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Kurtz M, Desquilbet L, Maire J, Da Riz F, Canonne-Guibert M, Benchekroun G, Maurey C. Alendronate treatment in cats with persistent ionized hypercalcemia: A retrospective cohort study of 20 cases. Vet Med (Auckl) 2022; 36:1921-1930. [PMID: 36181368 DOI: 10.1111/jvim.16508] [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: 02/04/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited information is available concerning treatment of ionized hypercalcemia in cats. HYPOTHESIS/OBJECTIVES Describe clinical findings in a cohort of cats with persistent ionized hypercalcemia and evaluate long-term tolerance and efficacy of alendronate in these patients. ANIMALS Twenty cats with persistent ionized hypercalcemia of undetermined origin, presented for routine or referral consultation at the teaching hospital of Maisons-Alfort (France). METHODS Medical records were retrospectively reviewed. Cats were divided into Group 1 (cats that received alendronate as well as other treatments, n = 11) and Group 2 (cats that did not receive alendronate, n = 9). Survival analysis (Kaplan-Meier method, log-rank test, and Cox proportional hazard models) was conducted to compare time to selected outcomes. RESULTS Azotemia was present in 15 cats (75%). Alendronate treatment was administered and well tolerated during the entire follow-up period (median, 9.5 months; interquartile range [IQR], 6.3; 27) in all cats from Group 1, except in 1 cat that developed severe hypophosphatemia, prompting treatment discontinuation. Univariate analysis determined that alendronate treatment was significantly associated with shorter time to reach a 15% decrease in ionized calcium concentration (iCa) from baseline during follow-up (119 days vs median not reached, P = .02). This association was no longer significant after adjustment for age and initial iCa. CONCLUSIONS AND CLINICAL IMPORTANCE Alendronate overall was well tolerated with chronic use in this cohort, and can be considered a treatment option for persistent ionized hypercalcemia in cats.
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Affiliation(s)
- Maxime Kurtz
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Loïc Desquilbet
- Department of Clinical Epidemiology and Biostatistics, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Créteil, INSERM, IMRB, Maisons-Alfort, France
| | - Justine Maire
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Fiona Da Riz
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Morgane Canonne-Guibert
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Créteil, INSERM, IMRB, Maisons-Alfort, France
| | - Ghita Benchekroun
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Créteil, INSERM, IMRB, Maisons-Alfort, France
| | - Christelle Maurey
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Bagger LW, Hansen PKD, Schwarz P, Nielsen BR. Republished: Severe hypophosphataemia following oral bisphosphonate treatment in a patient with osteoporosis. Drug Ther Bull 2021; 59:107-111. [PMID: 34031179 DOI: 10.1136/dtb.2021.235083rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Louise Wulff Bagger
- Department of Internal Medicine M, Geriatric Section, Amager Hvidovre Hospital, Glostrup, Denmark
| | - Per Kim Dyhr Hansen
- Department of Internal Medicine M, Geriatric Section, Amager Hvidovre Hospital, Glostrup, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Rubek Nielsen
- Department of Internal Medicine M, Geriatric Section, Amager Hvidovre Hospital, Glostrup, Denmark
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3
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Koumakis E, Cormier C, Roux C, Briot K. The Causes of Hypo- and Hyperphosphatemia in Humans. Calcif Tissue Int 2021; 108:41-73. [PMID: 32285168 DOI: 10.1007/s00223-020-00664-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/20/2020] [Indexed: 12/11/2022]
Abstract
Phosphate homeostasis involves several major organs that are the skeleton, the intestine, the kidney, and parathyroid glands. Major regulators of phosphate homeostasis are parathormone, fibroblast growth factor 23, 1,25-dihydroxyvitamin D, which respond to variations of serum phosphate levels and act to increase or decrease intestinal absorption and renal tubular reabsorption, through the modulation of expression of transcellular transporters at the intestinal and/or renal tubular level. Any acquired or genetic dysfunction in these major organs or regulators may induce hypo- or hyperphosphatemia. The causes of hypo- and hyperphosphatemia are numerous. This review develops the main causes of acquired and genetic hypo- and hyperphosphatemia.
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Affiliation(s)
- Eugénie Koumakis
- Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Reference Center for Rare Genetic Bone Disorders, OSCAR Filière, Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Catherine Cormier
- Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Reference Center for Rare Genetic Bone Disorders, OSCAR Filière, Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Christian Roux
- Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Reference Center for Rare Genetic Bone Disorders, OSCAR Filière, Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Karine Briot
- Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Reference Center for Rare Genetic Bone Disorders, OSCAR Filière, Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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4
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Abdelrahman S, Ireland A, Winter EM, Purcell M, Coupaud S. Osteoporosis after spinal cord injury: aetiology, effects and therapeutic approaches. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2021; 21:26-50. [PMID: 33657753 PMCID: PMC8020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Osteoporosis is a long-term consequence of spinal cord injury (SCI) that leads to a high risk of fragility fractures. The fracture rate in people with SCI is twice that of the general population. At least 50% of these fractures are associated with clinical complications such as infections. This review article presents key features of osteoporosis after SCI, starting with its aetiology, a description of temporal and spatial changes in the long bones and the subsequent fragility fractures. It then describes the physical and pharmacological approaches that have been used to attenuate the bone loss. Bone loss after SCI has been found to be highly site-specific and characterised by large inter-variability and site-specific changes. The assessment of the available interventions is limited by the quality of the studies and the lack of information on their effect on fractures, but this evaluation suggests that current approaches do not appear to be effective. More studies are required to identify factors influencing rate and magnitude of bone loss following SCI. In addition, it is important to test these interventions at the sites that are most prone to fracture, using detailed imaging techniques, and to associate bone changes with fracture risk. In summary, bone loss following SCI presents a substantial clinical problem. Identification of at-risk individuals and development of more effective interventions are urgently required to reduce this burden.
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Affiliation(s)
- Shima Abdelrahman
- Department of Biomedical Engineering, Wolfson Building, University of Strathclyde, Glasgow, United Kingdom,Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom,Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, United Kingdom,Corresponding author: Shima Abdelrahman, Department of Biomedical Engineering, University of Strathclyde, Wolfson Building, Glasgow G4 0NW E-mail:
| | - Alex Ireland
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Elizabeth M. Winter
- Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology and Centre for Bone Quality, The Netherlands
| | - Mariel Purcell
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, United Kingdom
| | - Sylvie Coupaud
- Department of Biomedical Engineering, Wolfson Building, University of Strathclyde, Glasgow, United Kingdom,Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, United Kingdom
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5
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Bagger LW, Hansen PKD, Schwarz P, Nielsen BR. Severe hypophosphataemia following oral bisphosphonate treatment in a patient with osteoporosis. BMJ Case Rep 2020; 13:13/10/e235083. [DOI: 10.1136/bcr-2020-235083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 76-year-old woman was treated with oral bisphosphonate, alendronate, for osteoporosis in an outpatient clinic. Routine blood tests 4 months after alendronate prescription surprisingly revealed severe hypophosphataemia. The patient was hospitalised and treated with intravenous and oral phosphate supplements. Alendronate was later reintroduced as treatment for osteoporosis and the patient once again presented with severe hypophosphataemia in subsequent routine blood tests. The patient had only presented with lower extremity pain, muscle weakness and difficulty walking. Blood tests in the emergency department both times reconfirmed severe hypophosphataemia. Plasma (p-)ionised calcium levels were normal or slightly elevated and p-parathyroid hormone levels were normal or slightly suppressed. The p-25-hydroxyvitamin-D and p-creatine were in the normal range. Critical illness, malabsorption, nutritional issues and genetics were reviewed as potential causes but considered unlikely. Phosphate levels were quickly restored each time on replacement therapy and the case was interpreted as bisphosphonate-induced severe hypophosphataemia.
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Craven BC, Giangregorio LM, Alavinia SM, Blencowe LA, Desai N, Hitzig SL, Masani K, Popovic MR. Evaluating the efficacy of functional electrical stimulation therapy assisted walking after chronic motor incomplete spinal cord injury: effects on bone biomarkers and bone strength. J Spinal Cord Med 2017; 40:748-758. [PMID: 28929919 PMCID: PMC5778938 DOI: 10.1080/10790268.2017.1368961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To determine the efficacy of functional electrical stimulation therapy assisted walking (FES-T) compared to a conventional aerobic and resistance training (CONV) with respect to bone biomarkers and lower extremity bone strength outcomes among adults with chronic motor incomplete spinal cord injury (SCI). DESIGN Parallel group randomized controlled trial ( www.clinicaltrials.gov - NCT0020196819). Site: Tertiary academic rehabilitation centre in Canada. METHODS Adults with chronic (≥18 months) motor incomplete SCI (C2-T12 AIS C-D) were consented and randomized to FES-T or CONV training for 45 minutes thrice-weekly for 4 months. Osteocalcin (OC), β-cross laps (CTX) and sclerostin were assessed at baseline, and 4 months. Similarly, total hip, distal femur and proximal tibia region bone mineral density (BMD) via DXA (4500A, Hologic Inc. Waltham, MA, USA) and tibia bone quality via pQCT (Stratec XCT-2000, Mezintecknik, Pforzheim, Germany) were assessed at baseline, 4, and 12 months. Between group differences were analyzed using repeated measures general linear models. RESULTS Thirty-four participants (17 FES-T, 17 CONV) consented and were randomized, 27 participants completed the 4-month intervention and 12-month outcome assessments. Participants in the FES-T arm had a decrease in CTX and a significant increase in OC at intervention completion (P<0.05). Significant biomarker changes were not observed in the CONV group. No within or between group differences from baseline were observed in sclerostin or bone strength. CONCLUSIONS Four months of FES-T improved bone turnover (increase in OC and decrease in CTX) but not bone strength among individuals with chronic SCI. Future, long term FES-T may augment lower extremity bone strength.
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Affiliation(s)
- B. Catharine Craven
- Toronto Rehabilitation Institute - UHN, Toronto, ON, Canada,Department of Medcine, University of Toronto, Toronto, ON, Canada,University of Waterloo, Waterloo, ON, Canada,Correspondence to: B. Catharine Craven, BA, MD, MSc, FRCPC, University Health Network, Toronto Rehab, Lyndhurst Centre, 206J-520 Sutherland Drive, Toronto, ON M4G 3V9 Canada.
| | - Lora M. Giangregorio
- Toronto Rehabilitation Institute - UHN, Toronto, ON, Canada,University of Waterloo, Waterloo, ON, Canada
| | | | | | - Naaz Desai
- Toronto Rehabilitation Institute - UHN, Toronto, ON, Canada
| | - Sander L. Hitzig
- Toronto Rehabilitation Institute - UHN, Toronto, ON, Canada,Sunnybrook Research Institute - Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kei Masani
- Toronto Rehabilitation Institute - UHN, Toronto, ON, Canada,Institute of Biomaterials and Biomedical Engineering BBME, University of Toronto, Toronto, ON, Canada
| | - Milos R. Popovic
- Toronto Rehabilitation Institute - UHN, Toronto, ON, Canada,Institute of Biomaterials and Biomedical Engineering BBME, University of Toronto, Toronto, ON, Canada
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7
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Schulman RC, Moshier EL, Rho L, Casey MF, Godbold JH, Zaidi M, Mechanick JI. INTRAVENOUS PAMIDRONATE IS ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH CHRONIC CRITICAL ILLNESS. Endocr Pract 2016; 22:799-808. [PMID: 26919649 DOI: 10.4158/ep151050.or] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Chronic critical illness (CCI), characterized by prolonged mechanical ventilation and tracheostomy, commonly manifests with elevated bone resorption, which has previously been shown to abate after treatment with intravenous (IV) bisphosphonates. Our study assessed the impact of pamidronate administration on clinical outcomes in a CCI cohort. METHODS A retrospective case series was performed on 148 patients admitted to The Mount Sinai Hospital Respiratory Care Unit (RCU) from 2009-2010. We identified patients with CCI who did (n = 30) or did not (n = 118) receive IV pamidronate (30 to 90 mg). Both groups included patients with normal and abnormal renal function. Pamidronate was administered for elevated urine or serum N-telopeptide, hypercalciuria, or hypercalcemia. RESULTS RCU and 1-year mortality were significantly lower in the pamidronate group (0 and 20%, respectively) compared to nonreceivers (19 and 56%, respectively) (P = .0077 and P = .0004, respectively). After adjusting for differences in baseline creatinine, estimated glomerular filtration rate, and serum calcium, the association with reduced mortality remained significant at 1 year (P = .0132) and with borderline significance for RCU mortality (P = .0911). Creatinine was significantly lower 7 days following pamidronate administration (P = .0025), with no significant difference at 14 days compared to baseline. Pamidronate receivers showed a greater increase in albumin during the RCU stay (2.49 to 3.23 g/dL), compared to nonreceivers (2.43 to 2.64 g/dL) (P = .0007). Pamidronate administration was associated with a significantly reduced rate of hypoglycemia compared to RCU patients not receiving pamidronate (0.09 versus 0.12; P = .0071). CONCLUSION Pamidronate use in a CCI population is associated with reduced mortality, lower hypoglycemia rates, improved albumin, and stable renal function. ABBREVIATIONS BMI = body mass index CCI = chronic critical illness CI = confidence interval CKD = chronic kidney disease CTx = C-telopeptide eGFR = estimated glomerular filtration rate ICU = intensive care unit IV = intravenous NTx = N-telopeptide PMV = prolonged mechanical ventilation RCU = respiratory care unit.
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8
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Abstract
Recent studies of inherited disorders of phosphate metabolism have shed new light on the understanding of phosphate metabolism. Phosphate has important functions in the body and several mechanisms have evolved to regulate phosphate balance including vitamin D, parathyroid hormone and phosphatonins such as fibroblast growth factor-23 (FGF23). Disorders of phosphate homeostasis leading to hypo- and hyperphosphataemia are common and have clinical and biochemical consequences. Notably, recent studies have linked hyperphosphataemia with an increased risk of cardiovascular disease. This review outlines the recent advances in the understanding of phosphate homeostasis and describes the causes, investigation and management of hypo- and hyperphosphataemia.
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Affiliation(s)
- P Manghat
- Department of Chemical Pathology, Darent Valley Hospital, Dartford, UK
| | - R Sodi
- Department of Biochemistry, NHS Lanarkshire, East Kilbride, UK
| | - R Swaminathan
- Department of Chemical Pathology, St. Thomas Hospital, London, UK
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9
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Maïmoun L, Fattal C, Sultan C. Bone remodeling and calcium homeostasis in patients with spinal cord injury: a review. Metabolism 2011; 60:1655-63. [PMID: 21632079 DOI: 10.1016/j.metabol.2011.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/13/2011] [Accepted: 04/16/2011] [Indexed: 01/27/2023]
Abstract
Patients with spinal cord injury exhibit early and acute bone loss with the major functional consequence being a high incidence of pathological fractures. The bone status of these patients is generally investigated by dual-energy x-ray absorptiometry, but this technique does not reveal the pathophysiological mechanism underlying the bone loss. Bone cell activity can be indirectly evaluated by noninvasive techniques, including measurement of specific biochemical markers of bone formation (such as osteocalcin or bone-alkaline phosphatase) and resorption (such as procollagen type I N- or C-terminal propeptide). The bone loss in spinal cord injury is clearly due to an uncoupling of bone remodeling in favor of bone resorption, which starts just after the injury and peaks at about 1 to 4 months. Beyond 6 months, bone resorption activity decreases progressively but remains elevated for many years after injury. Conversely, bone formation is less affected. Antiresorptive treatment induces an early and acute reduction in bone resorption markers. Level of injury and health-related complications do not seem to be implicated in the intensity of bone resorption. During the acute phase, the hypercalcemic status is associated with the suppression of parathyroid hormone and vitamin D metabolites. The high sensitivity of these markers after treatment suggests that they can be used for monitoring treatment efficacy and patient compliance. The concomitant use of bone markers and dual-energy x-ray absorptiometry may improve the physician's ability to detect patients at risk of severe bone loss and subsequent fractures.
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Affiliation(s)
- Laurent Maïmoun
- Département d'Hormonologie, Hôpital Lapeyronie, CHU Montpellier and UMI, 34295 Montpellier, France.
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10
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Abstract
Hypophosphatemia (serum phosphorus concentration <2.5 mg/dl, 0.8 mmol/l), although rare in the general population, is commonly observed in hospitalized patients and may be associated with drug therapy. In fact, hypophosphatemia frequently develops in the course of treatment with drugs used in every-day clinical practice including diuretics and bisphosphonates. Proper diagnostic approach of patients with low serum phosphorus concentrations should involve a detailed medical history with special attention to the recent use of medications. The clinical manifestations of drug-induced hypophosphatemia are usually mild but might also be severe and potentially life-threatening. This review aims at a thorough understanding of the underlying pathophysiological mechanisms and risk factors of drug therapy-related hypophosphatemia thus allowing prevention and effective intervention strategies.
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Affiliation(s)
- G Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
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11
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Abstract
BACKGROUND/OBJECTIVE Bone density loss occurs rapidly after traumatic spinal cord injury (SCI) and is associated with low-energy fractures below the level of injury, commonly occurring around the knee. Bisphosphonates have been tested as potential agents to prevent bone loss after SCI, but no guidelines exist for clinical use of bisphosphonates in these patients. The objective of this study was to systematically review and evaluate evidence quality in studies of bisphosphonate use in patients with post-treatment follow-up of sublesional bone mineral density. METHODS Literature search in MEDLINE/PubMed and ISI database using key words bisphosphonates, spinal cord injury, quadriplegia, paraplegia, and tetraplegia. RESULTS The search identified 6 experimental studies and 1 quasi-experimental study of bisphosphonate therapy in patients with acute and chronic SCI. The studies were small and of fair or poor quality, and none included fracture outcomes. Mild attenuation of bone density loss with acute administration of bisphosphonates after SCI was found at some measurement sites but was not always maintained during follow-up. CONCLUSIONS Data were insufficient to recommend routine use of bisphosphonates for fracture prevention in these patients. Current studies are limited by heterogeneity of patient populations and outcome measures. Uniform bone density measurement sites with rigorous quality control and compliance monitoring are needed to improve reliability of outcomes. Future studies should address specific populations (acute or chronic SCI) and should assess fracture outcomes.
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Affiliation(s)
- Julia E Bryson
- Department of Physical Medicine and Rehabilitation, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27517, USA.
| | - Margaret L Gourlay
- 1Department of Physical Medicine and Rehabilitation, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina; 2Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina; 3School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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12
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Morse LR, Battaglino RA, Stolzmann KL, Hallett LD, Waddimba A, Gagnon D, Lazzari AA, Garshick E. Osteoporotic fractures and hospitalization risk in chronic spinal cord injury. Osteoporos Int 2009; 20:385-92. [PMID: 18581033 PMCID: PMC2640446 DOI: 10.1007/s00198-008-0671-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 05/12/2008] [Indexed: 12/13/2022]
Abstract
UNLABELLED Osteoporosis is a well acknowledged complication of spinal cord injury. We report that motor complete spinal cord injury and post-injury alcohol consumption are risk factors for hospitalization for fracture treatment. The clinical assessment did not include osteoporosis diagnosis and treatment considerations, indicating a need for improved clinical protocols. INTRODUCTION Treatment of osteoporotic long bone fractures often results in lengthy hospitalizations for individuals with spinal cord injury. Clinical features and factors that contribute to hospitalization risk have not previously been described. METHODS Three hundred and fifteen veterans > or = 1 year after spinal cord injury completed a health questionnaire and underwent clinical exam at study entry. Multivariate Cox regression accounting for repeated events was used to assess longitudinal predictors of fracture-related hospitalizations in Veterans Affairs Medical Centers 1996-2003. RESULTS One thousand four hundred and eighty-seven hospital admissions occurred among 315 participants, and 39 hospitalizations (2.6%) were for fracture treatment. Median length of stay was 35 days. Fracture-related complications occurred in 53%. Independent risk factors for admission were motor complete versus motor incomplete spinal cord injury (hazard ratio = 3.73, 95% CI = 1.46-10.50). There was a significant linear trend in risk with greater alcohol consumption after injury. Record review indicated that evaluation for osteoporosis was not obtained during these admissions. CONCLUSIONS Assessed prospectively, hospitalization in Veterans Affairs Medical Centers for low-impact fractures is more common in motor complete spinal cord injury and is associated with greater alcohol use after injury. Osteoporosis diagnosis and treatment considerations were not part of a clinical assessment, indicating the need for improved protocols that might prevent low-impact fractures and related admissions.
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Affiliation(s)
- L R Morse
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA 02118, USA.
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13
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Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J 2007; 6:2. [PMID: 17227589 PMCID: PMC1784104 DOI: 10.1186/1475-2891-6-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 01/16/2007] [Indexed: 12/20/2022] Open
Abstract
Human, animal, and in vitro research indicates a beneficial effect of appropriate amounts of omega-3 (n-3) polyunsaturated fatty acids (PUFA) on bone health. This is the first controlled feeding study in humans to evaluate the effect of dietary plant-derived n-3 PUFA on bone turnover, assessed by serum concentrations of N-telopeptides (NTx) and bone-specific alkaline phosphatase (BSAP). Subjects (n = 23) consumed each diet for 6 weeks in a randomized, 3-period crossover design: 1) Average American Diet (AAD; [34% total fat, 13% saturated fatty acids (SFA), 13% monounsaturated fatty acids (MUFA), 9% PUFA (7.7% LA, 0.8% ALA)]), 2) Linoleic Acid Diet (LA; [37% total fat, 9% SFA, 12% MUFA, 16% PUFA (12.6% LA, 3.6% ALA)]), and 3) alpha-Linolenic Acid Diet (ALA; [38% total fat, 8% SFA, 12% MUFA, 17% PUFA (10.5% LA, 6.5% ALA)]). Walnuts and flaxseed oil were the predominant sources of ALA. NTx levels were significantly lower following the ALA diet (13.20 +/- 1.21 nM BCE), relative to the AAD (15.59 +/- 1.21 nM BCE) (p < 0.05). Mean NTx level following the LA diet was 13.80 +/- 1.21 nM BCE. There was no change in levels of BSAP across the three diets. Concentrations of NTx were positively correlated with the pro-inflammatory cytokine TNFalpha for all three diets. The results indicate that plant sources of dietary n-3 PUFA may have a protective effect on bone metabolism via a decrease in bone resorption in the presence of consistent levels of bone formation.
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Affiliation(s)
- Amy E Griel
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Kirsten F Hilpert
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Guixiang Zhao
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Sheila G West
- Department of Biobehavioral Health, 315 Health & Human Development East, The Pennsylvania State University, University Park, PA 16802, USA
| | - Rebecca L Corwin
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
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