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de Molon RS, Fiori LC, Verzola MHA, Belluci MM, de Souza Faloni AP, Pereira RMR, Tetradis S, Orrico SRP. Long-term evaluation of alendronate treatment on the healing of calvaria bone defects in rats. Biochemical, histological and immunohistochemical analyses. Arch Oral Biol 2020; 117:104779. [PMID: 32559508 DOI: 10.1016/j.archoralbio.2020.104779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of the long-term alendronate administration on bone healing in defects created in rat calvarias. MATERIALS AND METHODS Female Wistar rats were randomly distributed into 2 groups: Control (CTL): animals received saline solution once a week; and Alendronate (ALD): rats underwent alendronate treatment (1 mg/kg/weekly). After 120 days from the commencement of treatment, a critical size defect was created in all animals, and 10 animals from each group were sacrificed at 5, 10, 15, 20, 25, 30, 45 and 60-days after the defect creation. On the day of sacrifice, urine and blood samples were collected for determination of the serum levels of bone resorption and formation markers by enzyme linked immunosorbent assay, and the urinary concentration of deoxypyridinoline. Bone mineral density (BMD) in the femurs, descriptive histology, tartrate-resistant acid-phosphatase staining and immunohistochemical analyzes were assessed in the calvaria. RESULTS Alendronate group showed increased BMD compared to the test group. The concentration of C-terminal telopeptide of type I collagen and deoxypyridinoline decreased significantly, and the concentration of aminoterminal propeptide of procollagen type 1 and osteocalcin were significant lower in the alendronate group. Immunohistochemical analysis showed significant downregulation in the inducible nitric oxide synthase, runt-related transcription factor-2, cathepsin-K and receptor activator of nuclear factor kappa-B ligand expression in the alendronate group. Vascular endothelial growth factor and osteopontin were upregulated in the later periods of alendronate group. CONCLUSIONS Our results suggest that long-term treatment with alendronate did not compromise the repair processing of critical size defects in rat.
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Affiliation(s)
- Rafael Scaf de Molon
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara Sao Paulo, Brazil.
| | - Leslie Cristine Fiori
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara Sao Paulo, Brazil
| | - Mario Henrique Arruda Verzola
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara Sao Paulo, Brazil
| | - Marina Montosa Belluci
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara Sao Paulo, Brazil
| | - Ana Paula de Souza Faloni
- Department of Health Sciences, Implantology Post Graduation Course, University Centre of Araraquara - UNIARA, Sao Paulo, Brazil
| | | | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, 10833, CA, USA; Molecular Biology Institute, UCLA, Los Angeles, 10833, CA, USA
| | - Silvana Regina Perez Orrico
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara Sao Paulo, Brazil; Advanced Research Center in Medicine, Union of the Colleges of the Great Lakes (UNILAGO), São José do Rio Preto, S.P., Brazil
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Corral‐Gudino L, Tan AJH, del Pino‐Montes J, Ralston SH. Bisphosphonates for Paget's disease of bone in adults. Cochrane Database Syst Rev 2017; 12:CD004956. [PMID: 29192423 PMCID: PMC6486234 DOI: 10.1002/14651858.cd004956.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bisphosphonates are considered to be the treatment of choice for people with Paget's disease of bone. However, the effects of bisphosphonates on patient-centred outcomes have not been extensively studied. There are insufficient data to determine whether reducing and maintaining biochemical markers of bone turnover to within the normal range improves quality of life and reduces the risk of complications. OBJECTIVES To assess the benefits and harms of bisphosphonates for adult patients with Paget's disease of bone. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ISI Web of Knowledge and trials registers up to March 2017. We searched regulatory agency published information for rare adverse events. SELECTION CRITERIA Randomised controlled trials (RCTs) of bisphosphonates as treatment for Paget's disease in adults. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, extracted data and assessed studies for risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 20 trials (25 reports, 3168 participants). Of these, 10 trials (801 participants) compared bisphosphonates (etidronate, tiludronate, ibandronate, pamidronate, olpadronate, alendronate, risedronate, zoledronate) versus placebo, seven compared two bisphosphonates (992 participants), one trial compared a bisphosphonates with a bisphosphonate plus calcitonin (44 participants), and two studies, the largest trial (1331 participants) and its interventional extension study (502 participants), compared symptomatic treatment and intensive treatment where the goal was to normalise alkaline phosphatase.Most studies were assessed at low or unclear risk of bias. Six of 10 studies comparing bisphosphonates versus placebo were assessed at high risk of bias, mainly around incomplete outcome data and selective outcome reporting.Participant populations were reasonably homogeneous in terms of age (mean age 66 to 74 years) and sex (51% to 74% male). Most studies included participants who had elevated alkaline phosphatase levels whether or not bone pain was present. Mean follow-up was six months.Bisphosphonates versus placeboBisphosphonates tripled the proportion (31% versus 9%) of participants whose bone pain disappeared (RR 3.42, 95% confidence interval (CI) 1.31 to 8.90; 2 studies, 205 participants; NNT 5, 95% CI 1 to 31; moderate-quality evidence). This result is clinically important. Data were consistent when pain change was measured as any reduction (RR 1.97, 95% CI 1.29 to 3.01; 7 studies, 481 participants).There was uncertainty about differences in incident fractures: 1.4% fractures occurred in the bisphosphonates group and none in the placebo group (RR 0.89, 95% CI 0.18 to 4.31; 4 studies, 356 participants; very low-quality evidence).None of the studies reported data on orthopaedic surgery, quality of life or hearing thresholds.Results regarding adverse effects and treatment discontinuation were uncertain. There was a 64% risk of mild gastrointestinal adverse events in intervention group participants and 48% in the control group (RR 1.32, 95% CI 0.91 to 1.92; 6 studies, 376 participants; low-quality evidence). The likelihood of study participants discontinuing due to adverse effects was slightly higher in intervention group participants (4.4%) than the control group (4.1%) (RR 1.01, 95% CI 0.41 to 2.52; 6 studies, 517 participants; low-quality evidence). Zoledronate was associated with an increased risk of transient fever or fatigue (RR 2.57, 95% CI 1.21 to 5.44; 1 study, 176 participants; moderate-quality evidence).Bisphosphonates versus active comparatorMore participants reported pain relief with zoledronate than pamidronate (RR 1.30, 95% CI 1.10 to 1.53; 1 study, 89 participants; NNT 5, 95% CI 3 to 11) or risedronate (RR 1.36, 95% CI 1.06 to 1.74; 1 study, 347 participants; NNT 7, 95% CI 4 to 24; very low quality evidence). This result is clinically important.There was insufficient evidence to confirm or exclude differences in adverse effects of bisphosphonates (RR 1.05, 95% CI 0.95 to 1.76; 2 studies, 437 participants; low-quality evidence) and treatment discontinuation (2 studies, 437 participants) (RR 2.04, 95% CI 0.43 to 9.59; 2 studies, 437 participants; very low-quality evidence).Intensive versus symptomatic treatmentThere was no consistent evidence of difference to response in bone pain, bodily pain or quality of life in participants who received intensive versus symptomatic treatment.Inconclusive results were observed regarding fractures and orthopaedic procedures for intensive versus symptomatic treatment (intensive treatment for fracture: RR 1.84, 95% CI 0.76 to 4.44; absolute risk 8.1% versus 5.2%; orthopaedic procedures: RR 1.58, 95% CI 0.80 to 3.11; absolute risk 5.6% versus 3.0%; 1 study, 502 participants; low-quality evidence).There was insufficient evidence to confirm or exclude an important difference in adverse effects between intensive and symptomatic treatment (RR 1.05, 95% CI 0.79 to 1.41; low-quality evidence).There was insufficient evidence to confirm or exclude an important difference of risk of rare adverse events (including osteonecrosis of the jaw) from the regulatory agencies databases. AUTHORS' CONCLUSIONS We found moderate-quality evidence that bisphosphonates improved pain in people with Paget's disease of bone when compared with placebo. We are uncertain about the results of head-to-head studies investigating bisphosphonates. We found insufficient evidence of benefit in terms of pain or quality of life from intensive treatment. Information about adverse effects was limited, but serious side effects were rare, and rate of withdrawals due to side effects was low.
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Affiliation(s)
- Luis Corral‐Gudino
- Hospital el Bierzo, Gerencia de Asistencia Sanitaria del Bierzo, SACYL, IBSAL, RETICEFInternal Medicine Departmentc/Medicos Sin fronteras, 7PonferradaLeonSpain24411
| | - Adrian JH Tan
- Western General HospitalRheumatic Diseases UnitEdinburghUKEH4 2XU
| | - Javier del Pino‐Montes
- University of Salamanca, University Hospital of Salamanca, IBSAL, RETICEFDepartment of Medicine, Service of RheumatologyPaseo San Vicente 54SalamancaSalamancaSpain37007
| | - Stuart H Ralston
- University of EdinburghCentre for Genomic and Experimental MedicineWestern General HospitalEdinburghUKEH4 2XU
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Stagi S, Cavalli L, Seminara S, de Martino M, Brandi ML. The ever-expanding conundrum of primary osteoporosis: aetiopathogenesis, diagnosis, and treatment. Ital J Pediatr 2014; 40:55. [PMID: 24906390 PMCID: PMC4064514 DOI: 10.1186/1824-7288-40-55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/27/2014] [Indexed: 01/07/2023] Open
Abstract
In recent years, as knowledge regarding the etiopathogenetic mechanisms of bone involvement characterizing many diseases has increased and diagnostic techniques evaluating bone health have progressively improved, the problem of low bone mass/quality in children and adolescents has attracted more and more attention, and the body evidence that there are groups of children who may be at risk of osteoporosis has grown. This interest is linked to an increased understanding that a higher peak bone mass (PBM) may be one of the most important determinants affecting the age of onset of osteoporosis in adulthood. This review provides an updated picture of bone pathophysiology and characteristics in children and adolescents with paediatric osteoporosis, taking into account the major causes of primary osteoporosis (PO) and evaluating the major aspects of bone densitometry in these patients. Finally, some options for the treatment of PO will be briefly discussed.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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Tommasini SM, Trinward A, Acerbo AS, De Carlo F, Miller LM, Judex S. Changes in intracortical microporosities induced by pharmaceutical treatment of osteoporosis as detected by high resolution micro-CT. Bone 2012; 50:596-604. [PMID: 22226688 PMCID: PMC3278519 DOI: 10.1016/j.bone.2011.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 12/20/2022]
Abstract
Bone's microporosities play important biologic and mechanical roles. Here, we quantified 3D changes in cortical osteocyte-lacunae and other small porosities induced by estrogen withdrawal and two different osteoporosis treatments. Unlike 2D measurements, these data collected via synchrotron radiation-based μCT describe the size and 3D spatial distribution of a large number of porous structures. Six-month old female Sprague-Dawley rats were separated into four groups of age-matched controls, untreated OVX, OVX treated with PTH, and OVX treated with Alendronate (ALN). Intracortical microporosity of the medial quadrant of the femoral diaphysis was quantified at endosteal, intracortical, and periosteal regions of the samples, allowing the quantification of osteocyte lacunae that were formed primarily before versus after the start of treatment. Across the overall thickness of the medial cortex, lacunar volume fraction (Lc.V/TV) was significantly lower in ALN treated rats compared to PTH. In the endosteal region, average osteocyte lacunar volume (<Lc.V>) of untreated OVX rats was significantly lower than in age-matched controls, indicating a decrease in osteocyte lacunar size in bone formed on the endosteal surface after estrogen withdrawal. The effect of treatment (OVX, ALN, PTH) on the number of lacunae per tissue volume (Lc.N/TV) was dependent on the specific location within the cortex (endosteal, intracortical, periosteal). In both the endosteal and intracortical regions, Lc.N/TV was significantly lower in ALN than in untreated OVX, suggesting a site-specific effect in osteocyte lacuna density with ALN treatment. There also were a significantly greater number of small pores (5-100 μm(3) in volume) in the endosteal region for PTH compared to ALN. The mechanical impact of this altered microporosity structure is unknown, but might serve to enhance, rather than deteriorate bone strength with PTH treatment, as smaller osteocyte lacunae may be better able to absorb shear forces than larger lacunae. Together, these data demonstrate that current treatments of osteoporosis can alter the number, size, and distribution of microporosities in cortical rat lamellar bone.
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Affiliation(s)
- Steven M. Tommasini
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Andrea Trinward
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Alvin S. Acerbo
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
- National Synchrotron Light Source, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Francesco De Carlo
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, USA
| | - Lisa M. Miller
- National Synchrotron Light Source, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Stefan Judex
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
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Characterization of alendronate sodium-loaded UHMWPE for anti-osteolysis in orthopedic applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2012. [DOI: 10.1016/j.msec.2011.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zati A, Bilotta TW. Degeneration of Paget's disease into sarcoma: clinical and therapeutic influencing factors. ACTA ACUST UNITED AC 2008; 92:33-7. [PMID: 18409034 DOI: 10.1007/s12306-008-0043-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 12/14/2007] [Indexed: 10/22/2022]
Abstract
We analysed a series of 119 patients presenting with Paget's bone disease treated at the Istituto Ortopedico Rizzoli (Bologna Italy) over 35 years (from 1970 to 2006). Among these, we found 18 cases that had degenerated into sarcoma. The first goal of this study was to underline the potential factors of Paget's disease transformation into sarcoma. In detail we considered: age, gender, duration of disease, clinical expression, levels of total alkaline phosphatase and type of therapy. The results highlighted an interesting correlation between therapy and degeneration into sarcoma; more specifically, malignant transformation occurred both in patients who had not received any therapy and those who had received regular calcitonin treatment; otherwise, no sarcoma degeneration occurred in the patients treated with bisphosphonates. These data seem to indicate a preventing effect of bisphosphonates towards the degeneration of Paget's disease into sarcoma.
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Affiliation(s)
- Alessandro Zati
- Unit of Rehabilitation, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40134, Bologna, Italy.
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Takada J, Iba K, Yamashita T. Low dose of oral alendronate decreases bone turnover in Japanese patients with Paget's disease of bone. J Bone Miner Metab 2005; 23:333-6. [PMID: 15981032 DOI: 10.1007/s00774-005-0609-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 01/11/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Junichi Takada
- Department of Orthopaedic Surgery, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo 060-8543, Japan.
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Hayami T, Pickarski M, Wesolowski GA, McLane J, Bone A, Destefano J, Rodan GA, Duong LT. The role of subchondral bone remodeling in osteoarthritis: reduction of cartilage degeneration and prevention of osteophyte formation by alendronate in the rat anterior cruciate ligament transection model. ACTA ACUST UNITED AC 2004; 50:1193-206. [PMID: 15077302 DOI: 10.1002/art.20124] [Citation(s) in RCA: 422] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE It has been suggested that subchondral bone remodeling plays a role in the progression of osteoarthritis (OA). To test this hypothesis, we characterized the changes in the rat anterior cruciate ligament transection (ACLT) model of OA and evaluated the effects of alendronate (ALN), a potent inhibitor of bone resorption, on cartilage degradation and on osteophyte formation. METHODS Male Sprague-Dawley rats underwent ACLT or sham operation of the right knee. Animals were then treated with ALN (0.03 and 0.24 microg/kg/week subcutaneously) and necropsied at 2 or 10 weeks postsurgery. OA changes were evaluated. Subchondral bone volume and osteophyte area were measured by histomorphometric analysis. Coimmunostaining for transforming growth factor beta (TGF beta), matrix metalloproteinase 9 (MMP-9), and MMP-13 was performed to investigate the effect of ALN on local activation of TGF beta. RESULTS ALN was chondroprotective at both dosages, as determined by histologic criteria and collagen degradation markers. ALN suppressed subchondral bone resorption, which was markedly increased 2 weeks postsurgery, and prevented the subsequent increase in bone formation 10 weeks postsurgery, in the untreated tibial plateau of ACLT joints. Furthermore, ALN reduced the incidence and area of osteophytes in a dose-dependent manner. ALN also inhibited vascular invasion into the calcified cartilage in rats with OA and blocked osteoclast recruitment to subchondral bone and osteophytes. ALN treatment reduced the local release of active TGF beta, possibly via inhibition of MMP-13 expression in articular cartilage and MMP-9 expression in subchondral bone. CONCLUSION Subchondral bone remodeling plays an important role in the pathogenesis of OA. ALN or other inhibitors of bone resorption could potentially be used as disease-modifying agents in the treatment of OA.
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Affiliation(s)
- Tadashi Hayami
- Merck Research Laboratories, West Point, Pennsylvania 19486, USA
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White DK, Street CC, Jenkins WS, Clark AR, Ford JE. Panoramic radiograph in pathology. Atlas Oral Maxillofac Surg Clin North Am 2003; 11:1-53. [PMID: 12725098 DOI: 10.1016/s1061-3315(02)00012-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dean K White
- Division of Oral and Maxillofacial Pathology, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0298, USA.
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Abstract
The current status of transdermal drug delivery for the treatment of bone diseases is described in this review. The structure, physiology and function of skin and their importance in determining delivery into and across skin are discussed. Special emphasis has been devoted to a description of the major pathways of transport across the skin and the quite continuing controversy over the importance of the transfollicular route. An overview of anatomic site-dependent drug absorption is also provided and is particularly relevant to determination of transdermal patch location. Brief descriptions of the criteria for selection of transdermal drug candidate, transdermal patch designs and currently marketed transdermal products are also included. Transdermal estradiol delivery systems are examined in more detail for their clinical and biological effects. Finally, the feasibility of delivering drugs such as bisphosphonates across skin is discussed.
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Affiliation(s)
- C Ramachandran
- College of Pharmacy, University of Michigan, Ann Arbor, MI 48109-1065, USA.
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Abstract
The main biologic action of bisphosphonates consists of the inhibition of osteoclastic bone resorption, and, at least, for the drugs introduced after etidronate, without any significant inhibition of bone mineralization. Bisphosphonates therefore play a major role in conditions that are characterized, at least partly, by an increased bone resorption. Primary and secondary osteoporosis by far constitute the most widespread indications for bisphosphonates, mostly because recent published trials have demonstrated their ability to prevent fractures. Potentially crippling conditions such as symptomatic Paget disease of bone remain a major therapeutic challenge for bisphosphonates, but the prevention of the major complications such as sarcoma has still to be proven. The availability of more potent bisphosphonates, less toxic for bones, has certainly widened the therapeutic interventions to asymptomatic patients, bearing in mind the various potential troublesome complications. Fibrous dysplasia resembles, in certain aspects, Paget disease; it is therefore not surprising that bisphosphonate therapy has been proposed in this indication. With the aging of world populations, more and more cancers will be diagnosed. For those with a bone metastatic propensity or malignant hematologic condition, such as multiple myeloma, the most recent generation of more potent bisphosphonates may bring more comfort to crippled patients and even, hopefully, have a direct antitumoral activity, if used synergistically with the armamentarium already available to the clinician. New indications for bisphosphonates include osteogenesis imperfecta both in children and adults. In the future, they might be used in the prevention of erosions in rheumatoid arthritis and of loosening of joint prostheses, as well as possibly in osteoarthritis. Now that the fear of theoretically freezing bone remodeling has been reasonably dismissed, potential uses for bisphosphonates might be considered nearly infinite.
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Affiliation(s)
- J P Devogelaer
- Department of Rheumatology, St-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Spina LD, Carvalho FCD, Eksterman LF, Torres SR, Janini MER, Farias MLFD. Doença de paget com manifestação nos maxilares. ACTA ACUST UNITED AC 2000. [DOI: 10.1590/s0004-27302000000300012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Discutimos um caso incomum de doença de Paget do osso, de apresentação nos maxilares. Esta forma rara de manifestação de uma doença sistêmica levou à dificuldade inicial em estabelecer o diagnóstico, sendo a etiologia firmada apenas pela biópsia da lesão. Utilizamos bisfosfonatos com boa resposta. Ressaltamos no artigo a necessidade do acompanhamento multidisciplinar desses pacientes devido às complicações odontológicas da doença quando localizada nos maxilares.
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Fu KK, Ko A. The treatment with alendronate in hemifacial spasm associated with Paget's disease of bone. Clin Neurol Neurosurg 2000; 102:48-51. [PMID: 10717405 DOI: 10.1016/s0303-8467(99)00082-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The association of Paget's disease of bone and hemifacial spasm has rarely been reported. Hemifacial spasm is often associated with compression of the facial nerve by a vascular loop at the point where the nerve leaves the brainstem before traversing the cerebellopontine angle. It is believed that narrowing of the cerebellopontine angle cistern caused by Paget's disease increases the chance of vascular compression of the facial nerve. Whilst specific antipagetic therapy such as calcitonin has been used with good response in hemifacial spasm associated with Paget's disease, the usefulness of the newer bisphosphonates is not clear. A 65-year-old woman with hemifacial spasm associated with Paget's disease was treated with alendronate, and the hemifacial spasm became very infrequent 4 months after commencement of the therapy.
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Affiliation(s)
- K K Fu
- Department of Medicine, The University of, Hong Kong, Hong Kong
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