orthopaedics, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK
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Ward LM, Kinnett K, Bonewald L. Proceedings of a Parent Project Muscular Dystrophy Bone Health Workshop: Morbidity due to osteoporosis in DMD: The Path Forward May 12-13, 2016, Bethesda, Maryland, USA. Neuromuscul Disord 2017; 28:64-76. [PMID: 28756052 DOI: 10.1016/j.nmd.2017.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Middletown, OH, USA
| | - Lynda Bonewald
- Indiana Center for Musculoskeletal Health, Departments of Anatomy and Cell Biology and Orthopaedic Surgery, Indiana University, Indianapolis, IN, USA
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25
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Ma J, McMillan HJ, Karagüzel G, Goodin C, Wasson J, Matzinger MA, DesClouds P, Cram D, Page M, Konji VN, Lentle B, Ward LM. The time to and determinants of first fractures in boys with Duchenne muscular dystrophy. Osteoporos Int 2017; 28:597-608. [PMID: 27774565 DOI: 10.1007/s00198-016-3774-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Boys with vertebral fractures (VF) identified through routine spine radiographs had milder, less symptomatic, and fewer VF compared to those diagnosed with VF following consultation for back pain. Spontaneous (i.e., medication-unassisted) reshaping of fractured vertebral bodies was absent. Long bone fractures were present even before Duchenne muscular dystrophy (DMD) diagnosis in some boys. INTRODUCTION The objective of the study was to determine the time to and characteristics of first fractures in Duchenne muscular dystrophy. METHODS This study was a retrospective longitudinal study of 30 boys with DMD <18 years. Boys were classified into four groups according to their first fracture: those with VF identified on routine lateral spine radiographs, those with VF diagnosed following consultation for back pain, those with long bone fractures, and those without fractures. RESULTS Compared to boys diagnosed with VF as their initial fracture following consultation for back pain, those with VF surveillance radiographs had shorter durations of glucocorticoid (GC) therapy at the time of VF diagnosis (median 1.6 versus 5.3 years, p < 0.01), higher areal (mean ± standard deviation -1.4 ± 0.7 versus -3.1 ± 0.8, p = 0.01), and volumetric (-0.3 ± 0.5 versus -2.6 ± 0.8, p < 0.01) lumbar spine bone mineral density Z-scores, as well as fewer VF (median 1.4 versus 5.2 per person, p < 0.01) and a lower median spinal deformity index (median 1.5 versus 9.5, p < 0.01). Vertebral body reshaping following VF was not observed. Ten boys sustained a long bone fracture as their first fracture at a mean age of 8.9 ± 4.0 years; four of these boys later sustained a total of 27 incident VF. CONCLUSIONS Routine lateral spine radiographs led to detection of VF in their earlier stages, vertebral body reshaping following VF was absent, and VF were frequent after the first long bone fracture. These results support the inclusion of a lateral spine radiograph starting at the time of GC initiation as part of routine bone health monitoring in DMD.
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Affiliation(s)
- J Ma
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - H J McMillan
- Department of Pediatrics, and Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - G Karagüzel
- Department of Pediatric Endocrinology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - C Goodin
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - J Wasson
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M A Matzinger
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - P DesClouds
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - D Cram
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Page
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - V N Konji
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - B Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - L M Ward
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- Department of Pediatrics, and Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
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Hoyer-Kuhn H, Bartz-Seel J, Blickheuser R, v. Deimling U, Stücker R, Wirth T, Wolf J, Wollinsky KH, Semler O. Diagnostik und Therapie der Osteogenesis imperfecta. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0189-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Osteogenesis imperfecta is caused by a genetic defect resulting in an abnormal type I collagen bone matrix which typically results in multiple fractures with little or no trauma. Bisphosphonates are used in an attempt to increase bone mineral density and reduce these fractures in people with osteogenesis imperfecta. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the effectiveness and safety of bisphosphonates in increasing bone mineral density, reducing fractures and improving clinical function in people with osteogenesis imperfecta. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Inborn Errors of Metabolism Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of journals and conference proceedings. We additionally searched PubMed and major conference proceedings.Date of the most recent search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Register: 28 April 2016. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing bisphosphonates to placebo, no treatment, or comparator interventions in all types of osteogenesis imperfecta. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias of the included trials. MAIN RESULTS Fourteen trials (819 participants) were included. Overall, the trials were mainly at a low risk of bias, although selective reporting was an issue in several of the trials. Data for oral bisphosphonates versus placebo could not be aggregated; a statistically significant difference favouring oral bisphosphonates in fracture risk reduction and number of fractures was noted in two trials. No differences were reported in the remaining three trials which commented on fracture incidence. Five trials reported data for spine bone mineral density; all found statistically significant increased lumbar spine density z scores for at least one time point studied. For intravenous bisphosphonates versus placebo, aggregated data from two trials showed no statistically significant difference for the number of participants with at least one fracture, risk ratio 0.56 (95% confidence interval 0.30 to 1.06). In the remaining trial no statistically significant difference was noted in fracture incidence. For spine bone mineral density, no statistically significant difference was noted in the aggregated data from two trials, mean difference 9.96 (95% confidence interval -2.51 to 22.43). In the remaining trial a statistically significant difference in mean per cent change in spine bone mineral density z score favoured intravenous bisphosphonates at six and 12 months. Data describing growth, bone pain, and functional outcomes after oral or intravenous bisphosphonate therapy, or both, as compared to placebo were incomplete among all studies, but do not show consistent improvements in these outcomes. Two studies compared different doses of bisphosphonates. No differences were found between doses when bone mineral density, fractures, and height or length z score were assessed. One trial compared oral versus intravenous bisphosphonates and found no differences in primary outcomes. Two studies compared the intravenous bisphosphonates zoledronic acid and pamidronate. There were no significant differences in primary outcome. However, the studies were at odds as to the relative benefit of zoledronic acid over pamidronate for lumbosacral bone mineral density at 12 months. AUTHORS' CONCLUSIONS Bisphophonates are commonly prescribed to individuals with osteogenesis imperfecta. Current evidence, albeit limited, demonstrates oral or intravenous bisphosphonates increase bone mineral density in children and adults with this condition. These were not shown to be different in their ability to increase bone mineral density. It is unclear whether oral or intravenous bisphosphonate treatment consistently decreases fractures, though multiple studies report this independently and no studies report an increased fracture rate with treatment. The studies included here do not show bisphosphonates conclusively improve clinical status (reduce pain; improve growth and functional mobility) in people with osteogenesis imperfecta. Given their current widespread and expected continued use, the optimal method, duration of therapy and long-term safety of bisphosphonate therapy require further investigation. In addition, attention should be given to long-term fracture reduction and improvement in quality of life indicators.
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Affiliation(s)
- Kerry Dwan
- Cochrane Central ExecutiveSt Albans House, 57‐59 HaymarketLondonEnglandUKSW1Y 4QX
| | - Carrie A Phillipi
- Oregon Health & Science UniversityPediatrics Department707 SW Gaines StreetPortlandOregonUSA97239‐2901
| | - Robert D Steiner
- Marshfield Clinic Research Foundation1000 N. OakMarshfieldWisconsinUSA54449
- Doernbecher Children's Hospital, Oregon Health & Science UniversityDepartments of Pediatrics and Molecular and Medical Genetics, Institute on Development and DisabilityPortlandOregonUSA
| | - Donald Basel
- Division of Genetics. MC#716Department of Pediatrics9000W Wisconsin AvenueMilwaukeeWisconsinUSAWI 53226
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Abstract
This article reviews the manifestations and risk factors associated with osteoporosis in childhood, the definition of osteoporosis and recommendations for monitoring and prevention. As well, this article discusses when a child should be considered a candidate for osteoporosis therapy, which agents should be prescribed, duration of therapy and side effects. There has been significant progress in our understanding of risk factors and the natural history of osteoporosis in children over the past number of years. This knowledge has fostered the development of logical approaches to the diagnosis, monitoring, and optimal timing of osteoporosis intervention in this setting. Current management strategies are predicated upon monitoring at-risk children to identify and then treat earlier rather than later signs of osteoporosis in those with limited potential for spontaneous recovery. On the other hand, trials addressing the prevention of the first-ever fracture are still needed for children who have both a high likelihood of developing fractures and less potential for recovery. This review focuses on the evidence that shapes the current approach to diagnosis, monitoring, and treatment of osteoporosis in childhood, with emphasis on the key pediatric-specific biological principles that are pivotal to the overall approach and on the main questions with which clinicians struggle on a daily basis. The scope of this article is to review the manifestations of and risk factors for primary and secondary osteoporosis in children, to discuss the definition of pediatric osteoporosis, and to summarize recommendations for monitoring and prevention of bone fragility. As well, this article reviews when a child is a candidate for osteoporosis therapy, which agents and doses should be prescribed, the duration of therapy, how the response to therapy is adjudicated, and the short- and long-term side effects. With this information, the bone health clinician will be poised to diagnose osteoporosis in children and to identify when children need osteoporosis therapy and the clinical outcomes that gauge efficacy and safety of treatment.
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Affiliation(s)
- L M Ward
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada.
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
| | - V N Konji
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
| | - J Ma
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Rijks EBG, Bongers BC, Vlemmix MJG, Boot AM, van Dijk ATH, Sakkers RJB, van Brussel M. Efficacy and Safety of Bisphosphonate Therapy in Children with Osteogenesis Imperfecta: A Systematic Review. Horm Res Paediatr 2016; 84:26-42. [PMID: 26021524 DOI: 10.1159/000381713] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To systematically assess contemporary knowledge regarding the effectiveness and safety of bisphosphonates (BPs) in children with osteogenesis imperfecta (OI). METHODS PubMed/MEDLINE, Embase, and Cochrane were searched for eligible articles up to June 2014. Studies eligible for inclusion were (randomized) controlled trials assessing the effects of BPs in children with OI. Methodological quality was assessed independently by 4 reviewers using the Cochrane Collaboration's tool for risk of bias. RESULTS Ten studies (519 children) were included. Four studies (40%) showed a low risk of bias. All studies investigating lumbar spine areal bone mineral density indicated a significant increase as a result of BP treatment. Most studies observed a significant decrease in fracture incidence. The most frequently reported adverse events were gastrointestinal complaints, fever, and muscle soreness. A significant decrease in (bone) pain due to BP treatment was observed in more than half of the studies. Most studies measuring urinary markers of bone resorption reported a significant decrease. The majority of studies with intravenous treatment showed a significant increase in lumbar projection area, whereas studies with oral treatment did not. CONCLUSIONS Treatment with oral or intravenous BPs in children with OI results in an increase in bone mineral density and seems to be safe and well tolerated.
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Affiliation(s)
- Ester B G Rijks
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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30
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[Osteogenesis imperfecta]. DER ORTHOPADE 2014; 43:764-71. [PMID: 25116245 DOI: 10.1007/s00132-013-2229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is the most common genetic disease of bone and is characterized by fragile bones and growth disorders of varying severity. Most cases of OI are inherited autosomal dominant and caused by a mutation in the collagen type I gene. DIAGNOSTICS Indications for OI are bone fragility, stunted growth, scoliosis, skull deformities, blue sclera, loss of hearing, dentinogenesis imperfecta and increased laxity of ligaments and skin. In most cases it is possible to make a clinical diagnosis but a skin biopsy or genetic testing can be useful; however, negative results for these tests do not exclude OI. THERAPY Therapy must be carried out in a multidisciplinary team and includes conservative (e.g. physiotherapy, rehabilitation programs and orthopedic aids), operative (e.g. intramedullary stabilization procedures) and pharmaceutical (e.g. biphosphonates and growth hormones) procedures. PROGNOSIS The prognosis depends on the type of OI and ranges from normal life expectations for type 1 patients up to up to perinatal mortality for type II patients.
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Cyclic pamidronate infusion for neonatal-onset osteogenesis imperfecta. Pediatr Neonatol 2014; 55:306-11. [PMID: 24486247 DOI: 10.1016/j.pedneo.2013.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/09/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients with severe osteogenesis imperfecta (OI; MIM number 259420) suffer from low bone mass, fractures, and bone pain since birth, and have poor prognosis. This study assessed the outcome of patients with severe OI who were treated with cyclic pamidronate prior to the age of 1 year. METHODS The six patients, who had bone fractures either in utero or in their 1st month of life, were treated with cyclic pamidronate from a mean age of 2.8 months. RESULTS All the patients tolerated the infusion, except for having transient hypocalcemia at the first infusion. Decreases in irritability and improvements in feeding were observed 2-3 months after the first infusion. All patients showed a rapid increase in bone mineral density over the first 2 years. Fractures occurred at a rate of 0.6/year. At a mean age of 6.4 years, five patients with no interruption in treatment had normal ambulatory function, but they were short in height. CONCLUSION Patients with neonatal OI can have a favorable outcome when treated with cyclic pamidronate infusions early in life.
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Abstract
BACKGROUND Osteogenesis imperfecta is caused by a genetic defect resulting in an abnormal type I collagen bone matrix which typically results in multiple fractures with little or no trauma. Bisphosphonates are used in an attempt to increase bone mineral density and reduce these fractures in people with osteogenesis imperfecta. OBJECTIVES To assess the effectiveness and safety of bisphosphonates in increasing bone mineral density, reducing fractures and improving clinical function in people with osteogenesis imperfecta. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Inborn Errors of Metabolism Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of journals and conference proceedings. We additionally searched PubMed and major conference proceedings.Date of the most recent search: 07 April 2014. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing bisphosphonates to placebo, no treatment, or comparator interventions in all types of osteogenesis imperfecta. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias of the included trials. MAIN RESULTS Fourteen trials (819 participants) were included. Overall, the trials were mainly at a low risk of bias, although selective reporting was an issue in several of the trials. Data for oral bisphosphonates versus placebo could not be aggregated; a statistically significant difference favouring oral bisphosphonates in fracture risk reduction and number of fractures was noted in two trials. No differences were reported in the remaining three trials which commented on fracture incidence. Five trials reported data for spine bone mineral density; all found statistically significant increased lumbar spine density z scores for at least one time point studied. For intravenous bisphosphonates versus placebo, aggregated data from two trials showed no statistically significant difference for the number of participants with at least one fracture, risk ratio 0.56 (95% confidence interval 0.30 to 1.06). In the remaining trial no statistically significant difference was noted in fracture incidence. For spine bone mineral density, no statistically significant difference was noted in the aggregated data from two trials, mean difference 9.96 (95% confidence interval -2.51 to 22.43). In the remaining trial a statistically significant difference in mean per cent change in spine bone mineral density z score favoured intravenous bisphosphonates at six and 12 months. Data describing growth, bone pain, and functional outcomes after oral or intravenous bisphosphonate therapy, or both, as compared to placebo were incomplete among all studies, but do not show consistent improvements in these outcomes. Two studies compared different doses of bisphosphonates. No differences were found between doses when bone mineral density, fractures, and height or length z score were assessed. One study compared oral versus intravenous bisphosphonates and found no differences in primary outcomes. Two studies compared the intravenous bisphosphonates zoledronic acid and pamidronate. There were no significant differences in primary outcome. However, the studies were at odds as to the relative benefit of zoledronic acid over pamidronate for lumbosacral bone mineral density at 12 months. AUTHORS' CONCLUSIONS Bisphophonates are commonly prescribed to individuals with osteogenesis imperfecta. Current evidence, albeit limited, demonstrates oral or intravenous bisphosphonates increase bone mineral density in children and adults with this condition. These were not shown to be different in their ability to increase bone mineral density. It is unclear whether oral or intravenous bisphosphonate treatment consistently decreases fractures, though multiple studies report this independently and no studies report an increased fracture rate with treatment. The studies included here do not show bisphosphonates conclusively improve clinical status (reduce pain; improve growth and functional mobility) in people with osteogenesis imperfecta. Given their current widespread and expected continued use, the optimal method, duration of therapy and long-term safety of bisphosphonate therapy require further investigation. In addition, attention should be given to long-term fracture reduction and improvement in quality of life indicators.
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Affiliation(s)
- Kerry Dwan
- Department of Biostatistics, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, England, UK, L12 2AP
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Hoyer-Kuhn H, Semler O, Garbes L, Zimmermann K, Becker J, Wollnik B, Schoenau E, Netzer C. A nonclassical IFITM5 mutation located in the coding region causes severe osteogenesis imperfecta with prenatal onset. J Bone Miner Res 2014; 29:1387-91. [PMID: 24293101 DOI: 10.1002/jbmr.2156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/24/2013] [Accepted: 11/27/2013] [Indexed: 11/08/2022]
Abstract
Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by a wide range of skeletal symptoms. Most patients have dominantly inherited or de novo mutations in COL1A1 or COL1A2. Up to 5% of patients have OI type V, characterized by hyperplastic callus formation after fractures, calcification of the interosseous membrane of the forearm, and a mesh-like lamellation pattern observed in bone histology. Recently, a heterozygous mutation in the 5'-untranslated region (UTR) of IFITM5 (c.-14C > T) was identified as the underlying cause of OI type V, and only this specific mutation was subsequently identified in all patient cohorts with this OI subtype. We now present a case of a heterozygous mutation within the coding region of IFITM5 (c.119C > T; p.S40L). The mutation occurred de novo in the patient and resulted in severe OI with prenatal onset and extreme short stature. At the age of 19 months, the typical clinical hallmarks of OI type V were not present. Our finding has important consequences for the genetic "work-up" of patients suspected to have OI, both in prenatal and in postnatal settings: The entire gene-not only the 5'-UTR harboring the "classical" OI type V mutation-has to be analyzed to exclude a causal role of IFITM5. We propose that this should be part of the initial diagnostic steps for genetic laboratories performing SANGER sequencing in OI patients.
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Escribano Rey R, Duart-Clemente J, Martínez de la Llana O, Beguiristáin Gúrpide J. Osteogenesis imperfecta: Treatment and results of a case series. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Escribano-Rey RJ, Duart-Clemente J, Martínez de la Llana O, Beguiristáin-Gúrpide JL. [Osteogenesis imperfecta: Treatment and results of a case series]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:114-9. [PMID: 24438858 DOI: 10.1016/j.recot.2013.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 11/07/2013] [Accepted: 11/10/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To describe our experience in the management of patients with osteogenesis imperfect (OI). MATERIAL AND METHODS We conducted a retrospective study of a series of cases affected with OI treated in the Clínica Univesidad de Navarra from 1980 to 2007, with a mean follow up of 17.3 years (7-27 years). We collected descriptive data of the sample, the fractures and the deformities, and the treatments given. The complications presented and the functional outcomes at the end of follow-up were also reviewed. RESULTS The sample included ten patients. Approximately two-thirds (65%) of fractures were sustained in the lower limbs. One patient received medical treatment only. Three patients had combined medical and surgical treatment. Some type of surgical treatment was performed on 6 patients. The most common surgery was the Sofield-Millar performed on 37 occasions, with a third of them requiring revision surgery due to migration of the nails. There were 17 episodes of re-fracture. Complications such as non-union, iatrogenic fractures, and infections, were also observed. The functional outcome, according to the Hoffer-Bullock scale, at the end of follow-up was grade I/II in 7 patients. CONCLUSIONS Despite the need for multiple interventions and complications presented during follow up, the appropriate treatment of patients with OI can provide acceptable functional outcomes.
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Affiliation(s)
- R J Escribano-Rey
- Departamento de Cirugía Ortopédica y Traumatología, Clínica San Miguel, Pamplona, Navarra, España
| | - J Duart-Clemente
- Departamento de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - O Martínez de la Llana
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Cruces, Barakaldo, Vizcaya, España
| | - J L Beguiristáin-Gúrpide
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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36
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Hennedige AA, Jayasinghe J, Khajeh J, Macfarlane TV. Systematic review on the incidence of bisphosphonate related osteonecrosis of the jaw in children diagnosed with osteogenesis imperfecta. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 4:e1. [PMID: 24478911 PMCID: PMC3904727 DOI: 10.5037/jomr.2013.4401] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/16/2013] [Indexed: 11/30/2022]
Abstract
Objectives To conduct a systematic review of epidemiological
literature to determine the incidence of bisphosphonate related osteonecrosis of
the jaw occurring either spontaneously or after dental surgery, in children and
adolescents diagnosed with osteogenesis imperfecta. Material and Methods MEDLINE, HMIC and EMBASE were used to search for English-language
articles published from 1946 - 2013. Inclusion criteria consisted of population
based studies of children and adolescents (24 years and younger) diagnosed with
osteogenesis imperfecta, only studies which included a dental examination, and patients
treated with intravenous bisphosphonates were included. Articles were excluded if
patients had any other co-morbidity which could affect osteonecrosis of the jaw,
and those which treated patients with oral bisphosphonates only. Results Five studies consisting of four retrospective cohort
studies and one case series were identified. Study populations ranged from 15 to
278 patients and number of subjects with osteogenesis imperfecta ranged from 15
to 221. Mean duration of intravenous bisphosphonate use ranged from 4.5 to 6.8 years.
All patients were clinically examined and no patients were found to have osteonecrosis
of the jaw. Conclusions There is no evidence to support hypothesis of causal
relationship between bisphosphonates and osteonecrosis of the jaw in children and
adolescents with osteogenesis imperfecta. More prospective studies on bisphosphonate
use in osteogenesis imperfecta needs to be carried out.
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Affiliation(s)
- Anusha Adeline Hennedige
- University of Aberdeen Dental School Aberdeen United Kingdom. ; Aberdeen Royal Infirmary, Oral and Maxillofacial Department United Kingdom
| | - Jap Jayasinghe
- University of Aberdeen Dental School Aberdeen United Kingdom
| | - Janette Khajeh
- University of Aberdeen Dental School Aberdeen United Kingdom
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Gatti D, Rossini M, Viapiana O, Povino MR, Liuzza S, Fracassi E, Idolazzi L, Adami S. Teriparatide treatment in adult patients with osteogenesis imperfecta type I. Calcif Tissue Int 2013; 93:448-52. [PMID: 23907723 DOI: 10.1007/s00223-013-9770-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/12/2013] [Indexed: 12/17/2022]
Abstract
Osteogenesis imperfecta (OI) is a hereditary disease characterized by low bone mass, increased bone fragility, short stature, and skeletal deformities. This study focuses on OI type I, the mildest form of the disease. Bisphosphonates represent the prevailing standard of care in patients with OI. Teriparatide (TPD) is a PTH analog with bone-anabolic actions which has been approved for osteoporosis treatment. Thirteen postmenopausal women with type I OI who had been on treatment with neridronate for at least 2 years and who incurred new vertebral fracture during treatment were treated with TPD for 18 months. Bone mineral density (BMD) increased significantly over 18 months up to 3.5 % at the lumbar spine (p = 0.001), while no significant changes were noted in hip BMD. Serum markers of bone formation and of bone resorption increased significantly during the treatment. The Wnt inhibitors serum dickkopf-1 (DKK1) and sclerostin were also measured. A nonsignificant increase was seen in serum sclerostin levels, while serum DKK1 rose gradually and significantly during TPD treatment. In patients affected by type I OI, TPD treatment is associated with a remarkable response in markers of bone formation. This suggests a normal osteoblastic response to TPD. However, the observed increases in BMD were somewhat lower than those in postmenopausal or senile osteoporosis treated with TPD for the same lag time. Our results open the possibility to develop TPD for the treatment of adult type I OI, but particularly for the lack of a control group, a properly designed controlled study is warranted.
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Affiliation(s)
- Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy,
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Abstract
The long-established study of osteogenesis imperfecta (OI) has opened a realm of scientific research surrounding connective tissue disorders. Over the past decade alone there have been vast advancements in the understanding of the underlying genetic variations of this disease, pharmacologic treatments, and the technological and surgical options for fracture deformity. It is important to appreciate the progressive nature of the advances concerning OI. This article aims to synthesize the expanding evolution of the field surrounding OI over the past decade.
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Affiliation(s)
- Dominique Laron
- Department of Orthopedic Surgery, University of California San Francisco, Children's Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA
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Gatti D, Rossini M, Viapiana O, Idolazzi L, Adami S. Clinical development of neridronate: potential for new applications. Ther Clin Risk Manag 2013; 9:139-47. [PMID: 23589692 PMCID: PMC3622395 DOI: 10.2147/tcrm.s35788] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Neridronate is an aminobisphosphonate, licensed in Italy for the treatment of osteogenesis imperfecta (OI) and Paget's disease of bone (PDB). A characteristic property of neridronate is that it can be administered both intravenously and intramuscularly, providing a useful system for administration in homecare. In this review, we discuss the latest clinical results of neridronate administration in OI and PDB, as well as in osteoporosis and other conditions. We will focus in particular on the latest evidence of the effect of neridronate on treatment of complex regional pain syndrome type I.
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Affiliation(s)
- Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
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40
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Abstract
The classic Sillence classification of the four types of osteogenesis imperfecta (OI) has been extended by six additional forms in recent years. OI is a heterogeneous disease, which can exhibit a mild, moderate and severe clinical picture. The clinical variability is expressed by a different frequency of fracture incidences and bone deformity risks so that both factors lead to very different degrees of mobility and autonomy of patients. The treatment principles comprise long standing medication of bisphosphonates, rehabilitation measures and orthopedic treatment. The orthopedic treatment uses modern techniques of conservative and operative fracture management for fracture stabilization and modern telescopic rods for deformity correction. These combined treatment modalities have given an improved quality of life to OI patients of all severity grades.
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Rohrbach M, Giunta C. Recessive osteogenesis imperfecta: clinical, radiological, and molecular findings. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2012; 160C:175-89. [PMID: 22791419 DOI: 10.1002/ajmg.c.31334] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Osteogenesis imperfecta (OI) or "brittle bone disease" is currently best described as a group of hereditary connective tissue disorders related to primary defects in type I procollagen, and to alterations in type I procollagen biosynthesis, both associated with osteoporosis and increased susceptibility to bone fractures. Initially, the autosomal dominant forms of OI, caused by mutations in either COL1A1 or COL1A2, were described. However, for decades, the molecular defect of a small percentage of patients clinically diagnosed with OI has remained elusive. It has been in the last 6 years that the genetic causes of several forms of OI with autosomal recessive inheritance have been characterized. These comprise defects of collagen chaperones, and proteins involved in type I procollagen assembly, processing and maturation, as well as proteins involved in the formation and homeostasis of bone tissue. This article reviews the recently characterized forms of recessive OI, focusing in particular on their clinical and molecular findings, and on their radiological characterisation. Clinical management and treatment of OI in general will be discussed, too.
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Affiliation(s)
- Marianne Rohrbach
- Connective Tissue Unit, Division of Metabolism, University Children's Hospital and Children's Research Center, Zurich, Switzerland
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42
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Maines E, Monti E, Doro F, Morandi G, Cavarzere P, Antoniazzi F. Children and adolescents treated with neridronate for osteogenesis imperfecta show no evidence of any osteonecrosis of the jaw. J Bone Miner Metab 2012; 30:434-8. [PMID: 22065238 DOI: 10.1007/s00774-011-0331-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 10/12/2011] [Indexed: 11/25/2022]
Abstract
Over recent years, several reports have been published on unusual cases of osteonecrosis of the jaw (ONJ) in adults using second- and third-generation nitrogen-containing bisphosphonates such as pamidronate, alendronate, risedronate and zoledronate, but no case has ever been reported either in children or in adult patients taking neridronate. Children and adolescents affected by osteogenesis imperfecta (OI) could belong to a high-risk group for ONJ because bone fragility in OI is associated with a connective tissue malfunction. The purpose of this study is to evaluate the incidence of ONJ in a pediatric population treated with neridronate for OI. A total of 102 pediatric patients with OI who received neridronate infusions for a mean of 6.81 years (SD ± 3.06 years) were clinically assessed for possible ONJ. Eligibility criteria for participation included patients between 1.2 and 24 years old who received cyclical neridronate infusions for at least 1 year. All the patients were reviewed to determine duration, dosage and cumulative dose of their bisphosphonate therapy and were examined clinically to assess their oral health status. We have not demonstrated any occurrence of ONJ in our patients. In conclusion, at the moment insufficient data are available to prove a greater risk of ONJ in children with OI than in children affected by other forms of bone fragility. However, cases may emerge in future because the risk of ONJ seems to be related to the cumulative dose and the duration of therapy.
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Affiliation(s)
- Evelina Maines
- Department of Life Sciences and Reproduction Sciences, Pediatric Clinic, University of Verona, General Hospital Giambattista Rossi, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy.
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Abstract
Osteogenesis imperfecta (OI), a rare clinical disease with abnormal type I collagen, is inherited or caused by mutation. A classification of OI into four types was proposed in 1979 and has been used up until four new types were added recently. A tough clinical challenge, OI causes abnormal blood coagulation and cardiovascular structure, airways obstruction, and delayed wound healing. The authors of the current article have reviewed recent progress in OI worldwide, including the mechanisms, classification, detection, clinical difficulties, and treatment.
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Affiliation(s)
- Xiang Zhao
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Nicolaou N, Agrawal Y, Padman M, Fernandes JA, Bell MJ. Changing pattern of femoral fractures in osteogenesis imperfecta with prolonged use of bisphosphonates. J Child Orthop 2012; 6:21-7. [PMID: 23450103 PMCID: PMC3303010 DOI: 10.1007/s11832-011-0380-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 12/30/2011] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Osteogenesis imperfecta (OI) has been treated with bisphosphonates for many years, with some clear clinical benefits. In adults, there are reports of a new pattern of atraumatic subtrochanteric fractures with bisphosphonate treatment. This study assesses if bisphosphonate treatment leads to an altered pattern of femoral fractures. METHODS Retrospective review of imaging for a cohort of 176 bisphosphonate-treated OI patients to identify the locations of femoral fractures over a two-year period, as compared to a historical control group managed pre-bisphosphonates. RESULTS Sixteen femoral fractures were identified in this time period in the bisphosphonate-treated group. All but two were within the subtrochanteric region. In comparison, the historical group-composed of 26 femoral fractures-had a more widespread fracture pattern, with the most frequent location being the mid-diaphysis. Many of the subtrochanteric fractures in the treatment group occurred with minimal trauma. CONCLUSIONS It appears that concerns over the treatment of the adult osteoporotic population with bisphosphonates are amplified and mirrored in OI. It is possible that the high bending moments in the proximal femur together with altered mechanical properties of cortical bone secondary to the use of this group of drugs increase the risk of this type of injury, which warrants further modification of surgical management of the femur.
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Affiliation(s)
- N. Nicolaou
- Department of Orthopaedics, Sheffield Children’s Hospital, Western Bank, Sheffield, South Yorkshire UK
| | - Y. Agrawal
- Department of Orthopaedics, Sheffield Children’s Hospital, Western Bank, Sheffield, South Yorkshire UK
| | - M. Padman
- Department of Orthopaedics, Sheffield Children’s Hospital, Western Bank, Sheffield, South Yorkshire UK
| | - J. A. Fernandes
- Department of Orthopaedics, Sheffield Children’s Hospital, Western Bank, Sheffield, South Yorkshire UK
| | - M. J. Bell
- Department of Orthopaedics, Sheffield Children’s Hospital, Western Bank, Sheffield, South Yorkshire UK
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Short-term effects of zoledronate on the histomorphology of osteoclast in young albino rats. Ann Anat 2011; 193:509-15. [PMID: 21530208 DOI: 10.1016/j.aanat.2011.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 03/19/2011] [Accepted: 03/20/2011] [Indexed: 11/22/2022]
Abstract
The present study was conducted to histomorphometrically evaluate the effects of short-term administration of zoledronate, a third generation bisphosphonate, on the metaphysis of the proximal end of tibia in twenty day old male albino rats. Zoledronate (2.8 μg/kg body weight), was daily given subcutaneously for eleven days. The animals were sacrificed; tibiae were dissected out and decalcified in EDTA. Seven micron thick, serial longitudinal paraffin sections were stained with haematoxylin and eosin and examined under a Zeiss light microscope and Image Pro-Express Analyzer. In zoledronate treated rats, a significant increase (p<0.05) in the number of osteoclasts was observed both in the regions of primary spongiosa (zoledronate treated: 6.41 ± 0.30/mm(2), control: 2.90 ± 0.28/mm(2)) and secondary spongiosa (zoledronate treated: 49.58 ± 0.84/mm(2), control: 31.81 ± 2.02/mm(2)) along with a significant increase (p<0.05) in the length of the metaphyseal region as compared to the control group. The number of nuclei per osteoclast and area of the osteoclast also showed a significant increase (p<0.001; p<0.05 respectively) following the uptake of zoledronate. The findings in the present study, suggest that the osteoclasts are the primary sites of action of zoledronate resulting in decreased osteoclastic activity, which would account for the great increase in the number and size of inactive osteoclasts resulting in marked cancellous bone formation.
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Engel Espinosa W, Arrázola Cabrera B, Peralta Rodríguez P, Fernández Izquierdo MC, García Molina C, Ortigosa Solórzano E. [Anesthetic treatment of patients with osteogenesis imperfecta]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:151-155. [PMID: 21534289 DOI: 10.1016/s0034-9356(11)70022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients' quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. PATIENTS AND METHODS Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. RESULTS From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. CONCLUSIONS The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease.
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Affiliation(s)
- W Engel Espinosa
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Getafe, Madrid
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Abstract
Osteogenesis imperfecta is characterised by bone fragility leading to fracture and bone deformity, chronic bone pain and reduced mobility. Presentation in infancy may be anticipated through shortened or bowed femurs on antenatal ultrasound scanning, or because of family history. Other conditions can present in the neonatal period with osteoporosis and fractures, but clinical features should allow differentiation. Management is multidisciplinary, with the mainstay of medical intervention being the use of bisphosphonates. Intervention with these medications, in association with specialised nursing, physio- and occupational therapy input, has reduced fracture frequency by up to 50% in published series, and has shown significant effects on vertebral morphometry when started early (around 6 weeks age). Outcomes in older children are encouraging with a reduction in fracture frequency of up to 50%; however, the longer term effects of early intervention remain to be determined. In particular the effects on life-limiting structural outcomes such as scoliosis and basilar invagination remain unclear.
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Affiliation(s)
- Nick Bishop
- Department of Human Metabolism, University of Sheffield, Sheffield Children's Hospital, Western Bank, UK.
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Monti E, Mottes M, Fraschini P, Brunelli P, Forlino A, Venturi G, Doro F, Perlini S, Cavarzere P, Antoniazzi F. Current and emerging treatments for the management of osteogenesis imperfecta. Ther Clin Risk Manag 2010; 6:367-81. [PMID: 20856683 PMCID: PMC2940745 DOI: 10.2147/tcrm.s5932] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Indexed: 11/23/2022] Open
Abstract
Osteogenesis imperfecta (OI) is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II), in which the problem is survival at birth; the severe and moderate forms (types III-IX), in which the objective is 'autonomy'; and the mild form (type I), in which the aim is to reach 'normal life'. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting), surgical management (intramedullary rod positioning, spinal and basilar impression surgery) and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI). Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment.
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Affiliation(s)
- Elena Monti
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Monica Mottes
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Paolo Fraschini
- Istituto Di Ricovero e Cura a Carattere Scientifico, ‘E. Medea’, Associazione La Nostra Famiglia, Bosisio Parini (LC), Italy
| | | | - Antonella Forlino
- Department of Biochemistry “A. Castellani”, University of Pavia, Italy
| | - Giacomo Venturi
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Francesco Doro
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Silvia Perlini
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
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Antoniazzi F, Monti E, Venturi G, Franceschi R, Doro F, Gatti D, Zamboni G, Tatò L. GH in combination with bisphosphonate treatment in osteogenesis imperfecta. Eur J Endocrinol 2010; 163:479-87. [PMID: 20592128 DOI: 10.1530/eje-10-0208] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To verify the effects of bisphosphonates (Bps) in combination with recombinant human GH (rGH) in pediatric osteogenesis imperfecta (OI) patients; we focused on possible improvement of bone mineral density (BMD), projected bone areas, growth velocity, and fractures risk. DESIGN A randomized controlled 1-year clinical trial on 30 prepubertal children (M:F=14:16) affected by OI (type I, IV, and III) being treated with neridronate. METHODS Following an observational period of 12 months during ongoing neridronate treatment, the patients were randomly divided into two groups: 15 were treated for 12 months with rGH and neridronate (group Bp+rGH) and 15 continued neridronate alone (group Bp). We evaluated auxological parameters, number of fractures, bone age (BA), bone metabolic parameters, and bone mass measurements (at lumbar spine and radius by dual-energy X-ray absorptiometry). RESULTS The mean variation in percentage of BMD (Delta%BMD)--at lumbar spine (L2-L4), at distal and ultradistal radius--and the projected area of lumbar spine increased significantly in group Bp+rGH (P<0.05). Growth velocity was significantly higher during rGH treatment in group Bp+rGH versus group Bp and versus pretreatment (P<0.05), with no difference in increase in BA or fracture risk rate. Patients with quantitative (-qt) collagen synthesis defects had a higher, although not significant, response to rGH in terms of growth velocity and BMD. CONCLUSIONS In OI patients, the combined rGH-Bp treatment may give better results than Bp treatment alone, in terms of BMD, lumbar spine projected area and growth velocity, particularly in patients with quantitative defects.
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Affiliation(s)
- Franco Antoniazzi
- Department of Mother and Child, Biology and Genetics, Pediatric Clinic, University of Verona, Policlinico Giambattista Rossi, Piazza Ludovico Antonio Scuro, 10, I-37134 Verona, Italy.
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Bisphosphonates in patients with autoimmune rheumatic diseases: Can they be used in women of childbearing age? Autoimmun Rev 2010; 9:547-52. [PMID: 20307690 DOI: 10.1016/j.autrev.2010.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 03/15/2010] [Indexed: 01/13/2023]
Abstract
Autoimmune rheumatic diseases (ARD) are prevalent in women during their childbearing age. For their treatment, high doses of corticosteroid (CS) for long-term periods are often required, increasing the risk of bone loss. According to recent guidelines, bisphosphonates (BP) should be used as first line treatment to prevent CS induced osteoporosis. However, due to their long-term release from bone and their ability to cross the placenta, it has been suggested to avoid BP in women during their fertile years. BP seem to decrease foetus bone length in pregnant animals, but not in humans, at least, when they are administered at therapeutic dosage. BP are embryo toxic in animals when used at high dosage. In a systematic literature review, we found 58 women treated with BP close before or during pregnancy, showing no related congenital malformations. However, the Unit of Clinical and Epidemiological Genetics in University of Padova collected ten cases of women treated with BP during pregnancy, reporting 20% of congenital malformations. Thus, we suggest to avoid BP during pregnancy and caution with their use in fertile women. When they have to be given before pregnancy, specific affinities of the BP have to be considered to plan the washout period beforehand.
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