1
|
Bharwani N, Rathod P, Salunke AA, Patel D, Tripathi U, Varun M, Krishana G, Dave D, Patel K, Sharma M, Puj K, Aron J, Bhalerao R, Shah K, Deshmukh S, Pandya S. Fibrous Dysplasia Involving Cranio-Facial Region Treated with Zolendronic Acid: A Single Institutional Experience and Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:4270-4279. [PMID: 39376397 PMCID: PMC11456058 DOI: 10.1007/s12070-024-04835-0] [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: 06/01/2024] [Accepted: 06/20/2024] [Indexed: 10/09/2024] Open
Abstract
Fibrous dysplasia (FD), commonly known as Lichtenstein-Jaffe disease, is a benign fibro-osseous bone disease. Clinical symptoms often include bone pain, deformities, pathological fractures, or nerve compression. Fibrous dysplasia (FD) in the cranio-facial region presents major management concerns because to the risk of deformity, loss of function, and recurrence. The purpose of this study is to demonstrate a single institution's experience managing cranio-facial FD with zolendronic acid, as well as an extensive review of the available literature on the subject. This retrospective study was conducted in the Orthopedic Oncology unit of the Department of Surgical Oncology with a study duration between January 1, 2019, and January 1, 2022. There were seven patients with cranio-facial fibrous dysplasia in the current study. The effects of zolendronic acid were evaluated using clinical assessment, data, radiological findings, biochemical indicators. Furthermore, a comprehensive literature review was conducted in order to compile the current data of cranio-facial FD. The study included seven individuals (five men and two females), four with polyostotic FD and three with cranio-facial FD. The average follow-up duration was 18.75 months. The study found that all parameters improved: the mean VAS score increased from 7 to 1, mean serum calcium levels increased from 8.75 to 8.46 mg/dL, mean serum phosphorus levels increased from 4.46 to 4.17 mg/dL, and serum alkaline phosphatase levels increased from 152 to 93.25 IU/L.A comprehensive literature review was conducted using PubMed and Google Scholar with the following keywords: "Fibrous dysplasia," "Cranio-facial bones," "Bisphosphonate," and "Zolendronic acid." The search included 24 studies published between 2000 and 2022, incorporating all relevant studies available to date. Our study demonstrated the effectiveness of zolendronic acid in the treatment of cranio-facial fibrous dysplasia. Zolendronic acid offers potential as a feasible treatment options in treating cranio-facial FD, with possible advantages including alleviating symptoms, disease progression stabilisation, and morbidity reduction. However, multi-centre prospective randomised study with larger sample numbers and longer follow-up periods are needed in future.
Collapse
Affiliation(s)
- Nandlal Bharwani
- Orthopedic Oncology, Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Priyank Rathod
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Abhijeet Ashok Salunke
- Orthopedic Oncosurgeon, Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Dhruv Patel
- Orthopedic Oncology, Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Umank Tripathi
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - M. Varun
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Geeta Krishana
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Dipesh Dave
- Department of Pediatric Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Mohit Sharma
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Ketul Puj
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Jebin Aron
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Raghavendra Bhalerao
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure, Technology, Research And Management (IITRAM), Ahmedabad, India
| | - Krupa Shah
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure, Technology, Research And Management (IITRAM), Ahmedabad, India
| | - Suahant Deshmukh
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India
| |
Collapse
|
2
|
Nanda N, Alphonse MP. From Host Defense to Metabolic Signatures: Unveiling the Role of γδ T Cells in Bacterial Infections. Biomolecules 2024; 14:225. [PMID: 38397462 PMCID: PMC10886488 DOI: 10.3390/biom14020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
The growth of antibiotic-resistant bacterial infections necessitates focusing on host-derived immunotherapies. γδ T cells are an unconventional T cell subset, making up a relatively small portion of healthy circulating lymphocytes but a substantially increased proportion in mucosal and epithelial tissues. γδ T cells are activated and expanded in response to bacterial infection, having the capability to produce proinflammatory cytokines to recruit neutrophils and clear infection. They also play a significant role in dampening immune response to control inflammation and protecting the host against secondary challenge, making them promising targets when developing immunotherapy. Importantly, γδ T cells have differential metabolic states influencing their cytokine profile and subsequent inflammatory capacity. Though these differential metabolic states have not been well studied or reviewed in the context of bacterial infection, they are critical in understanding the mechanistic underpinnings of the host's innate immune response. Therefore, this review will focus on the context-specific host defense conferred by γδ T cells during infection with Staphylococcus aureus, Streptococcus pneumoniae, Listeria monocytogenes, and Mycobacterium tuberculosis.
Collapse
Affiliation(s)
| | - Martin P. Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| |
Collapse
|
3
|
Bertin H, Moussa MS, Komarova S. Efficacy of antiresorptive agents in fibrous dysplasia and McCune Albright syndrome, a systematic review and meta-analysis. Rev Endocr Metab Disord 2023; 24:1103-1119. [PMID: 37632645 DOI: 10.1007/s11154-023-09832-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
Fibrous dysplasia (FD) is a rare skeletal disorder in which normal bone is replaced by a fibro-osseous tissue, resulting in possible deformities and fractures. The aim of this systematic review and meta-analysis was to synthesize the available evidence on the use of antiresorptive drugs in FD in terms of changes in bone turnover markers (BTMs), bone mineral density (BMD), and reducing pain. Three databases were searched in October 2022, with an update in July 2023. Of the 1037 studies identified, 21 were retained after eligibility assessment. A random-effects model was used to calculate global effect size and the corresponding standard error. Pamidronate and Denosumab were the most reported drugs in a total of 374 patients assessed. The initiation of treatments was accompanied by an average reduction of 40.5% [CI95% -51.6, -29.3] in the bone resorption parameters, and 22.0% [CI95% -31.9, -12.1] in the parameters of bone formation after 6-12 months. BMD was increased in both FD lesions and in the unaffected skeleton. Pain was reduced by 32.7% [CI95% -52.7, -12.6] after 6-12 months of treatment, and by 44.5% [CI95% -65.3, -23.6] after a mean 41.2 months of follow-up. The variation in pain was highly correlated to variation in bone resorption (R2 = 0.08, p < 0.0001) and formation parameters (R2 = 0.17, p < 0.0001). This study supports the overall efficacy of antiresorptive therapies in terms of reducing bone remodeling, improving bone density, and pain in FD.
Collapse
Affiliation(s)
- Hélios Bertin
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, H3A 1G1, Canada.
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France.
- Nantes Université, UnivAngers, CHU Nantes, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France.
| | - Mahmoud S Moussa
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, H3A 1G1, Canada
- Shriners Hospitals for Children - Canada, Montreal, QC, H4A 0A9, Canada
| | - Svetlana Komarova
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, H3A 1G1, Canada
- Shriners Hospitals for Children - Canada, Montreal, QC, H4A 0A9, Canada
| |
Collapse
|
4
|
Reza E, Hesam A, Sara S, Shahab R. Neglected huge chest wall mass. A case report of fibrous dysplasia. Int J Surg Case Rep 2023; 103:107912. [PMID: 36764076 PMCID: PMC9929683 DOI: 10.1016/j.ijscr.2023.107912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION fibrous dysplasia is a slow-growing bone tumor and is caused by the failure of bone maturation. It is usually asymptomatic thus it is generally found incidentally in radiologic evaluations. Computed tomography is the best radiologic modality for its evaluation. The characteristic findings are ground-glass lesions surrounded by a rim or shell of reactive bone. PRESENTATION OF CASE This study presents a 52-year-old male patient with a huge chest wall tumor arising from the posterolateral aspect of the right fourth to seventh ribs measuring 38 cm. He underwent a thoracotomy and the tumor was resected. For safe margin, the third and eighth ribs were also resected. The defect was reconstructed with a prolene mesh patch and a pectoralis major flap. The final pathology report stated a tumor composed of spindle cells without pleomorphism or mitotic figures with intervening branching and anastomosing bone trabeculae. The margins were tumor-free and on the follow-up, the patient's condition was decent. DISCUSSION Primary tumors of the rib account for 5 % to 7 % of all primary bone neoplasms. Fibrous dysplasia makes up 0.8 % of primary bone tumors. Fibrous dysplasia usually causes no symptoms although it can get massive enough to get symptomatic. Its diagnosis is made through clinical, radiological, and histopathological investigations. CT scan findings are the cornerstone for radiologic evaluations. An individualized approach based on the patient's age and symptoms should be considered. CONCLUSION Considering that the malignant degeneration of the tumor is uncommon, early diagnosis and surgical resection of the tumor can be curative.
Collapse
Affiliation(s)
- Ershadi Reza
- Department of Thoracic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amini Hesam
- Department of Pulmonology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soltanmohammadi Sara
- Department of Pulmonology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Rafieian Shahab
- Department of Thoracic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Medication Correction of the Bone Tissue’s Structural Condition in Patients with Different Forms of Braitsev-Lichtenstein Disease. Fam Med 2021. [DOI: 10.30841/2307-5112.2-3.2021.240769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article presents a modern view on anti-osteoporotic medication therapy in patients with various forms of Braitsev-Lichtenstein disease. Against the background of fundamental studies of the bone tissue’s structural condition in this pathology improved and tested medication correction of its disorders depending on changes in bone metabolism, shape, clinical and orthopedic manifestations of the disease, the patient’s age.
The article presents the rationale, general principles and features of anti-osteoporotic therapy; indications and contraindications to it; dose calculations and regimens for the use of certain medications, including from the group of bisphosphonates in various forms of Braitsev-Lichtenstein disease.
The presented medication therapy has been successfully tested in 16 patients with Braitsev-Lichtenstein disease. The effectiveness of the treatment is confirmed by the reduction or elimination of pain, stopping the progression of pathological diseases on average in the bones of the lower extremities, improving the structural condition of bone tissue and its metabolism.
Collapse
|
6
|
Bhadada SK, Pal R, Sood A, Dhiman V, Saini UC. Co-administration of Systemic and Intralesional Zoledronic Acid in a Case of Fibrous Dysplasia: A Potentially Novel Therapy. Front Endocrinol (Lausanne) 2019; 10:803. [PMID: 31803145 PMCID: PMC6877477 DOI: 10.3389/fendo.2019.00803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Fibrous dysplasia (FD) is a benign bone lesion characterized by replacement of normal bone with abnormal fibrous tissue, clinically manifesting as deformities, bone pains, and pathological fractures. The standard medical management for FD includes systemic bisphosphonate therapy. The efficacy of systemic bisphosphonate is however limited with minimal functional improvement and pain relief. Keeping the above lacunae in mind, we have made a solitary attempt at treating FD with locally administered zoledronic acid. A 25-year-old gentleman had presented to our institute with swelling and pain involving the left thigh and left lower leg. He was diagnosed as having polyostotic FD, confirmed on bone histopathology. He was administered 4 mg of zoledronic acid intravenously while 1 mg of the drug was injected locally into the femoral lesion under ultrasound and fluoroscopy guidance. There were no peri-procedural complications. At 6 months follow-up, there was marked improvement in pain scores at the left thigh, while that at the left leg remained unchanged. In addition, repeat bone scintigraphy showed a 20.8% and 25.3% reduction in anterior and posterior uptake values, respectively, at the left femur while that at the left tibia remained unaltered.
Collapse
Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Sanjay Kumar Bhadada
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uttam Chand Saini
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Rotman M, Hamdy NAT, Appelman-Dijkstra NM. Clinical and translational pharmacological aspects of the management of fibrous dysplasia of bone. Br J Clin Pharmacol 2018; 85:1169-1179. [PMID: 30471134 PMCID: PMC6533424 DOI: 10.1111/bcp.13820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 12/11/2022] Open
Abstract
Fibrous dysplasia (FD) is a genetic, noninheritable rare bone disease caused by a postzygotic activating mutation of the α subunit of the stimulatory G‐protein causing increased abnormal bone formation leading to pain, deformity and fractures. To date, no cure has been identified for FD/McCune–Albright syndrome (MAS) and treatment is symptomatic and aimed at decreasing pain and/or local bone turnover. Various drugs have been used to achieve clinical improvement in FD/MAS patients including bisphosphonates and denosumab, however further translational studies are also warranted to address unresolved pathophysiological issues and explore novel pharmacological targets for the management of FD/MAS. In this article, we review literature on the medical treatment of FD/MAS, discuss the unresolved pathophysiological issues and explore novel pharmacological targets for the management of FD/MAS.
Collapse
Affiliation(s)
- Marlous Rotman
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - Neveen Agnes Therese Hamdy
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - Natasha M Appelman-Dijkstra
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
8
|
Corsi A, Ippolito E, Robey PG, Riminucci M, Boyde A. Bisphosphonate-induced zebra lines in fibrous dysplasia of bone: histo-radiographic correlation in a case of McCune-Albright syndrome. Skeletal Radiol 2017; 46:1435-1439. [PMID: 28660402 PMCID: PMC5709201 DOI: 10.1007/s00256-017-2698-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 02/02/2023]
Abstract
Bisphosphonates (BPs) are currently used in the treatment of diverse bone diseases including fibrous dysplasia of bone (FD). In pediatric patients, a radiographic consequence of cyclical administration of BPs is the development of apo-, epi-, and meta-physeal sclerotic bands, otherwise known as zebra lines, which result from the temporary inhibition of osteoclastic activity at the time of drug treatment. We report here on a child with McCune-Albright syndrome (FD in addition to hyperfunctioning endocrinopathies and skin hyperpigmentation) treated with cyclical intravenous infusions of pamidronate in which conventional radiography, contact microradiography, histology, and backscattered electron image analysis demonstrated that zebra lines formed only where bone was normal, were arrested at the boundary between FD-unaffected and FD-affected bone where bone is sclerotic, and were absent within the undermineralized FD bone. Moreover, in spite of the treatment, the FD lesions continued to expand. This case report is unique because no previously published studies correlated the radiographic and the histologic features of BP-induced zebra lines in the metaphysis of an FD-affected long bone of the limbs.
Collapse
Affiliation(s)
- Alessandro Corsi
- Department of Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina 324, 00161, Rome, Italy.
| | - Ernesto Ippolito
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Pamela G Robey
- Skeletal Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Mara Riminucci
- Department of Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina 324, 00161, Rome, Italy.
| | - Alan Boyde
- Dental Physical Sciences, Queen Mary University of London, London, E1 4NS, UK
| |
Collapse
|
9
|
Giant Hemifacial Fibrous Dysplasia Functional Treatment and Place of Pamidronate. J Craniofac Surg 2017; 28:706-708. [PMID: 28468152 DOI: 10.1097/scs.0000000000003640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The authors report the case of a 9-year-old child with severe form of hemifacial fibrous dysplasia. The authors review the pathology of this treatment modality through the case description and detail the place of pamidronate in the treatment of fibrous dysplasia.
Collapse
|
10
|
McCune–Albright syndrome, natural history and multidisciplinary management in a series of 14 pediatric cases. ANNALES D'ENDOCRINOLOGIE 2016; 77:7-13. [DOI: 10.1016/j.ando.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 11/23/2022]
|
11
|
Parisi MS, Oliveri B. Long-term pamidronate treatment of polyostotic fibrous dysplasia of bone: A case series in young adults. Curr Ther Res Clin Exp 2014; 70:161-72. [PMID: 24683227 DOI: 10.1016/j.curtheres.2009.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2008] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Limited information is available about long-term pamidronate treatment in adults with fibrous dysplasia (FD) of bone. OBJECTIVE The aim of this case series was to report the clinical outcomes and the biochemical and densitometric findings in a group of young adult patients with polyostotic FD treated for ≥3 years with IV pamidronate. METHODS Pamidronate was administered every 6 months (60 mg/d for 3 days) for 2 years. Thereafter, treatment was individualized. Pamidronate was administered at shorter or longer intervals based on response. Bone pain, radiography, serum bone alkaline phosphatase (BALP) activity, and urinary C-terminal cross-linking telopep-tide of type I collagen (CTX-I) concentration were assessed for a mean of 7 years. Bone mineral density (BMD) of FD areas (FDas) and contralateral areas (CLas) were measured at baseline and at 12 and 24 months. Data were collected prospectively. RESULTS Seven patients (5 women, 2 men; mean [SD] age, 31.0 [7.2] years [range, 22-43 years]) were included in the study. Patients received IV pamidronate for a mean of 6.9 years (median, 7.1 years [range, 3.7-10.9 years]). Pamidronate was associated with a reduction in bone pain and a significant reduction in BALP in all patients at the end of follow-up (P < 0.02). The mean reduction from baseline in CTX-I concentration (measured in 3 patients) was 56%; this difference was not significant. Mean BMD values of FDas were significantly increased at 12 months (by 5.9%; P < 0.05) compared with baseline; but was not significantly increased at 24 months (7.3%), probably reflecting a higher dispersion of values due to individual responses to treatment. No significant changes were observed in CLa BMDs. Mean BMD of FDa had a numerically lower decrease of 15.3% compared with CLa at baseline; these decreases with pamidronate were 10.8% at 12 months (P = NS) and 9.3% at 24 months (P < 0.05). Refilling of osteolytic lesions was not observed. CONCLUSIONS These patients with FD of bone treated with IV pamidronate long term had improvement in bone pain and BMD. The effectiveness of individualized pamidronate administration in the long-term treatment of FD in adult patients should be investigated in blinded controlled trials.
Collapse
Affiliation(s)
- Muriel S Parisi
- Metabolic Bone Disease Section, University of Buenos Aires Hospital, Buenos Aires, Argentina
| | - Beatriz Oliveri
- Metabolic Bone Disease Section, University of Buenos Aires Hospital, Buenos Aires, Argentina
| |
Collapse
|
12
|
Gaski G, Hansen D, Willis LM, Bos GD, Kean JR. Intramedullary rod fixation of fibrous dysplasia without use of bisphosphonates. J Child Orthop 2013; 7:277-83. [PMID: 24432087 PMCID: PMC3799931 DOI: 10.1007/s11832-013-0522-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 08/12/2013] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Controversy exists regarding approach to treatment of pediatric patients with fibrous dysplasia. METHODS We retrospectively reviewed medical records of seven patients who were treated at our institution for fibrous dysplasia by intramedullary rod fixation without bisphosphonate supplementation. RESULTS Seven patients with a total of ten fibrous dysplasia lesion sites surgically treated by intramedullary rod fixation were included. Of these ten lesion sites, eight demonstrated pathologic fracture at the time of fixation. Complete fracture healing was observed in all eight sites, with no incidence of recurrent pathologic fractures examined radiographically. There were no major infections or neurologic deficits, and lesions appeared to stabilize. CONCLUSIONS In this series, intramedullary rod fixation proved to be successful in treatment of acute pathologic fracture and incompletely healed fibrous dysplasia lesions. We observed partial resolution of fibrous dysplasia lesions at all ten sites without significant long-term complications. Following treatment, there were no refractures. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Greg Gaski
- Nationwide Children’s Hospital, 700 Children’s Drive, A2630, Columbus, OH 43205-2696 USA
| | - Dane Hansen
- Nationwide Children’s Hospital, 700 Children’s Drive, A2630, Columbus, OH 43205-2696 USA
| | - Leisel M. Willis
- Nationwide Children’s Hospital, 700 Children’s Drive, A2630, Columbus, OH 43205-2696 USA
| | - Gary D. Bos
- Kittitas Valley Orthopedics, Ellensburg, WA USA
| | - John R. Kean
- Nationwide Children’s Hospital, 700 Children’s Drive, A2630, Columbus, OH 43205-2696 USA ,Department of Orthopaedics, The Ohio State University, Columbus, OH USA
| |
Collapse
|
13
|
Atsali E, Zoubos AB, Stathopoulos KD, Stefos E, Bournazos I, Papadimitriou A, Nicolaidou P, Skarantavos G. Estimation of bone strength parameters and response to treatment in McCune-Albright syndrome using peripheral quantitative computed tomography of the tibia. J Clin Densitom 2012; 15:461-466. [PMID: 22819140 DOI: 10.1016/j.jocd.2012.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Erato Atsali
- 3rd Department of Pediatrics, University of Athens, "Attikon" University Hospital, Athens, Greece; Bone Metabolic Unit, 1st Department of Orthopedics, University of Athens, "Attikon" University Hospital, Athens, Greece.
| | - Aristides B Zoubos
- Bone Metabolic Unit, 1st Department of Orthopedics, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Konstantinos D Stathopoulos
- Bone Metabolic Unit, 1st Department of Orthopedics, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Eustathios Stefos
- 3rd Department of Pediatrics, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Ilias Bournazos
- Bone Metabolic Unit, 1st Department of Orthopedics, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Anastasios Papadimitriou
- 3rd Department of Pediatrics, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Polyxeni Nicolaidou
- 3rd Department of Pediatrics, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Grigoris Skarantavos
- Bone Metabolic Unit, 1st Department of Orthopedics, University of Athens, "Attikon" University Hospital, Athens, Greece
| |
Collapse
|
14
|
Chapurlat RD, Gensburger D, Jimenez-Andrade JM, Ghilardi JR, Kelly M, Mantyh P. Pathophysiology and medical treatment of pain in fibrous dysplasia of bone. Orphanet J Rare Dis 2012; 7 Suppl 1:S3. [PMID: 22640953 PMCID: PMC3359957 DOI: 10.1186/1750-1172-7-s1-s3] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
One of the most common complications of fibrous dysplasia of bone (FD) is bone pain. Usual pain killers are often of inadequate efficacy to control this bone pain. The mechanism of bone pain in FD remains uncertain, but by analogy with bone tumors one may consider that ectopic sprouting and formation of neuroma-like structures by sensory and sympathetic nerve fibers also occur in the dysplastic skeleton. Bone pain has been reported in up to 81% of adults and 49% of children. It affects predominantly the lower limbs and the spine. The degree of pain is highly variable and adults reports more pain than children. Bisphosphonates have been shown to reduce bone pain in uncontrolled studies. Their influence on bone strength remains unknown. In a randomized trial testing alendronate, bone pain was not significantly improved. Another trial assessing the effect of risedronate is ongoing. Possible future therapies include tocilizumab, denosumab and drugs targeting nerve growth factor and its receptor TrkA.
Collapse
Affiliation(s)
- Roland D Chapurlat
- INSERM UMR 1033, Université de Lyon, Hospices Civils de Lyon, Hôpital E Herriot, 69437 Lyon, France
| | | | | | | | | | | |
Collapse
|
15
|
Surgical treatment of giant fibrous dysplasia of the mandible with concomitant craniofacial involvement. J Oral Maxillofac Surg 2011; 70:102-18. [PMID: 21636197 DOI: 10.1016/j.joms.2011.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 01/15/2011] [Indexed: 12/26/2022]
|
16
|
Oral Alendronate Treatment for Severe Polyostotic Fibrous Dysplasia due to McCune-Albright Syndrome in a Child: A Case Report. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2010; 2010:432060. [PMID: 20976302 DOI: 10.1155/2010/432060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 07/02/2010] [Accepted: 09/14/2010] [Indexed: 12/21/2022]
Abstract
Polyostotic fibrous dysplasia (FD) associated to McCune-Albright Syndrome (MAS) often leads to fractures, deformities, and bone pain resulting in bad quality of life. Parenteral bisphosphonates have been used in children and adolescents to improve these symptoms with few adverse effects. We evaluated the response to oral Alendronate in a girl with severe MAS FD and observed improved quality of life with reduction of bone pain.
Collapse
|
17
|
Sbrocchi AM, Forget S, Laforte D, Azouz EM, Rodd C. Zoledronic acid for the treatment of osteopenia in pediatric Crohn's disease. Pediatr Int 2010; 52:754-61. [PMID: 20524999 DOI: 10.1111/j.1442-200x.2010.03174.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pediatric patients with Crohn's disease often have low bone mass (osteopenia) for age. No randomized, placebo-controlled trials using zoledronic acid have ever been performed in this population. The objective of this study was to assess the efficacy of zoledronic acid in children with Crohn's disease and osteopenia. METHODS A double-blind, randomized, placebo-controlled design was used. Thirteen adolescents received either a single intravenous dose of zoledronic acid (0.066 mg/kg, max 4 mg, n= 7) or saline placebo (n= 6). The primary outcome was change in lumbar spine bone mineral density (LSBMD) z-score at 6 months. Secondary outcomes included bone markers and adverse events. RESULTS At 6 months, the change in LSBMD z-score was significantly higher in the zoledronic acid group compared to placebo (0.7 vs 0.1, P < 0.001). Volumetrically adjusted LSBMD z-score also significantly increased in the treated group. This significant difference persisted until 12 months. With zoledronic acid, urinary C-telopeptide excretion decreased by 50% at 6 months and remained suppressed at 12 months (P= 0.02), but no changes were observed with placebo. Both groups had similar adverse events which included transient fever, arthralgias, and nausea (3/7 treated, 2/6 placebo, P= NS). CONCLUSIONS In this study, zoledronic acid demonstrated a significant increase in LSBMD at 6 and 12 months following a well-tolerated infusion.
Collapse
Affiliation(s)
- Anne Marie Sbrocchi
- Division of Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
| | | | | | | | | |
Collapse
|
18
|
Aragão A, Silva I. Oral Alendronate Treatment for Severe Polyostotic Fibrous Dysplasia due to McCune-Albright Syndrome in a Child: A Case Report. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2010. [DOI: 10.1186/1687-9856-2010-432060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
19
|
Chen Y, Ding X, Yang Y, Yan W, Chen D, Li Z. Craniofacial Fibrous Dysplasia Associated With McCune-Albright Syndrome. J Oral Maxillofac Surg 2009; 67:637-44. [DOI: 10.1016/j.joms.2008.01.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 12/19/2007] [Accepted: 01/07/2008] [Indexed: 10/21/2022]
|
20
|
Bacchetta J, Chapurlat R, Bouvier R, Antignac C, Dubourg L, Kohler R, Delmas PD, Cochat P. Nephronophthisis-like nephritis associated with fibrous dysplasia of bone. Pediatr Nephrol 2008; 23:1559-63. [PMID: 18512082 DOI: 10.1007/s00467-008-0850-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 03/20/2008] [Accepted: 03/26/2008] [Indexed: 10/22/2022]
Abstract
Nephronophthisis is a chronic tubulointerstitial nephritis with autosomal recessive inheritance whose evolution to end-stage renal disease is insidious but constant. Fibrous dysplasia of bone is characterized by focal replacement of normal bone and marrow with abnormal bone and fibrous tissue. We report on a young boy initially diagnosed with fibrous dysplasia of bone, who underwent renal investigation because of treatment with pamidronate. He presented with mild proteinuria (albuminuria/creatininuria 19 mg/mmol) and decreased glomerular filtration rate (GFR) (79 ml/min per 1.73 m(2) body surface area) leading to kidney biopsy, which showed nephronophthisis-like lesions, but neither NPHP1 gene deletion nor UMOD (uromodulin) mutation were identified. No association between fibrous dysplasia of bone and nephronophthisis has yet been described. Nephronophthisis-like nephritis associated with fibrous dysplasia of bone might represent a possible new syndrome in the nephronophthisis and medullary cystic kidney disease complex. However, a fortuitous association between these two conditions is also possible.
Collapse
Affiliation(s)
- Justine Bacchetta
- Département de Pédiatrie, Centre de référence des maladies rénales rares, Hôpital Edouard-Herriot and Université Claude Bernard-Lyon 1, Lyon, France
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Chapurlat RD, Orcel P. Fibrous dysplasia of bone and McCune-Albright syndrome. Best Pract Res Clin Rheumatol 2008; 22:55-69. [PMID: 18328981 DOI: 10.1016/j.berh.2007.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fibrous dysplasia of bone is a genetic, non-inheritable disease, characterized by bone pain, bone deformities and fracture, involving one or several bones. It is caused by mis-sense mutations occurring post-zygotically in the gene coding for the alpha-subunit of the stimulatory G-protein, Gs, in the guanine nucleotide binding, alpha stimulating (GNAS) complex locus in chromosome 20q13. This mutation results in osteoblastic differentiation defects, and bone resorption is often increased. The bone lesions may be associated with endocrine dysfunctions and café-au-lait spots; this is known as McCune-Albright syndrome. Patients with polyostotic fibrous dysplasia often have renal phosphate wasting. The disease, however, has a wide clinical spectrum, so many patients are asymptomatic. Diagnosis relies on radiographs and pathology. Bisphosphonates have been used in the treatment of fibrous dysplasia to relieve bone pain and improve lytic lesions, but they are still under clinical evaluation. Calcium, vitamin D and phosphorus supplements may be useful in some patients. Surgery is also helpful to prevent and treat fracture and deformities.
Collapse
Affiliation(s)
- Roland D Chapurlat
- INSERM Research Unit 831, Université de Lyon, and National Reference Centre for Fibrous Dysplasia of Bone, Department of Orthopaedics, Rheumatology and Bone Diseases, Hôpital E Herriot, Lyon, France.
| | | |
Collapse
|
22
|
Barros ER, Dias da Silva MR, Kunii IS, Lazaretti-Castro M. Three years follow-up of pamidronate therapy in two brothers with osteoporosis-pseudoglioma syndrome (OPPG) carrying an LRP5 mutation. J Pediatr Endocrinol Metab 2008; 21:811-8. [PMID: 18825883 DOI: 10.1515/jpem.2008.21.8.811] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Osteoporosis-pseudoglioma (OPPG) is a rare syndrome characterized by severe osteoporosis and ocular defects caused by homozygotic inactivation mutations in the LRP5 gene. Bisphosphonate has been demonstrated to improve bone mineral density (BMD) in children with OPPG. We present here a 3 years follow-up of two brothers with OPPG carrying a novel mutation in the LRP5 gene, who were treated with intravenous pamidronate. PATIENT REPORT We looked for a mutation in the LRP5 gene in two brothers (12 and 4 years old) with clinical features of OPPG (blindness, low BMD and fragility fractures) and in their consanguineous parents to confirm the diagnosis of OPPG. The patients were treated with bisphosphonate for 3 years. They received 1 mg/kg/day of pamidronate for 2 consecutive days, every 3 months during the first year, and every 4 months in subsequent years. Calcium, phosphorus, total alkaline phosphatase, parathyroid hormone, hepatic transaminases, creatinine and hemogram tests were performed before each infusion. Bone densitometry was performed at baseline and at the end of the follow-up. RESULTS AND CONCLUSION The affected brothers carry a missense mutation in the third codon of exon 8 (AAT-->ATT) that led to the exchange of an asparagine for an isoleucine (N531I). Both parents were found to be heterozygous for this mutation. The intravenous pamidronate therapy was safe for up to 3 years of use. Moreover, increased BMD and decreased fracture rate were observed in our patients with OPPG.
Collapse
|
23
|
Delalande D, Jung C, Labedan I, Lechevalier P, Madre C, Roche S, Koné-Paut I. Les ostéoporoses juvéniles. Arch Pediatr 2008; 15:420-30. [DOI: 10.1016/j.arcped.2007.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 10/28/2007] [Accepted: 11/27/2007] [Indexed: 11/28/2022]
|
24
|
Kelly MH, Brillante B, Collins MT. Pain in fibrous dysplasia of bone: age-related changes and the anatomical distribution of skeletal lesions. Osteoporos Int 2008; 19:57-63. [PMID: 17622477 DOI: 10.1007/s00198-007-0425-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 05/10/2007] [Indexed: 01/01/2023]
Abstract
UNLABELLED To determine the prevalence, distribution, age-related changes and treatment of pain in fibrous dysplasia, we studied 78 children and adults. Pain was common, more prevalent and intense in adults, sometimes requiring narcotic analgesia. It was often untreated, especially in children, and surprisingly severity did not correlate with skeletal disease burden. INTRODUCTION Pain is common in fibrous dysplasia (FD), but relatively unstudied. We studied a well-characterized population of patients with a spectrum of disease. METHODS Thirty-five children (16 male, 19 female, mean age 11.4 (range 5-18)) and 43 adults (15 male, 28 female, 23-62 yrs, mean age 40.3 (range 23-62)) were studied. Bone scans were used to identify the location and extent of disease. The Brief Pain Inventory was used to determine severity. RESULTS Pain at sites of FD was common, reported by 67% of the population, but more prevalent and severe in the adult group than the children (81% and 49%, respectively p < 0.005, severity 4.1/10, and 2.8/10, respectively, p < 0.01). Surprisingly, there was no correlation between pain severity and skeletal disease burden. Children were more likely than adults to be untreated for pain (44% vs. 26%). CONCLUSIONS Pain, which was sometimes severe, was common in subjects with FD. It was often un- or under-treated, especially in children. The prevalence and severity of pain was greater in the adult group, but unrelated to the burden of FD.
Collapse
Affiliation(s)
- M H Kelly
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | | | | |
Collapse
|
25
|
Genetic Disorders and Bone Affecting the Craniofacial Skeleton. Oral Maxillofac Surg Clin North Am 2007; 19:467-74, v. [DOI: 10.1016/j.coms.2007.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
26
|
Diaz A, Danon M, Crawford J. McCune-Albright syndrome and disorders due to activating mutations of GNAS1. J Pediatr Endocrinol Metab 2007; 20:853-80. [PMID: 17937059 DOI: 10.1515/jpem.2007.20.8.853] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
It has been more than seven decades since Drs. Fuller Albright and Donovan McCune published the first reports on individuals with McCune-Albright syndrome (MAS). Since then, the classic triad of precocious puberty, café-aulait spots, and polyostotic bone dysplasia continues to define the syndrome. However, having gathered a better picture of the pathophysiology of MAS, the way this condition is understood has changed. Isolated activating mutations of the alpha subunit of the G protein (GNAS1) have been found in different tissues, including pituitary adenomas, thyroid adenomas, ovarian cysts, monostotic bone dysplasia, and the adrenal glands, to name a few. For this reason, we have added 'and disorders due to activating mutations of GNAS1' to the title of this review. We discuss here the clinical consequences of GNAS1 activating mutations in different body systems and organs, the diagnostic approach to MAS, and the current therapeutic recommendations.
Collapse
Affiliation(s)
- Alejandro Diaz
- Division of Pediatric Endocrinology, Weill Medical College of Cornell University, New York, NY, USA
| | | | | |
Collapse
|
27
|
Maldonado I, Catalano E, Reginato AJ. Pathologic fracture of the femoral neck in a female soccer player. J Clin Rheumatol 2007; 8:30-4. [PMID: 17039197 DOI: 10.1097/00124743-200202000-00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of a healthy, young, female soccer player who developed progressive pain in her right hip. A bone cystic lesion was found in the right femoral neck and proximal femur. The lesion was considered a benign bone cyst and the patient was treated with injections of autologous bone marrow and grafting into the femoral neck. However, the cystic lesion did not heal. Subsequently, the patient fell and developed a fracture of the femoral neck that required internal fixation. The bone biopsy showed characteristic histologic features of fibrous dysplasia. A bone scan showed other areas of suspected dysplasia. Pamidronate therapy was given, and a reduction of the increased uptake was seen on bone scans. Fibrous dysplasia must be considered in the differential diagnosis of any cystic bone lesion.
Collapse
Affiliation(s)
- Irama Maldonado
- Department of Medicine, Rheumatology Section, Cooper Hospital University Medical Center, Camden, New Jersey 08103, USA
| | | | | |
Collapse
|
28
|
Leet AI, Collins MT. Current approach to fibrous dysplasia of bone and McCune-Albright syndrome. J Child Orthop 2007; 1:3-17. [PMID: 19308500 PMCID: PMC2656698 DOI: 10.1007/s11832-007-0006-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 12/22/2006] [Indexed: 02/07/2023] Open
Abstract
Fibrous dysplasia (FD) of bone is an uncommon disease caused by sporadic, congenital mutations in the cAMP regulating protein, G(s)alpha. It is an example of somatic mosaicism in which a wide spectrum of disease is possible. Widespread skeletal involvement is often associated with varying combinations of café-au-lait skin spots, and/or endocrine dysfunction (precocious puberty, renal phosphate wasting, hyperthyroidism, and/or growth hormone excess). Unrecognized and untreated endocrine dysfunction can exacerbate the skeletal disease. The diagnosis is usually established on clinical grounds on the basis of physical examination and typical radiographic appearance. Occasionally, gene testing of affected tissue may be helpful. The skeletal sites involved with disease are established at an early age, and the complications of fracture deformity are most pronounced in childhood. Bone pain in the absence of a fracture is more common in adults, but can also be present in children. Treatment with bisphosphonates is usually effective at relieving pain, but probably has no effect on the natural history of the disease. Scoliosis, which was previously thought to be an uncommon occurrence, has been shown to be common and progressive, and as such, warrants investigation and, when necessary, surgical treatment. The surgical management of FD remains challenging. Timing and technique remain controversial, but some consensus exists in that grafting materials (of any type) usually fail and should not be a central aspect of the surgical approach. Intramedullary devices are in general superior to side plates and screws. In extremely widespread disease with very early fracture and deformity, no surgical approach will affect final functional outcome. Efforts should be made for the initiation of international collaborative studies to better define optimal surgical approaches to the treatment of this challenging disease.
Collapse
Affiliation(s)
- Arabella I. Leet
- />Division of Pediatric Orthopedics, Johns Hopkins University, Baltimore, MD USA
| | - Michael T. Collins
- />Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD USA
| |
Collapse
|
29
|
Affiliation(s)
- Francis H Glorieux
- Genetics Unit, Shriners Hospital for Children, McGill University, Montreal, Canada.
| | | |
Collapse
|
30
|
Lala R, Matarazzo P, Andreo M, Marzari D, Bellone J, Corrias A, de Sanctis C. Bisphosphonate treatment of bone fibrous dysplasia in McCune-Albright syndrome. J Pediatr Endocrinol Metab 2006; 19 Suppl 2:583-93. [PMID: 16789621 DOI: 10.1515/jpem.2006.19.s2.583] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the main features of McCune-Albright syndrome is bone fibrous dysplasia (BFD) often associated with severe clinical outcomes, such as bone pain, bone deformities and pathological fractures. Medical treatment with bisphosphonates started 15 years ago. Recent trials in pediatric patients with BFD have shown encouraging results. We evaluated long-term efficacy and safety of pamidronate treatment of BFD in children and adolescents with MAS. The drug was administered at 4 month-1 year intervals according to alkaline phosphatase levels. The study included 14 patients (10 females and 4 males between the ages of 5.3 and 18.7 years) with moderate or severe BFD. Follow up lasted 1.9-9 years. Bone pain, fractures, deformities, and bone turnover markers were evaluated before every therapeutic course. The study shows the beneficial effects of long-term bisphosponate treatment on BFD lesions leading to reduced fracture rate and bone pain, and radiological evidence of long bone lesion healing.
Collapse
Affiliation(s)
- Roberto Lala
- Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
31
|
Chan B, Zacharin M. Pamidronate treatment of polyostotic fibrous dysplasia: failure to prevent expansion of dysplastic lesions during childhood. J Pediatr Endocrinol Metab 2006; 19:75-80. [PMID: 16509531 DOI: 10.1515/jpem.2006.19.1.75] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To examine outcomes of pamidronate treatment on fibrous dysplasia of bone in three children with McCune-Albright syndrome (MAS). METHODS Radiological evidence of fibrous dysplasia progress was reviewed for three children with MAS who were treated with pamidronate from age 2.5-5 years, for 8-10.5 years. RESULTS Despite minimal pain and a low fracture rate in long bones, except where gross deformity exists, all dysplastic lesions present in long bones continued to undergo uncontrolled expansion. In contrast, there were no major new changes in facial configuration, no clinically obvious expansion of sphenoid wing lesions and no encroachment on optic foramina or visual field restriction in any patient. CONCLUSIONS Despite previous reports of limitation or reduction in size of fibrous dysplasia lesions in adults and children, it is our experience that bisphosphonate treatment of polyostotic fibrous dysplasia in children with MAS does not arrest the expanding nature of these lesions.
Collapse
Affiliation(s)
- Brendan Chan
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | | |
Collapse
|
32
|
|
33
|
Letocha AD, Cintas HL, Troendle JF, Reynolds JC, Cann CE, Chernoff EJ, Hill SC, Gerber LH, Marini JC. Controlled trial of pamidronate in children with types III and IV osteogenesis imperfecta confirms vertebral gains but not short-term functional improvement. J Bone Miner Res 2005; 20:977-86. [PMID: 15883638 DOI: 10.1359/jbmr.050109] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 01/10/2005] [Accepted: 01/12/2005] [Indexed: 11/18/2022]
Abstract
UNLABELLED Bisphosphonates have been widely administered to children with OI based on observational trials. A randomized controlled trial of q3m intravenous pamidronate in children with types III and IV OI yielded positive vertebral changes in DXA and geometry after 1 year of treatment, but no further significant improvement during extended treatment. The treated group did not experience significantly decreased pain or long bone fractures or have increased motor function or muscle strength. INTRODUCTION Bisphosphonates, antiresorptive drugs for osteoporosis, are widely administered to children with osteogenesis imperfecta (OI). Uncontrolled pamidronate trials in OI reported increased BMD, vertebral coronal area, and mobility, and decreased pain. We conducted a randomized controlled trial of pamidronate in children with types III and IV OI. MATERIALS AND METHODS This randomized trial included 18 children (4-13 years of age) with types III and IV OI. The first study year was controlled; 9 children received pamidronate (10 mg/m2/day IV for 3 days every 3 months). Four children in each group also received recombinant growth hormone (rGH) injections (0.06 mg/kg/day for 6 days/week). Seven children in the treatment group received pamidronate for an additional 6-21 months. All patients had L1-L4 DXA, spine QCT, spine radiographs, and musculoskeletal and functional testing. RESULTS In the controlled phase, treated patients experienced a significant increase in L1-L4 DXA z score (p < 0.001) and increased L1-L4 mid-vertebral height (p = 0.014) and total vertebral area (p = 0.003) compared with controls. During extended treatment, DXA z scores and vertebral heights and areas did not increase significantly beyond the 12-month values. Fracture rate decreased significantly in the upper extremities (p = 0.04) but not the lower extremities (p = 0.09) during the first year of treatment. Gross motor function, muscle strength, and pain did not change significantly during the controlled or extended treatment phases. CONCLUSIONS A controlled trial confirmed the spine benefits of short-term pamidronate treatment in children with types III and IV OI. Pamidronate increased L1-L4 vertebral DXA and decreased vertebral compressions and upper extremity fractures. Vertebral measures did not improve during the extended treatment phase. The treatment group did not experience decreased lower extremity long bone fractures, significant improvement in growth, ambulation, muscle strength, or pain. There was substantial variability in individual response to treatment.
Collapse
Affiliation(s)
- Anne D Letocha
- Section on Connective Tissue Disorders, BEMB, NICHD, NIH, Bethesda, Maryland 20892, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hernández Hernández JL, Riancho Moral JA, González Macías J. Bisfosfonatos intravenosos. Med Clin (Barc) 2005; 124:348-54. [PMID: 15760604 DOI: 10.1157/13072425] [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: 11/21/2022]
Abstract
Bisphosphonates possess a fundamental role in the treatment of bone metabolic diseases. Yet their main limitations are poor oral absorption and gastrointestinal side effects, mainly esophageal irritation. Indeed, oral administration is unpleasant for many patients, and it is difficult in bed-confined subjects. Therefore, intravenous administration of these agents can be very useful in several clinical scenarios, especially to improve the compliance. Recently, it has been showed that intravenous bisphosphonates are very useful to control hypercalcemia of malignancy, and to prevent bone complications related to metastases. Their use has also been analyzed in the prevention of bone disease after organ transplantation. Thus, their application to control Paget's disease of bone is well-known, and probably they could have an important role as antiresorptive agents in postmenopausal and steroidal osteoporosis. We present here a state of the art of the use of intravenous bisphosphonates for the aforementioned disorders.
Collapse
Affiliation(s)
- José Luis Hernández Hernández
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
| | | | | |
Collapse
|
35
|
Kitagawa Y, Tamai K, Ito H. Oral alendronate treatment for polyostotic fibrous dysplasia: a case report. J Orthop Sci 2005; 9:521-5. [PMID: 15449129 DOI: 10.1007/s00776-004-0809-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Accepted: 05/31/2004] [Indexed: 11/28/2022]
Abstract
Recently, intravenous therapy with pamidronate has been reported to be effective for treating fibrous dysplasia. However, very little is known about the efficacy of oral alendronate for fibrous dysplasia. We describe a patient with polyostotic fibrous dysplasia, who had complained of persistent pain for more than 20 years, that was treated with oral alendronate alone. Follow-up examinations were at intervals of 3 months for 2 years. The pain, radiographic findings, and bone turnover, which was monitored using various markers, improved. No adverse side effect was noted. Oral alendronate is suggested to be a useful option in the treatment of polyostotic fibrous dysplasia.
Collapse
Affiliation(s)
- Yasuyuki Kitagawa
- The Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
| | | | | |
Collapse
|
36
|
Abstract
Fibrous dysplasia is a developmental disorder of bone that can present in a monostotic or polyostotic form. Primarily affecting adolescents and young adults, it accounts for 7% of benign bone tumors. Many of the asymptomatic lesions are found incidentally; the remainder present with symptoms of swelling, deformity, or pain. Fibrous dysplasia has been associated with multiple endocrine and nonendocrine disorders and with McCune-Albright and Mazabraud's syndromes. The etiology remains unclear, but molecular biology suggests a mutation in the G(s)alpha subunit and activation of c-fos and other proto-oncogenes. Fibrous dysplasia has a characteristic radiographic appearance. Most cases do not require intervention, but those that do usually are managed surgically with curettage, bone grafting, and, in some cases, internal fixation. When some intervention is necessary but surgery is not practical, treatment is with bisphosphonates. The prognosis generally is good, although poor outcomes are more frequent in younger patients and in those with polyostotic forms of the disease. The risk of malignant transformation is low.
Collapse
Affiliation(s)
- Selene G Parekh
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
37
|
Bryowsky JJ, Bugnitz MC, Hak EB. Pamidronate Treatment for Hypercalcemia in an Infant Receiving Parenteral Nutrition. Pharmacotherapy 2004; 24:939-44. [PMID: 15303458 DOI: 10.1592/phco.24.9.939.36103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 17-day-old infant who was delivered 8 weeks premature underwent small bowel resection for necrotizing enterocolitis. During treatment with continuous infusions of furosemide and hydrocortisone, his total calcium concentration had increased. The calcium dose in his parenteral nutrition solution was decreased and then finally withheld. At 7 weeks of age and after 10 days of calcium-free parenteral nutrition, pamidronate 3 mg (1.1 mg/kg) in 60 ml of normal saline was infused over 6 hours. The infant's total serum calcium concentration decreased, but then 6 days later it had increased again; pamidronate 2 mg (0.7 mg/kg) in 40 ml of normal saline over 4 hours was administered. The patient demonstrated no signs or symptoms of adverse reactions to pamidronate. His serum calcium concentration returned to normal, and calcium-containing parenteral nutrition was tolerated. The use of pamidronate for treatment of hypercalcemia and chronic conditions that affect normal bone growth is increasing in children. Clinical trials in pediatric patients are necessary to determine how best to use bisphosphonates in this patient population.
Collapse
Affiliation(s)
- Jason J Bryowsky
- Department of Pharmacy, College of Pharmacy, University of Tennessee Health Science Center Memphis, Tennessee 38163, USA
| | | | | |
Collapse
|
38
|
Klein GL. Glucocorticoid-induced bone loss in children. Clin Rev Bone Miner Metab 2004. [DOI: 10.1007/s12018-004-0011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Kos M, Luczak K, Godzinski J, Klempous J. Treatment of monostotic fibrous dysplasia with pamidronate. J Craniomaxillofac Surg 2004; 32:10-5. [PMID: 14729043 DOI: 10.1016/j.jcms.2003.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Fibrous dysplasia is a condition where fibrous tissue and bone with an altered structure replace normal bone. The craniofacial involvement is difficult to treat due to location, uncontrolled proliferation and compression of nerves. These result in facial asymmetry, pain, cranial nerve deficiencies, loss of vision or hearing, alterations in breathing, etc. The use of pamidronate, which inhibits the resorptive activity of osteoclasts may be an alternative to surgical intervention and may improve the results of treatment. AIM OF STUDY To evaluate the treatment of monostotic craniofacial fibrous dysplasia with pamidronate. MATERIAL A prospective pilot study was undertaken in 6 children with progressive fibrous dysplasia located in the mandible (3 pts), maxilla (2 pts) or cranial base (1 pt). Surgery consisted only of a biopsy and implantation of gentamycin sponge into the biopsy bed in 3 cases in which an infection was initially suspected. All patients received pamidronate infusions (1mg/kg i.v. for 3 days, every 4-6 months). The changes in bone density and extension of the disease were evaluated by serial orthopantomograms and CT scans. Follow up time was 9-24 months. RESULTS Pain relief was achieved in all cases, decrease in swelling in 3, and stabilization in 3 cases. Radiological investigation revealed any progression but reduction in size and calcification of osteolytic lesions. The local bone density increased and there was no further spread of the disease in any of the patients. Inflammatory symptoms resolved in all cases. The only side effect was an increase in body temperature up to 38-40 degrees C. CONCLUSION Pamidronate appears to be an effective and well-tolerated therapeutic option for patients with fibrous dysplasia. In the future, the combination of the metabolic blockage of the dysplasia by pamidronate and limited non-mutilating surgical interventions are possible.
Collapse
Affiliation(s)
- Marcin Kos
- Department of Paediatric Surgery, Marciniak Hospital, Wroclaw, Poland.
| | | | | | | |
Collapse
|
40
|
Abstract
Fibrous dysplasia of the maxillary sinus might initially become apparent because of facial asymmetry. It can be differentiated from other osseo-odontogenic dysplasias radiographically by its occupancy of the affected sinus and by its diffuse, ground-glass, radiopaque appearance; it can be further confirmed with histologic findings. It is normally self-limiting in growth and does not usually become malignant.
Collapse
|
41
|
Plotkin H, Rauch F, Zeitlin L, Munns C, Travers R, Glorieux FH. Effect of pamidronate treatment in children with polyostotic fibrous dysplasia of bone. J Clin Endocrinol Metab 2003; 88:4569-75. [PMID: 14557424 DOI: 10.1210/jc.2003-030050] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intravenous infusions with the bisphosphonate compound pamidronate decrease bone pain and reportedly can lead to refilling of dysplastic lesions in adults with fibrous dysplasia (FD) of bone. Here we describe the effects of this treatment approach in 18 children and adolescents (age at start of therapy, 6.2-17.5 yr; eight girls) with polyostotic FD, who received pamidronate for 1.2-9.1 yr (median, 3.8 yr). Treatment cycles with pamidronate (1-1.5 mg/kg.d on 3 consecutive days) were given every 4 months. Levels of serum alkaline phosphatase and urinary collagen type I N-telopeptide were elevated at baseline and decreased continuously during the first 3 yr of therapy. There was no radiographic evidence of filling of lytic lesions or thickening of the bone cortex surrounding the lesions in any patient. Histomorphometric results in dysplastic bone tissue of patients receiving pamidronate (n = 7; time of therapy, 1.4-4.8 yr) were similar to those of patients without medical therapy (n = 9). No serious side effects were noted. In conclusion, pamidronate therapy appears to be safe in children and adolescents with polyostotic FD. However, we found no clear evidence that pamidronate has an effect on dysplastic lesions in such patients.
Collapse
Affiliation(s)
- Horacio Plotkin
- Genetics Unit, Shriners Hospital for Children, Québec, Canada H3G 1A6
| | | | | | | | | | | |
Collapse
|
42
|
Parisi MS, Oliveri B, Mautalen CA. Effect of intravenous pamidronate on bone markers and local bone mineral density in fibrous dysplasia. Bone 2003; 33:582-8. [PMID: 14555262 DOI: 10.1016/s8756-3282(03)00221-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bisphosphonates have proven to be effective in patients with fibrous dysplasia of the bone (FD) as shown by their effect on bone pain, markers of bone turnover, or radiological changes. The aim of this study was to evaluate the usefulness of measuring bone mineral density (BMD) of affected bones to assess the efficacy of bisphosphonate treatment. Seven patients (mean age 26 years) received courses of 180 mg intravenous infusion of pamidronate every 6 months (60 mg/day during 3 days). Clinical symptoms, serum alkaline phosphatase, and urinary C-terminal cross-linking telopeptide of type I collagen were assessed every 3 months. BMD of total skeleton and X-rays of FD areas (FDa) were performed at baseline and at 12 months. BMD of FDa was compared with the contralateral side (CL) using the region of interest program on the total skeleton scan. BMD of total skeleton was normal at baseline. Average BMD of FDa was -11.4% compared with CL, a significantly greater difference than that observed between the left and right sides in healthy controls, -0.7% (P < 0.02). At 12 months bone pain diminished in all patients. Bone turnover markers decreased. Mean total skeleton BMD increased 3.3% (P < 0.02). Subregions of the total skeleton scan presenting FD lesions augmented: arms +9.6% (P < 0.02), legs +4.2%, and pelvis +3.5% (P < 0.05). The increase in mean BMD of FDa was +6.8% compared with +2.6% in CL. No changes were observed on the X-ray. These results indicate that simultaneous determination of markers of bone turnover and BMD of FDa is useful in short-term follow-up to determine the efficacy of intravenous pamidronate.
Collapse
Affiliation(s)
- Muriel S Parisi
- Sección Osteopatías Médicas, Hospital de Clínicas, Universidad de Buenos Aires, Av. Córdoba 2351, 8(o) piso, 1120, Buenos Aires, Argentina.
| | | | | |
Collapse
|
43
|
Abstract
Paget's disease and fibrous dysplasia are benign disorders that can involve the temporal bone and skull base. They commonly lead to otolaryngologic symptoms such as impingement of cranial nerves or the orbit or blockage of the external auditory canal or paranasal sinuses, although they can often be a challenge to diagnose because of their insidious presentation. Their benign nature and common presentation within the difficult-to-access confines of the skull base should lead the clinician to exercise caution in their treatment, reserving surgical intervention for either diagnosis or the relief of symptoms. As a better understanding of the etiology of these conditions develops and new pharmacotherapeutic agents are tested, it is likely that physicians will be able to turn to medical rather than surgical techniques to treat these disorders.
Collapse
Affiliation(s)
- Timothy E Hullar
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Baltimore, MD, USA
| | | |
Collapse
|
44
|
Duke JL, Jones DP, Frizzell NK, Chesney RW, Hak EB. Pamidronate in a girl with chronic renal insufficiency dependent on parenteral nutrition. Pediatr Nephrol 2003; 18:714-7. [PMID: 12750976 DOI: 10.1007/s00467-003-1162-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2002] [Revised: 03/06/2003] [Accepted: 03/07/2003] [Indexed: 10/25/2022]
Abstract
A 10-year-old 40-kg African-American female with megacystis microcolon hypoperistalsis syndrome maintained on total parenteral nutrition (TPN), with a history of metabolic bone disease and renal insufficiency, was admitted with a Candida parapsilosis central venous line infection. During her 280-day hospital stay, she had multiple episodes of bacteremia and recurrent candidemia. Furthermore, she developed pathological fractures and hip displacement with osteomyelitis due to Enterobacter. Hypercalcemia and a history of nephrocalcinosis had prevented appropriate dosing of calcium prior to and during the first months of her hospital stay. Pamidronate and chlorothiazide were added to her regimen. The urinary calcium to creatinine ratio and ionized calcium decreased. The pamidronate dose was increased to 60 mg once a week and was well tolerated. Daily calcium was added to her TPN solution and was increased to 10 mEq/day by the time of discharge. We conclude that relatively large doses of pamidronate may be required in certain cases of refractory hypercalcemia and are well tolerated in children.
Collapse
Affiliation(s)
- Janet L Duke
- Department of Pharmacy, The Center for Pediatric Pharmacokinetics and Therapeutics, Pediatric Pharmacology Research Unit, University of Tennessee Health Science Center, Tennessee, USA
| | | | | | | | | |
Collapse
|
45
|
Batch JA, Couper JJ, Rodda C, Cowell CT, Zacharin M. Use of bisphosphonate therapy for osteoporosis in childhood and adolescence. J Paediatr Child Health 2003; 39:88-92. [PMID: 12603794 DOI: 10.1046/j.1440-1754.2003.00083.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Congenital and acquired forms of osteoporosis in childhood and adolescence can result in morbidity from fracture and pain in childhood, and place an individual at significant risk for problems in adult life. A range of therapies exist for the prevention and treatment of osteoporosis, including optimization of daily calcium intake, adequate vitamin D status, weight-bearing exercise, treatment with sex steroids where delayed puberty is a problem and, more recently, use of bisphosphonate therapy. Intravenous pamidronate therapy (a bisphosphonate) has been shown to reduce fractures and improve bone density in children with osteogenesis imperfecta, and might prove to be of benefit in other osteoporotic conditions in childhood. However, a number of issues regarding the optimal use of bisphosphonate therapy in children and adolescents remain to be resolved, including total annual dose and frequency and duration of administration. Bisphosphonate therapy should, therefore, be used only in the context of a well-run clinical programme with specialist knowledge in the management of osteopenic disorders in childhood.
Collapse
Affiliation(s)
- J A Batch
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Brisbane, Queensland, Australia.
| | | | | | | | | |
Collapse
|
46
|
Abstract
DEFINITION Fibrous dysplasia (FD) of bone is a non-inheritable congenital disorder affecting both genders. It is characterized by expanding fibrous lesions, which contain bone-forming mesenchymal cells. PATHOPHYSIOLOGY FD is caused by a somatic activating mutation of the alpha subunit of the Gs protein (Gsalpha). Bone mesenchymal cells produce a matrix of randomly distributed collagen fibres and islands of woven bone. Osteoclasts are responsible for the spread of the lesions. CLINICAL FINDINGS The symptoms are bone pain, fracture, bone deformities and neurological deficits. Spontaneous regression of lesions does not occur. TREATMENT Recently, an observational study of treatment with bisphosphonate has yielded promising results. There was a decreased intensity of bone pain, a decrease in biochemical markers of bone turnover and a radiographically apparent 'refilling of osteolytic sites' in about half of the patients. CONCLUSIONS Very little is known about the effects of bisphosphonate treatment in children and adolescents with FD. Most patients report decreased bone pain after the first pamidronate infusion, which, in our view, justifies the use of this drug in severely affected patients. The many unanswered questions regarding this form of treatment can only be addressed when a large number of patients is treated in a standardized fashion, and data on the outcome are collected.
Collapse
|
47
|
Kanumakala S, Boneh A, Zacharin M. Pamidronate treatment improves bone mineral density in children with Menkes disease. J Inherit Metab Dis 2002; 25:391-8. [PMID: 12408189 DOI: 10.1023/a:1020103901969] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Menkes disease is a severe multisystem disorder due to defective bioavailability and transport of copper at the cellular level. Deficient activity of lysyl oxidase, a copper-dependent enzyme, causes defective collagen cross-linking leading to osteoporosis and pathological fractures in these children. The objective of the study was to evaluate the changes in bone mineral density following pamidronate treatment in children with Menkes disease. The study design was an open observational study of three children with Menkes disease and significant osteoporosis with or without pathological fractures, all of whom received pamidronate treatment for 1 year. There were 34-55% and 16-36% increases in lumbar spine bone mineral content and areal bone mineral density, respectively, following 1 year of treatment with pamidronate. There were no further fractures in two of the three children treated. No adverse effects of pamidronate treatment were noted. Pamidronate treatment was associated with an increase in bone mineral density and may be an effective treatment modality for the management of osteoporosis in children with Menkes disease.
Collapse
Affiliation(s)
- S Kanumakala
- Department of Endocrinology and Diabetes, Genetic Health Services Victoria, Royal Children's Hospital, Parkville, Australia
| | | | | |
Collapse
|
48
|
Abstract
Nasal obstruction is one of the most common symptoms pediatric patients present to their physicians with. Usually this symptom is caused by allergic rhinitis or an upper respiratory infection, however, many conditions present with nasal obstruction. We present a 14-year-old patient with a rare cause of nasal obstruction, turbinate enlargement due to fibrous dysplasia, as diagnosed by CT scan and histopathologic analysis. Additionally, clinical history revealed precocious puberty, and a dermatologic exam revealed a café au lait macule, consistent with the McCune-Albright syndrome. This case illustrates the need to formulate a broad differential diagnosis and also consider the overall patient, not just the nasal cavity. The clinical presentation, diagnostic evaluation, long-term management plan and relevant literature are discussed.
Collapse
Affiliation(s)
- William E Bolger
- Department of Surgery and Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | | |
Collapse
|
49
|
Kone Paut I, Gennari JM, Retornaz K, Jouve JL, Bollini G. [Biphosphonates in children: present and future]. Arch Pediatr 2002; 9:836-42. [PMID: 12205795 DOI: 10.1016/s0929-693x(02)00006-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Biphosphonates are synthetic analogs of the natural pyrophosphate molecule, introduced primarily for the treatment of Paget disease of bone. Their main mechanism of action consisting in an inhibition of osteoclastic activity is critical for treatment of disorders including an increased bone resorption. In childhood osteoporosis (especially osteogenesis imperfecta), hypercalcemia and heterotopic calcifications are the three main situations in which they have been successfully used, with however few follow-up and no controlled studies. The evolution of these compounds generating more potent products, given orally, with limited effect on bone mineralization should allow an extension of their use in pediatric patients. Multicentric studies are now necessary to specify their efficacy and guidelines for use in children.
Collapse
Affiliation(s)
- I Kone Paut
- Service de pédiatrie, hôpital Nord, Chemin-des-Bourrelys, 13915 Marseille, France.
| | | | | | | | | |
Collapse
|
50
|
Zacharin M, Bateman J. Pamidronate treatment of osteogenesis imperfecta--lack of correlation between clinical severity, age at onset of treatment, predicted collagen mutation and treatment response. J Pediatr Endocrinol Metab 2002; 15:163-74. [PMID: 11874181 DOI: 10.1515/jpem.2002.15.2.163] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Severe forms of osteogenesis imperfecta (OI) are characterised by osteoporosis with multiple fractures, deformity, progressive loss of mobility and chronic bone pain. Bisphosphonates, as osteoclast inhibitors, reduce bone turnover and improve osteoporosis. OBJECTIVE To investigate the effect of pamidronate treatment of severe OI in children, and find any correlation between clinical severity, age at start of treatment, type of predicted collagen mutation and treatment response. DESIGN Open, observational trial. PATIENTS A two-year study of pamidronate treatment was undertaken in a cohort of 18 children, (1.4-14.5 years) with OI types III and IV. INTERVENTIONS Disodium pamidronate, 1 mg/kg/day for 3 days every 4 months, by i.v. infusion with measurement of bone turnover, bone density, vertebral morphology and skin biopsies to assess collagen mutation. RESULTS Eleven children have completed 2 years of treatment and three more have completed 20 months. Sustained cessation of bone pain, improved mobility and decreased fracture rate were seen in all patients. Bone turnover decreased slightly but was not statistically significant. Bone mineral density (BMD) of lumbar spine increased by a mean of 124.7 +/- 75.7% over 2 years (Z score mean -5.08 +/- 1.27, to -3.30 +/- 1.71, p <0.001); the greatest change in BMD was seen in the most severely affected patients: 138 +/- 50.6% (severe), 62.47 +/- 22.9% (mild). There was a mean increase in vertebral height at L4 of 68.5% and in vertebral area of 85.4%. The majority of patients had slow electrophoretic migration of type I collagen alpha chains or reduced secretion of type I collagen, indicative of structural, helix-breaking mutations. There was no correlation between phenotypic severity, age at start of treatment and treatment response (r2 = 0.14) CONCLUSIONS Pamidronate treatment of severe forms of OI is an effective therapeutic modality to increase bone density, decrease fracture rate, increase mobility and improve quality of life, irrespective of the severity of the mutation or clinical phenotype. It has a good short-term safety profile.
Collapse
Affiliation(s)
- Margaret Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia.
| | | |
Collapse
|