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El Masry AM, Azmy SI, Mustafa MAR, Abuelhadid MA. Using Denosumab as a Nonsurgical Management of Aneurysmal Bone Cysts in the Pelvis. Clin Orthop Surg 2024; 16:149-156. [PMID: 38304208 PMCID: PMC10825244 DOI: 10.4055/cios22228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 02/03/2024] Open
Abstract
Background Aneurysmal bone cysts (ABCs) are infrequent, benign, and locally destructive lesions that most commonly occur during the first two decades of life. They usually affect the metaphysis of the long bones, but the pelvis is involved in 8%-12% of the cases. The management of pelvic ABCs is a challenging issue due to difficulties in choosing the appropriate approach, adjacent neurovascular bundles, the risk of intraoperative bleeding with difficulty achieving good hemostasis, and the risk of injury to the hip or sacroiliac joints. Limited data exist concerning the use of denosumab as a non-surgical treatment for pelvic ABCs. Our hypothesis was that denosumab might be an effective and safe solo treatment of cases with ABCs in the pelvis. Methods We retrospectively assessed 20 patients with ABCs in the pelvis, who were treated by denosumab as a solo agent without surgery. Patients were assessed regarding disease control, the incidence of recurrence and non-oncological complications, and functional outcome. Results The mean follow-up period was 38.5 months. Disease control was achieved in 16 patients (80%), with no local recurrence. Tolerable drug-related complications occurred in 15% of cases. The mean Musculoskeletal Tumor Society score was 92.3%. Conclusions Denosumab may provide a reliable option in the nonsurgical treatment of ABCs of pelvic origin with expected lower morbidity than the surgical solution and tolerable complications. Further studies on the safety profile and long-term effects of denosumab especially in skeletally immature patients are required.
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Affiliation(s)
| | - Sherif Ishak Azmy
- Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Lechtholz-Zey E, Matti NY, Fredrickson VL, Buchanan I, Donoho DA. Vertebral Aneurysmal Bone Cyst Mimicking Osteosarcoma: Case Report and Review of the Literature. Cureus 2023; 15:e35033. [PMID: 36938191 PMCID: PMC10023236 DOI: 10.7759/cureus.35033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Aneurysmal bone cysts are benign osseous lesions containing blood-filled cavities separated by walls of connective tissue. They can be difficult to identify clinically due to similarities in presentation, imaging, and histology with other pathologies. Specifically, it is important to distinguish these benign lesions from malignant processes, as both surgical and medical management differ. We present the case of a 21-year-old patient who presented with impaired motor and sensory function in his lower extremities. Radiologic findings were concerning for an invasive neoplasm, and the intraoperative frozen section supported this conclusion. However, an additional histological investigation was confirmatory for a diagnosis of an aneurysmal bone cyst. The patient underwent corpectomy, laminectomy, and a posterior spinal fusion, and regained motor and sensory function shortly thereafter. This report details the importance of considering aneurysmal bone cysts in the differential of infiltrative bone lesions, despite their benign nature, as medical and surgical management can vary greatly.
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Affiliation(s)
- Elizabeth Lechtholz-Zey
- Orthopaedic Surgery, Keck School of Medicine of University of South California, Los Angeles, USA
| | - Nawar Y Matti
- Pathology, Southwest Healthcare System, Los Angeles, USA
| | | | | | - Daniel A Donoho
- Neurological Surgery, Children's National Hospital, Washington, DC, USA
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Baigorria JF, Besse M, Rosado Pardo JA, Steverlynck A, Sarotto AJ. Quiste óseo aneurismático vertebral agresivo: presentación de un caso y revisión bibliográfica. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introducción: El quiste óseo aneurismático es una lesión seudotumoral lítica, expansiva, compuesta por espacios llenos de sangre separados por tabiques. Representa el 15% de los tumores primarios en la columna, y su presentación de comportamiento agresivo es aún más infrecuente. Se han descrito diferentes opciones terapéuticas en función de su estadio y tasa de recurrencia. Presentamos a un paciente con compromiso neurológico secundario a un quiste óseo aneurismático en la columna torácica, decomportamiento agresivo, que requirió resolución quirúrgica.
Conclusión: Las opciones de tratamiento del quiste óseo aneurismático se deben adecuar a cada caso en particular, según sus características.
Nivel de Evidencia: IV
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Giantini-Larsen AM, Chakravarthy VB, Barzilai O, Newman WC, Wexler L, Bilsky MH. The role of neoadjuvant denosumab in the treatment of aneurysmal bone cysts: a case series and review of the literature. J Neurosurg Pediatr 2022; 30:547-554. [PMID: 36282899 DOI: 10.3171/2022.8.peds22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aneurysmal bone cysts (ABCs) are benign cystic lesions most commonly occurring in the long bones of pediatric patients. Spinal ABCs may be difficult to resect given their invasive, locally destructive nature, proximity to critical structures such as the spinal cord, and their intrinsic hypervascularity, for which complete embolization is often constrained by radiculomedullary segmental feeders. Denosumab, a monoclonal antibody that binds the receptor activator of nuclear factor kappa B (NF-κB) ligand, has been utilized in the treatment of ABCs most often as a rescue therapy for recurrent disease. Here, the authors present 3 cases of neoadjuvant denosumab use in surgically unresectable tumors to calcify and devascularize the lesions, allowing for safer, more complete resection. METHODS This is a single-center, retrospective case series treated at a tertiary care cancer center. The authors present 3 cases of spinal ABC treated with neoadjuvant denosumab. RESULTS All 3 patients experienced calcification, size reduction, and a significant decrease in the vascularity of their ABCs on denosumab therapy. None of the patients developed new neurological deficits while on denosumab. Subsequently, all underwent resection. One patient continued denosumab during the immediate postoperative period because a subtotal resection had been performed, with stabilization of the residual disease. No complications were associated with denosumab administration. CONCLUSIONS The use of denosumab in unresectable ABCs can cause calcification and devascularization, making safe resection more likely.
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Affiliation(s)
- Alexandra M Giantini-Larsen
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | | | | | - Leonard Wexler
- 3Pediatrics, Memorial Sloan Kettering Cancer Center, New York; and
| | - Mark H Bilsky
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
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Hung YP, Bredella MA, Lobmaier IVK, Lozano-Calderón SA, Rosenberg AE, Nielsen GP. Aneurysmal bone cyst and osteoblastoma after neoadjuvant denosumab: histologic spectrum and potential diagnostic pitfalls. APMIS 2022; 130:206-214. [PMID: 35114728 DOI: 10.1111/apm.13211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/27/2022] [Indexed: 01/28/2023]
Abstract
The use of denosumab to treat giant cell tumors of bone (GCT) and other giant cell-containing bone tumors has become more common. While the clinicopathologic features of denosumab-treated giant cell tumors of bone have been well-illustrated, descriptions of other denosumab-treated bone tumors are very limited. Surgical pathology files of two institutions and consultation files from two authors were searched for denosumab-treated aneurysmal bone cysts and denosumab-treated osteoblastomas. Clinicopathologic features were reviewed and analyzed. We identified four patients with denosumab-treated bone tumors other than GCT from our surgical pathology and consultation files, including two aneurysmal bone cysts and two osteoblastomas. All were treated with denosumab for 0.5-7.0 (median 4.5) months. Radiologically, denosumab-treated tumors showed decreased size with increased ossification and mineralization on CT and heterogeneous intermediate to hypointense signal on MRI. Histologically, denosumab-treated aneurysmal bone cyst contained thin, elongated, curvilinear, and anastomosing strands of bone with empty lacunae, while denosumab-treated osteoblastoma showed circumscribed nodules of woven bone lined by small osteoblasts. Denosumab-treated aneurysmal bone cyst and osteoblastoma showed treatment-related morphologic changes that can mimic other bone neoplasms. Their recognition requires correlation with the clinical history of denosumab use and radiologic findings.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ingvild V K Lobmaier
- Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | | | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Beaudouin S, Scailteux LM, Lefeuvre C, Gamby R, Cairon-Lejeune S. Jaw osteonecrosis in patients treated with denosumab 120 mg with regular dental monitoring: 4-year retrospective study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2021. [DOI: 10.1051/mbcb/2021035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is an expected, but rare adverse effect of denosumab. There are few data denosumab 120 mg related MRONJ occurrence when regular dental monitoring is planned. International and French recommendations do not detail the schedule of the follow-up visits, allowing local interpretations. Methods: The aim of this retrospective study was to describe our local experience of regular dental monitoring in patients receiving denosumab 120 mg. We included all ≥18-year-old patients exposed to denosumab 120 mg, bisphosphonate- and denosumab-naive, and with regular dental monitoring (pre-treatment and every 4 months after denosumab initiation) at the University Hospital Center, France, from 2015 to 2019. The crude incidence of denosumab-related osteonecrosis of the jaw was estimated per 100 person-years (95% confidence interval). Results: During the study period, 251 patients were included, of whom 77 did not attend the 1st follow-up visit at 4 months. Almost all patients had osteonecrosis of the jaw risk factors. Ten MRONJ cases were reported (four stage 0 and six stage 1). The crude incidence rate was 5.1 per 100 person-years (95% CI: 1.9–8.2). Denosumab was stopped in all patients who developed MRONJ, with favorable outcome for 3 cases and stabilization in 4 cases after osteonecrosis of the jaw management. Conclusion: This study suggested that a regular dental follow-up every 4 months may be a suitable option for prevention and early detection/treatment of MRONJ. A randomized study should be performed to determine the best dental monitoring schedule.
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Fadavi P, Arefpour AM, Hariri R, Vasheghani M, Garousi M, Taghizadeh‐Hesary F. Dramatic response of aneurysmal bone cyst to denosumab: Case report and literature review. Clin Case Rep 2021; 9:e04993. [PMID: 34745616 PMCID: PMC8548816 DOI: 10.1002/ccr3.4993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/12/2021] [Accepted: 10/09/2021] [Indexed: 02/02/2023] Open
Abstract
Denosumab, a monoclonal antibody that specifically targets cytokine receptor activator of nuclear factor-kappa B ligand (RANKL), is a potentially viable option in resistant aneurysmal bone cysts.
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Affiliation(s)
- Pedram Fadavi
- Radiation Oncology DepartmentIran University of Medical ScienceTehranIran
| | | | - Ramyar Hariri
- Radiation Oncology DepartmentIran University of Medical ScienceTehranIran
| | - Maryam Vasheghani
- Radiation Oncology DepartmentIran University of Medical ScienceTehranIran
| | - Maryam Garousi
- Radiation Oncology DepartmentIran University of Medical ScienceTehranIran
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Singh S, Rai A, Dinesh Iyer R, Surana R, Sharma D. Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee. SICOT J 2021; 7:49. [PMID: 34519640 PMCID: PMC8439180 DOI: 10.1051/sicotj/2021049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. Methods: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. Results: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 patients had full extension and knee flexion more than 100 degrees. The mean MSTS score was 25.2. Three patients had an MSTS score under 20. All three patients had an extension lag with a restricted range of motion. Conclusion: Joint preservation surgery, when done in line with the basic principles of tumor surgery, gives good radiographic and functional outcomes even in grade 2 and 3 giant cell tumors of bone around the knee and should be attempted before replacement surgeries.
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Affiliation(s)
- Saurabh Singh
- Professor, Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, Uttar Pradesh, India
| | - Alok Rai
- Department of Orthopaedics, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - R Dinesh Iyer
- Senior Resident, Department of Trauma and Emergency (Orthopaedics), All India Institute of Medical Sciences, Raipur 492099, Chhattisgarh, India
| | - Rishabh Surana
- Senior Resident, Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, Uttar Pradesh, India
| | - Divyansh Sharma
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, 249203 Rishikesh, Uttarakhand, India
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Maximen J, Robin F, Tronchot A, Rossetti A, Ropars M, Guggenbuhl P. Denosumab in the management of Aneurysmal bone cyst. Joint Bone Spine 2021; 89:105260. [PMID: 34481945 DOI: 10.1016/j.jbspin.2021.105260] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) is a benign, locally aggressive tumour that arises predominantly in long bones and spine. Following the encouraging results of denosumab use in Giant Cell Tumors (GCT) and the histological similarities between ABC and GCT, the interest on the role of denosumab in the therapeutic arsenal of the most advanced ABC is growing. The purpose of this literature review is to investigate the current state of knowledge about the use of denosumab in ABCs. METHODS A literature research was conducted through PUBMED, COCHRANE and GOOGLE SCHOLAR using the keywords "aneurysmal bone cyst" AND "denosumab". Seventeen articles were included. RESULTS A total of 43 cases were reported in the literature. There were 23 males, 20 females. The mean age was 15,9±8,1 year. Pain relief and neurological improvement were rapid and sustained. Radiological assessment showed ossification and/or volume reduction in 36/39 patients. Eight patients (18,6%) presented a recurrence after or during denosumab therapy of whom 7 were adults. Adverse events occurred in 11 patients, 5 of them were admitted to the intensive care unit due to hypercalcemia. CONCLUSION Denosumab use in non-surgical ABCs has shown a positive impact in pain and neurological symptoms. The oncological outcome remains unclear with a recurrence rate of 18,6% during/after denosumab therapy, mostly in adults. However, regarding the potential clinical benefits, its use might be discussed in the most advanced cases. Further research and clinical trials are mandatory to precise its belonging in the therapeutic arsenal.
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Affiliation(s)
- Julien Maximen
- Department of Orthopedic surgery, Pontchaillou University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes, France.
| | - François Robin
- Inserm, Univ Rennes, INRA, Rheumatology department CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), 35000 Rennes, France
| | - Alexandre Tronchot
- Department of Orthopedic surgery, Pontchaillou University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - Adrien Rossetti
- Department of Orthopedic surgery, Pontchaillou University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - Mickaël Ropars
- Department of Orthopedic surgery, Pontchaillou University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - Pascal Guggenbuhl
- Inserm, Univ Rennes, INRA, Rheumatology department CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), 35000 Rennes, France
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Deventer N, Deventer N, Gosheger G, de Vaal M, Vogt B, Budny T. Current strategies for the treatment of solitary and aneurysmal bone cysts: A review of the literature. J Bone Oncol 2021; 30:100384. [PMID: 34367902 PMCID: PMC8326748 DOI: 10.1016/j.jbo.2021.100384] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 02/09/2023] Open
Abstract
SBCs can mostly be treated conservatively. In ABCs a biopsy is compulsory. ABCs can be treated by polidocanol instillations adequately.
This review of the literature aims to compare the etiology, the pathogenesis, the clinical diagnostics and the relevant treatment options of two different types of cystic bone lesions: the solitary bone cyst (SBC) and the aneurysmal bone cyst (ABC). Whereas the clinical symptoms and the radiographic appearance can be similar, the diagnostic pathway and the treatment options are clearly different. The solitary bone cyst (SBC) represents a tumor-like bone lesion, occurring most frequently in the humerus and femur in children and adolescents. Pain caused by intercurrent pathological fractures is often the first symptom, and up to 87% of the cysts are associated with pathological fractures. In the majority of cases SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Pain under weight bearing or regaining the ability to mobilize after fracture timely can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution can be seen in rare cases. The aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the spine or the pelvis. ABC can be primary but also secondary to other bone pathologies. The diagnosis has to be confirmed by biopsy and histopathological examinations. With cytogenetic studies and the detection of specific translocations of the ubiquitin-specific protease (USP) 6 gene primary ABCs can be differentiated from secondary ABCs and other bone lesions. Among various modalities of treatment i.e. en bloc resection, intralesional curettage with adjuvants, embolization or the systemic application of denosumab, intralesional sclerotherapy using polidocanol is an effective and minimally invasive treatment of primary ABCs.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Nils Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Bjoern Vogt
- Department of Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Gandham S, Islim A, Alhamad S, Thambiraj S. The outcome of expandable titanium mesh implants for the treatment of multi-level vertebral compression fractures caused by multiple myeloma. SICOT J 2021; 7:28. [PMID: 33929312 PMCID: PMC8086425 DOI: 10.1051/sicotj/2021026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Painful vertebral compression fractures (VCFs) in myeloma patients severely reduce quality of life. Currently, the International Myeloma Working Group (IMWG) and National Institute of Clinical Excellence NICE advocate the use of either balloon kyphoplasty or vertebroplasty in the management of these fractures. METHODS All patients with VCFs and myeloma who adhered to the IMWG indications for vertebral augmentation were treated with the Osseofix® implant. Visual analogue scores (VAS) and Oswestry disability index (ODI) were taken preoperatively and at least one year following surgery. Cobb angle and implant migration were measured on lateral standing radiographs. RESULTS Sixteen patients (average age 62, SD = 11.6) consisting of 82 levels (range 3-8) were stabilised with no perioperative complications or revisions at one year. There was an improvement in patient-reported outcomes with the median preoperative VAS of 8.6 (IQR 7.3-10.0) reducing to 3 (IQR 1.0-4.0) after one year (P < 0.001) whilst an average improvement of 31.4 (SD = 19.6) points in the ODI scores was reported (P < 0.001). There was no significant collapse or implant failure at one year with a greater improvement in the VAS/ODI score, when more implants were used (P = 0.049 and 0.008, respectively). The average length of stay was 2.2 days (SD = 1.7). CONCLUSION The use of the Osseofix® implant in VCFs caused by multiple myeloma has shown a statistically significant improvement in both pain and outcome scores. There were no complications or significant radiological deterioration of spinal alignment over the course of a year.
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Affiliation(s)
- Surya Gandham
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Abdurrahman Islim
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Saud Alhamad
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Sathya Thambiraj
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
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Del Sindaco G, Berlanga P, Brugières L, Thebault E, Mantovani G, Wicart P, Linglart A. Mineral and Bone Consequences of High Dose Denosumab Therapy to Treat an Aneurysmal Bone Cyst, a Child Case Report. Front Endocrinol (Lausanne) 2021; 12:698963. [PMID: 34335473 PMCID: PMC8322664 DOI: 10.3389/fendo.2021.698963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aneurysmal bone cysts (ABCs) are rare benign pseudotumoral bone lesions with potential aggressive behavior due to the extensive destruction of surrounding bone. Traditionally, these tumors were treated with open surgery, but there is more and more a shift to less invasive procedures. In particular, treatment for spinal ABCs is generally unsatisfactory due to the risk of morbidity, neurological impairment and recurrence, and there is a need for innovative therapies. Denosumab has been reported as a useful treatment in giant cell tumors of bone (GCTB), so its efficacy has been tested also in other fibro-osseus lesions affecting children and adolescents, such as spinal aneurysmal bone cysts. The pediatric literature is limited to case reports and small series, all of which highlight the efficacy of this treatment on lesions growth and associated bone pain. Some of these reports have already reported well known side effects associated with denosumab, such as hypocalcemia at the beginning of the treatment, and rebound hypercalcemia at the discontinuation. The latter seems to be more frequent in children and adolescents than in adults, probably due to the higher baseline bone turnover in children. In addition, the use of denosumab in young patients could affect both bone modeling and remodeling, even if the consequences on the growing skeleton have not been reported in detail. Here we describe the case of a spinal ABC diagnosed in an 8-year old young boy which was not accessible to surgery but responded favorably to denosumab. Our aim is to describe the rapid changes in mineral and bone homeostasis in this patient, that required advice from the experts of the European Reference Network (ERN) for rare bone and endocrine diseases.
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Affiliation(s)
- Giulia Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ERN BOND, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- AP-HP, Service d’endocrinologie et diabète de l’enfant, ERN BOND, ERN for rare endocrine disorders, et Plateforme d’expertise des maladies rares, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Laurence Brugières
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Eric Thebault
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ERN BOND, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Philippe Wicart
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, Paris, France
- AP-HP, Department of Pediatric Orthopedic Surgery, Necker - Enfants Malades University Hospital, Paris, France. Paris Descartes University, Paris, France
| | - Agnès Linglart
- AP-HP, Service d’endocrinologie et diabète de l’enfant, ERN BOND, ERN for rare endocrine disorders, et Plateforme d’expertise des maladies rares, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, Paris, France
- Université de Paris Saclay, INSERM, U1185, Le Kremlin-Bicêtre, France
- *Correspondence: Agnès Linglart,
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The Efficacy of Denosumab in the Management of a Tibial Paediatric Aneurysmal Bone Cyst Compromised by Rebound Hypercalcaemia. Case Rep Pediatr 2020; 2020:8854441. [PMID: 33376615 PMCID: PMC7746474 DOI: 10.1155/2020/8854441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/28/2020] [Accepted: 12/02/2020] [Indexed: 01/28/2023] Open
Abstract
Surgery is the main treatment option for patients with aneurysmal bone cyst (ABC). We report our experience of using denosumab as an alternative treatment in a child with a multiply recurrent and unresectable tibial ABC. The efficacy and safety of denosumab in the paediatric population, and in the treatment of ABC, are still to be fully evaluated. We describe a 13-year-old boy with an extensive and aggressive ABC involving the proximal tibia, which had recurred following multiple previous surgeries. The patient had ongoing severe pain, was unable to weight-bear, and was at significant risk of pathological fracture. En bloc resection and embolization were not deemed viable, and a decision to use denosumab was made. He received 17 doses of subcutaneous denosumab (70 mg/m2) over a 27-month period, at increasing dose intervals. His symptoms significantly improved, and bony consolidation was observed within six months of treatment. He was able to walk without protection and fully weight-bear without any pain by 18 months. With an increase to a six-month dosing interval, the patient presented with a severe, symptomatic rebound hypercalcaemia requiring bisphosphonate therapy. This reoccurred on two further occasions. This case adds to the evidence that denosumab is effective in the treatment of ABC in paediatric patients, but there is a risk of rebound hypercalcaemia. Therefore, patient awareness and biochemical monitoring for rebound hypercalcaemia are essential.
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Polyzos SA, Makras P, Tournis S, Anastasilakis AD. Off-label uses of denosumab in metabolic bone diseases. Bone 2019; 129:115048. [PMID: 31454537 DOI: 10.1016/j.bone.2019.115048] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 01/16/2023]
Abstract
Denosumab (Dmab), a monoclonal antibody against the receptor activator of nuclear factor-κB (RANK) ligand (RANKL) which substantially suppresses osteoclast activity, has been approved for the treatment of common metabolic bone diseases, including postmenopausal osteoporosis, male osteoporosis, and glucocorticoid-induced osteoporosis, in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated. However, the imbalance of RANKL/RANK/osteoprotegerin is also implicated in the pathogenesis of several other rare metabolic bone diseases, including Juvenile Paget disease, fibrous dysplasia, Hajdu Cheney syndrome and Langerhans cell histiocytosis, thus rendering Dmab a potential treatment option for these diseases. Dmab has been also administered off-label in selected patients (e.g., with Paget's disease, osteogenesis imperfecta, aneurysmal bone cysts) due to contraindications or unresponsiveness to standard treatment, such as bisphosphonates. Moreover, Dmab was administered to improve hypercalcemia induced by various diseases, including primary hyperparathyroidism, tuberculosis and immobilization. The aim of this review is to summarize existing evidence on off-label uses of Dmab in metabolic bone diseases and provide opinion for or against its use, which should be always considered on an individual basis.
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Affiliation(s)
- Stergios A Polyzos
- First Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Polyzois Makras
- Department of Endocrinology and Diabetes and Department of Medical Research, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Symeon Tournis
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
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