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Rodríguez-Olleros Rodríguez C, Blanes Jacquart D, Arboiro Pinel R, de la Piedra Gordo C, Moro Álvarez MJ, Díaz Curiel M. Long term effects on biochemical bone markers of a single infusion of zoledronic acid in Paget disease of bone. J Orthop Sci 2020; 25:715-718. [PMID: 31669119 DOI: 10.1016/j.jos.2019.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 08/03/2019] [Accepted: 08/17/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of the present study is to evaluate long term biochemical response to a single dose of zoledronic acid in patients with Paget disease of bone, as well as evaluating the value of bone turnover markers in diagnosis and follow-up. METHODS This is an observational, descriptive and prospective study. Included patients received a single-dose intravenous infusion of 5 mg zoledronic acid. Bone turnover markers were measured at baseline, and in every follow up visit. RESULTS Thirty-nine patients with a mean follow-up of 56.49 months were included. At the time Paget disease was diagnosed, all of the patients (100%) had high serum procollagen type 1 amino-terminal propeptide values, but not all patients had high serum C-terminal telopeptide and alkaline phosphatase values (85% and 89% respectively). Biochemical response to therapy occurred in 38 out of 39 patients (97%). Two patients had partial response at 6 months but complete response thereafter. Only one patient relapsed (nadir procollagen type 1 amino-terminal propeptide 35.06 μg/l, value at relapse 75.2 μg/l) 4.5 years after treatment. Values of serum C-terminal telopeptide and alkaline phosphatase of this patient were normal despite P1NP relapse. CONCLUSIONS We hence conclude that zoledronic acid is effective in inducing and maintaining biochemical remission and that procollagen type 1 amino-terminal propeptide is a better diagnostic and prognostic marker in PDB when compared to C-terminal telopeptide and alkaline phosphatase.
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Affiliation(s)
- Celia Rodríguez-Olleros Rodríguez
- Internal Medicine, Bone Disease Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
| | - Daniel Blanes Jacquart
- Internal Medicine, Bone Disease Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Rosa Arboiro Pinel
- Internal Medicine, Bone Disease Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Concha de la Piedra Gordo
- Clinical Biochemistry Laboratory, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - María Jesús Moro Álvarez
- Internal Medicine, Hospital Universitario Infanta Leonor, Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Manuel Díaz Curiel
- Internal Medicine, Bone Disease Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
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Nebot E, Heimel P, Tangl S, Dockner M, Patsch J, Weber GW, Pretterklieber M, Teschler-Nicola M, Pietschmann P. Paget's Disease of Long Bones: Microstructural Analyses of Historical Bone Samples. Calcif Tissue Int 2019; 105:15-25. [PMID: 30850857 DOI: 10.1007/s00223-019-00539-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
Although Paget's disease of bone (PDB) is the second most common metabolic bone disease, there is only limited information about the microarchitecture of affected bones. Therefore, the aim of this study was to determine cortical and trabecular bone properties in clinically relevant locations by microcomputed tomography (µCT). Ten femora and ten tibiae affected by Paget's disease taken from the Natural History Museum Vienna were compared to 13 femora and 10 tibiae of non-affected body donors. Digitization of the cortical and trabecular bone microarchitecture was performed with an X-ray-based µCT scanner. Additionally, semi-quantitative gradings of trabecular and cortical architectural parameters of the femora and the tibiae were generated. Microcomputed tomography images showed changes in the thickness of cortices, cortical porosity, and trabecularization of cortical structures. Moreover, severe disorganization of trabecular structures, trabecular defects, and thickening of (remaining) trabeculae were detected. Numerical cortical analyses showed lower total bone volume (BV) and lower BV in the outer region (66-100%) (- 36%, p = 0.004, and - 50%, p < 0.001, respectively), lower total volume (TV) in the outer region (66-100%) (- 42%, p < 0.001), lower total bone volume fraction (BV/TV) and BV/TV in the outer region (66-100%) (- 23%, and - 12%, p < 0.001, respectively), higher BV and TV in the middle region (33-66%) and higher BV/TV in the inner region (0-33%) (123%, p = 0.011, 147%, p = 0.010, and 33%, p = 0.025, respectively) in Pagetic compared to non-affected bones. Trabecular analyses showed higher BV/TV (96%, p = 0.008) and Tb.Th (43%, p = 0.004) in Pagetic compared to non-affected bones. There is a major and consistent structural alteration of PDB at cortical and trabecular sites in weight-bearing long bones. Our findings are relevant for the differential diagnosis of PDB and for the pathogenesis of associated complications, since the disorder produces abnormalities in the structure that might lead to bone fragility.
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Affiliation(s)
- Elena Nebot
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090, Vienna, Austria
- Department of Physiology, School of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
- Department of Preventive Medicine and Public Health, School of Pharmacy, University of Granada, Granada, Spain
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology - Austrian Cluster for Tissue Regeneration, AUVA Research Center, Vienna, Austria
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Martin Dockner
- Department of Anthropology, and Core Facility for Micro-Computed Tomography, University of Vienna, Vienna, Austria
| | - Janina Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gerhard W Weber
- Department of Anthropology, and Core Facility for Micro-Computed Tomography, University of Vienna, Vienna, Austria
| | - Michael Pretterklieber
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Maria Teschler-Nicola
- Pathological-Anatomical Collection in the Fool's Tower, Department of Anthropology, Natural History Museum Vienna, Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090, Vienna, Austria.
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3
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Nebot Valenzuela E, Pietschmann P. Epidemiology and pathology of Paget's disease of bone - a review. Wien Med Wochenschr 2017; 167:2-8. [PMID: 27600564 PMCID: PMC5266784 DOI: 10.1007/s10354-016-0496-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 12/20/2022]
Abstract
Paget's disease of bone (PDB) is a noninflammatory, metabolic, skeletal disorder characterized by localized excessive osteoclastic bone resorption that is followed by compensatory increased osteoblastic activity leading to unstructured, fibroblastic, and biomechanically unstable bone. As a result, there is deformity and enlargement of the bone with a defective and disorganized pattern. Here, we review the epidemiology, etiology, pathology, macrostructure, histology, and quantitative histomorphometry findings of PDB. Hyperosteoclastosis and poor definition of the boundary between cortical and medullary bone are the main histological findings in PDB. Additionally, Pagetic bone is also characterized by hypertrophy and alteration of trabecular parameters.
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Affiliation(s)
- Elena Nebot Valenzuela
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Department of Physiology, School of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain.
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Menéndez-Bueyes LR, Soler Fernández MDC. Paget's Disease of Bone: Approach to Its Historical Origins. ACTA ACUST UNITED AC 2016; 13:66-72. [PMID: 27061664 DOI: 10.1016/j.reuma.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/13/2016] [Accepted: 02/17/2016] [Indexed: 01/24/2023]
Abstract
Paget's disease of bone is the second most common bone disease after osteoporosis. It is characterized by focal regions of highly exaggerated bone remodeling, with abnormalities in all phases of the remodeling process. This study aims to investigate the hypothesis of a possible British origin of Paget's disease of bone by studying the worldwide geographic distribution of cases identified in ancient skeletons excavated from archaeological sites. The methodology consists in reviewing cases of Paget's disease of bone described in the literature.
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Affiliation(s)
- Luis R Menéndez-Bueyes
- Departamento de Prehistoria, Historia Antigua y Arqueología, Universidad de Salamanca, Salamanca, España.
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Gavin CT, Ali SN, Tailly T, Olvera-Posada D, Alenezi H, Power NE, Hou J, St Amant AH, Luyt LG, Wood S, Wu C, Razvi H, Leong HS. Novel Methods of Determining Urinary Calculi Composition: Petrographic Thin Sectioning of Calculi and Nanoscale Flow Cytometry Urinalysis. Sci Rep 2016; 6:19328. [PMID: 26771074 PMCID: PMC4725893 DOI: 10.1038/srep19328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/09/2015] [Indexed: 11/09/2022] Open
Abstract
Accurate determination of urinary stone composition has significant bearing on understanding pathophysiology, choosing treatment modalities and preventing recurrence. A need exists for improved methods to determine stone composition. Urine of 31 patients with known renal calculi was examined with nanoscale flow cytometry and the calculi collected during surgery subsequently underwent petrographic thin sectioning with polarized and fluorescent microscopy. Fluorescently labeled bisphosphonate probes (Alendronate-fluorescein/Alendronate-Cy5) were developed for nanoscale flow cytometry to enumerate nanocrystals that bound the fluorescent probes. Petrographic sections of stones were also imaged by fluorescent and polarized light microscopy with composition analysis correlated to alendronate +ve nanocrystal counts in corresponding urine samples. Urine samples from patients with Ca2+ and Mg2+ based calculi exhibited the highest alendronate +ve nanocrystal counts, ranging from 100–1000 nm in diameter. This novel urine based assay was in agreement with composition determined by petrographic thin sections with Alendronate probes. In some cases, high alendronate +ve nanocrystal counts indicated a Ca2+ or Mg2+ composition, as confirmed by petrographic analysis, overturning initial spectrophotometric diagnosis of stone composition. The combination of nanoscale flow cytometry and petrographic thin sections offer an alternative means for determining stone composition. Nanoscale flow cytometry of alendronate +ve nanocrystals alone may provide a high-throughput means of evaluating stone burden.
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Affiliation(s)
- Carson T Gavin
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | - Sohrab N Ali
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | - Thomas Tailly
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Daniel Olvera-Posada
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Husain Alenezi
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Nicholas E Power
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jinqiang Hou
- Department of Chemistry, Western University, London, Ontario, Canada
| | - Andre H St Amant
- Department of Chemistry, Western University, London, Ontario, Canada
| | - Leonard G Luyt
- Department of Chemistry, Western University, London, Ontario, Canada
| | - Stephen Wood
- Department of Earth Sciences, Western University, London, Ontario, Canada
| | - Charles Wu
- Department of Earth Sciences, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Hon S Leong
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, Ontario, Canada
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6
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Oheim R. [Pathological and metabolic bone diseases: Clinical importance for fracture treatment]. Unfallchirurg 2015; 118:1007-16. [PMID: 26515168 DOI: 10.1007/s00113-015-0094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pathological and metabolic bone diseases are common and relevant occurrences in orthopedics and trauma surgery; however, fractures are often treated as being the illness itself and not seen as the symptom of an underlying bone disease. This is why further diagnostics and systemic treatment options are often insufficiently considered in the routine treatment of fractures. This review focuses on osteoporosis, osteopetrosis, hypophosphatasia and Paget's disease of bone.In patients with osteoporotic vertebral or proximal femur fractures, pharmaceutical treatment to prevent subsequent fractures is an integral part of fracture therapy together with surgical treatment. Osteopetrosis is caused by compromised osteoclastic bone resorption; therefore, even in the face of an elevated bone mass, vitamin D3 supplementation is crucial to avoid clinically relevant hypocalcemia. Unspecific symptoms of the musculoskeletal system, especially together with stress fractures, are typically found in patients suffering from hypophosphatasia. In these patients measurement of alkaline phosphatase shows reduced enzyme activity. Elevated levels of alkaline phosphatase are found in Paget's disease of bone where bisphosphonates are still the treatment of choice.
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Affiliation(s)
- R Oheim
- Klinik für Orthopädie und Unfallchirurgie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Deutschland. .,Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Deutschland.
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Bisfosfonatos intravenosos en la enfermedad ósea de Paget: mayor riesgo de efectos secundarios. Med Clin (Barc) 2014; 142:469-70. [DOI: 10.1016/j.medcli.2013.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/27/2022]
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