1
|
Celin MR, Simon JC, Krzak JJ, Fial AV, Kruger KM, Smith PA, Harris GF. Do Bisphosphonates Alleviate Pain in Children? A Systematic Review. Curr Osteoporos Rep 2020; 18:486-504. [PMID: 32960409 DOI: 10.1007/s11914-020-00621-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The goal of this systematic review is to analyze the effectiveness of bisphosphonates (BPs) to treat bone pain in children and adolescents who have diseases with skeletal involvement. RECENT FINDINGS We included 24 studies (2 randomized controlled trials, 3 non-randomized controlled trials, 10 non-randomized open-label uncontrolled studies, 8 retrospective studies, and 1 study with design not specified). The majority of included studies assessed pain from a unidimensional approach, with pain intensity the most frequently evaluated dimension. Only 38% of studies used validated tools; visual analogue scale was the most frequently employed. BPs were used to alleviate bone pain in a wide variety of pediatrics conditions such as osteogenesis imperfecta, secondary osteoporosis, osteonecrosis related to chemotherapy, chronic non-bacterial osteitis, idiopathic juvenile osteoporosis, unresectable benign bone tumor, and cancer-related pain. Twenty of the 24 studies reported a positive effect of BPs for alleviating pain in different pathologies, but 58% of the studies were categorized as having high risk of bias. Intravenous BPs are helpful in alleviating bone pain in children and adolescents. It is advised that our results be interpreted with caution due to the heterogeneity of the doses used, duration of treatments, and types of pathologies included. In addition, this review shows the paucity of high-quality evidence in the available literature and further research is needed. TRIAL REGISTRATION Before the completion of this review, the protocol was registered to PROSPERO (International prospective register of systematic reviews), PROSPERO 2020 ID # CRD42020158316. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316.
Collapse
Affiliation(s)
| | - Jackeline C Simon
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Joseph J Krzak
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Alissa V Fial
- Research and Instructional Services, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA
| | - Karen M Kruger
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Peter A Smith
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| |
Collapse
|
2
|
Udomchaiprasertkul W, Kuptanon C, Porntaveetus T, Shotelersuk V. A family with homozygous and heterozygous p.Gly337Ser mutations in COL1A2. Eur J Med Genet 2020; 63:103896. [PMID: 32081708 DOI: 10.1016/j.ejmg.2020.103896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/31/2020] [Accepted: 02/16/2020] [Indexed: 01/09/2023]
Abstract
Osteogenesis imperfecta (OI) is commonly caused by monoallelic mutations in COL1A1 or COL1A2. Biallelic mutations are extremely rare. Only five previous reports have identified seven OI patients with homozygous mutations in COL1A2. OI is a genetically and phenotypically heterogeneous disorder which challenges an establishment of genotype-phenotype correlation. Notably, more than thirty patients with OI possess the heterozygous mutation, p.Gly337Ser, in COL1A2. Their clinical severity ranges from mild OI type I to severe types III and IV. Here, we report a 17-year-old Thai female with recurrent bone fractures, short stature, blue sclerae, triangular face, missing teeth, dentinogenesis imperfecta (DI), skeletal deformities, and scoliosis. She was diagnosed with OI type III. Her parents were second-cousin-once-removed. The father was a professional Thai boxer. Both had normal bone mineral density, no history of bone fractures, and only teeth problems. They were diagnosed with DI without OI. Whole exome sequencing identified that the proband harbored the homozygous mutation, c.1009G > A (p.Gly337Ser), in exon 19 of COL1A2 while her parents were heterozygous for this mutation. This study reports the eighth child with OI and the homozygous mutation in COL1A2; and the first two individuals with the heterozygous p.Gly337Ser mutation in COL1A2 causing an isolated DI without OI.
Collapse
Affiliation(s)
- Wandee Udomchaiprasertkul
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand; Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand; Interdisciplinary Program of Biomedical Sciences, Graduate School, Chulalongkorn University, Bangkok, 10330, Thailand; Molecular Biology and Genomic Research Laboratory, Division of Research and International Relations, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, 10900, Thailand
| | - Chulaluck Kuptanon
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Thantrira Porntaveetus
- Genomics and Precision Dentistry Research Unit, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand; Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
| |
Collapse
|
3
|
Formenti AM, Doga M, Frara S, Ritelli M, Colombi M, Banfi G, Giustina A. Skeletal fragility: an emerging complication of Ehlers-Danlos syndrome. Endocrine 2019; 63:225-230. [PMID: 30554346 DOI: 10.1007/s12020-018-1822-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/21/2018] [Indexed: 12/31/2022]
Abstract
Ehlers-Danlos syndrome (EDS) is an emerging cause of skeletal fragility. Mechanism of bone damage are probably multifactorial in line with the different skeletal phenotypes that can be found in clinical practice. A structured approach to clinical management of bone metabolic complication in EDS is proposed.
Collapse
Affiliation(s)
| | - Mauro Doga
- Vita-Salute San Raffaele University, Milano, Italy
| | | | - Marco Ritelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marina Colombi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe Banfi
- IRCCS, Istituto Ortopedico Galeazzi, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | | |
Collapse
|
4
|
|
5
|
Bowden SA, Akusoba CI, Hayes JR, Mahan JD. Biochemical markers of bone turnover in children with clinical bone fragility. J Pediatr Endocrinol Metab 2016; 29:715-22. [PMID: 27049615 DOI: 10.1515/jpem-2014-0525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The role of biochemical bone turnover markers (BTMs) in assessing low bone mass and monitoring bisphosphonate treatment in pediatric patients with clinical bone fragility is not well established. The aim of the study was to examine the correlations of BTMs and the bone mineral density (BMD), and evaluate the effects of bisphosphonates therapy on BTMs in children with clinical bone fragility. METHODS Clinical data of 115 patients with clinical bone fragility (mean age 9.7±5.8 years), 102 of whom received bisphosphonates, were studied. Serum alkaline phosphatase (ALP), osteocalcin (OC), urine pyridinoline (PD) and deoxypyridinoline (DPD), BMD at baseline and subsequent years were analyzed. RESULTS There was a significant negative correlation between urine PD and lumbar BMD (slope=-0.29, p<0.001). There were no correlations between BTMs and lumbar BMD Z-score. There was a significant positive correlation between serum OC and serum ALP, urine PD and DPD (p<0.001). Serum OC, urine PD and DPD index, as expressed as measured value/upper limit of normal value for age, decreased during the first 3 years of bisphosphonate therapy. CONCLUSIONS In children with clinical bone fragility, BTMs correlated with each other, but not with lumbar BMD Z-score. While they were not reliable predictors of degree of low BMD, the bone markers showed suppression during bisphosphonate therapy and may be helpful in monitoring the response to therapy.
Collapse
|
6
|
Lindahl K, Kindmark A, Rubin CJ, Malmgren B, Grigelioniene G, Söderhäll S, Ljunggren Ö, Åström E. Decreased fracture rate, pharmacogenetics and BMD response in 79 Swedish children with osteogenesis imperfecta types I, III and IV treated with Pamidronate. Bone 2016; 87:11-8. [PMID: 26957348 DOI: 10.1016/j.bone.2016.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/02/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is an inherited heterogeneous bone fragility disorder, usually caused by collagen I mutations. It is well established that bisphosphonate treatment increases lumbar spine (LS) bone mineral density (BMD), as well as improves vertebral geometry in severe OI; however, fracture reduction has been difficult to prove, pharmacogenetic studies are scarce, and it is not known at which age, or severity of disease, treatment should be initiated. MATERIALS AND METHODS COL1A1 and COL1A2 were analyzed in 79 children with OI (type I n=33, type III n=25 and type IV n=21) treated with Pamidronate. Data on LS BMD, height, and radiologically confirmed non-vertebral and vertebral fractures were collected prior to, and at several time points during treatment. RESULTS An increase in LS BMD Z-score was observed for all types of OI, and a negative correlation to Δ LS BMD was observed for both age and LS BMD Z-score at treatment initiation. Supine height Z-scores were not affected by Pamidronate treatment, The fracture rate was reduced for all OI types at all time points during treatment (overall p<0.0003, <0.0001 and 0.0003 for all OI types I, III and IV respectively). The reduced fracture rate was maintained for types I and IV, while an additional decrease was observed over time for type III. The fracture rate was reduced also in individuals with continued low BMD after >4yrs Pamidronate. Twice as many boys as girls with OI type I were treated with Pamidronate, and the fracture rate the year prior treatment was 2.2 times higher for boys (p=0.0236). Greater Δ LS BMD, but smaller Δ fracture numbers were observed on Pamidronate for helical glycine mutations in COL1A1 vs. COL1A2. Vertebral compression fractures did not progress in any individual during treatment; however, they did not improve in 9%, and these individuals were all >11years of age at treatment initiation (p<0.0001). CONCLUSION Pamidronate treatment in children with all types of OI increased LS BMD, decreased fracture rate, and improved vertebral compression fractures. Fracture reduction was prompt and maintained during treatment, irrespective of age at treatment initiation and collagen I mutation type.
Collapse
Affiliation(s)
- K Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - A Kindmark
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Science for Life Laboratory, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - C-J Rubin
- Department of Medical Biochemistry and Microbiology, Uppsala University, Sweden
| | - B Malmgren
- Department of Dental Medicine, Division of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden
| | - G Grigelioniene
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Genetics, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - S Söderhäll
- Neuropediatric unit, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ö Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - E Åström
- Neuropediatric unit, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Biggin A, Zheng L, Briody JN, Coorey CP, Munns CF. The long-term effects of switching from active intravenous bisphosphonate treatment to low-dose maintenance therapy in children with osteogenesis imperfecta. Horm Res Paediatr 2016; 83:183-9. [PMID: 25676713 DOI: 10.1159/000369582] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Intravenous bisphosphonate therapy is the first-line treatment in moderate-to-severe osteogenesis imperfecta (OI), but there are varied treatment protocols with little data on long-term efficacy. This study evaluates the clinical outcomes when transitioning from active bisphosphonate treatment to maintenance therapy. METHODS A retrospective review was conducted on 17 patients before treatment, following active treatment (zoledronate 0.05 mg/kg 6-monthly or pamidronate 6-9 mg/kg/year) and after establishment on maintenance treatment for more than 2 years (zoledronate 0.025 mg/kg 6-monthly or pamidronate <4 mg/kg/year). RESULTS There was a significant reduction in mean fracture rate from 1.5 ± 1.1 fractures/year at baseline to 0.7 ± 0.7 fractures/year on active treatment. Z-scores for lumbar spine bone mineral density, bone mineral content, volumetric bone mineral density and bone mineral content for lean tissue mass increased during active treatment. These improvements were maintained during the period of maintenance treatment. Vertebral height improved in fractured thoracic vertebrae from pre-treatment to active therapy and improved further during maintenance treatment. Metacarpal cortical thickness and relative cortical area also increased over the treatment periods. CONCLUSION Maintenance intravenous bisphosphonate therapy preserved the beneficial effects of active treatment at the doses stated above. Further studies are required to determine the optimal bisphosphonate treatment regimen in the management of children with OI.
Collapse
Affiliation(s)
- Andrew Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Westmead, N.S.W., Australia
| | | | | | | | | |
Collapse
|
8
|
Beecham E, Candy B, Howard R, McCulloch R, Laddie J, Rees H, Vickerstaff V, Bluebond‐Langner M, Jones L. Pharmacological interventions for pain in children and adolescents with life-limiting conditions. Cochrane Database Syst Rev 2015; 2015:CD010750. [PMID: 25768935 PMCID: PMC6481584 DOI: 10.1002/14651858.cd010750.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain is one of the most common symptoms in children and young people (CYP) with life-limiting conditions (LLCs) which include a wide range of diagnoses including cancer. The current literature indicates that pain is not well managed, however the evidence base to guide clinicians is limited. There is a clear need for evidence from a systematic review to inform prescribing. OBJECTIVES To evaluate the evidence on the effectiveness of different pharmacological interventions used for pain in CYP with LLCs. SEARCH METHODS The following electronic databases were searched up to December 2014: CENTRAL (in the Cochrane Library), MEDLINE, EMBASE, PsycINFO and CINAHL. In addition, we searched conference proceedings and reference lists of included studies. For completeness, we also contacted experts in the field. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised studies and other studies that included a clearly defined comparator group were included. The studies investigated pharmacological treatments for pain associated with LLCs in CYP. The treatment included those specifically developed to treat pain and those that acted as an adjuvant, where the treatment was not primarily developed to treat pain but has pain relieving properties. The LLC was identified by its inclusion in the Richard Hain Directory of LLCs. DATA COLLECTION AND ANALYSIS Citations were screened by five review authors. Data were extracted by one review author and checked by a second. Two review authors assessed the risk of bias of included studies. A sufficient number of studies using homogeneous outcomes was not identified so a meta-analysis was not possible. MAIN RESULTS We identified 24,704 citations from our database search. Nine trials with 379 participants fulfilled our inclusion criteria. Participants had cerebral palsy (CP) in five of the studies and osteogenesis imperfecta (OI) in the other four. Participants across the trials ranged in age from 2 to 19 years. All studies, apart from one cross-over trial, were parallel designed RCTs. Three of the trials on CP evaluated intrathecal baclofen (ITB) and two botulinum toxin A (BoNT-A). All of the OI trials evaluated the use of bisphosphonates (two alendronate and one pamidronate). No trials were identified that evaluated a commonly used analgesic in this patient group. Pain was a secondary outcome in five of the eight identified studies. Overall the quality of the trials was mixed. Only one study involved over 100 participants.For the two ITB studies for pain in CP, in the same study population but assessed at different time points in their disease, both found an effect on pain favouring the intervention compared to the control group (standard care or placebo) (mean difference (MD) 4.20, 95% confidence interval (CI) 2.15 to 6.25; MD 26.60, 95% CI 2.61 to 50.59, respectively). In these studies most of the adverse events related to the procedure or device for administration rather than the drug, such as swelling at the pump site. In one trial there were also eight serious adverse effects; these included difficulty swallowing and an epileptic seizure. The trial did not state if these occurred in the intervention group. At follow-up in both BoNT-A trials there was no evidence of a difference in pain between the trial arms among CP participants. The adverse events in the BoNT-A trials mostly involved those who received the intervention drug and involved seizures. Gastrointestinal problems were the most frequent adverse event in those who received alendronate. The trial investigating pamidronate found no evidence of a difference in pain compared to the control group. No adverse events were reported in this trial. AUTHORS' CONCLUSIONS Published, controlled evidence on the pharmacological interventions for pain in CYP with LLCs is limited. The evidence that is currently available evaluated pain largely as a secondary outcome and the drugs used were all adjuvants and not always commonly used in general paediatric palliative care for pain. Based on current data this systematic review is unable to determine the effects of pharmacological interventions for pain for CYP with LLCs. Future trials with larger populations should examine the effects of the drugs commonly used as analgesics; with the rising prevalence of many LLCs this becomes more necessary.
Collapse
Affiliation(s)
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | - Richard Howard
- Great Ormond Street HospitalAnaesthesia and Pain ManagementGreat Ormond StreetLondonUKWC1N 3JH
| | - Renée McCulloch
- Great Ormond Street HospitalLouis Dundas Centre for Children's Palliative Care, Palliative Care TeamLondonUK
| | - Jo Laddie
- Evelina London Children's HospitalDepartment of Paediatric Palliative MedicineLondonUK
| | - Henrietta Rees
- UCL Institute of Child HealthLouis Dundas Centre for Children's Palliative CareLondonUK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | | | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| |
Collapse
|
9
|
D'Eufemia P, Finocchiaro R, Villani C, Zambrano A, Lodato V, Palombaro M, Properzi E, Celli M. Serum brain-type creatine kinase increases in children with osteogenesis imperfecta during neridronate treatment. Pediatr Res 2014; 75:626-30. [PMID: 24518563 DOI: 10.1038/pr.2014.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/09/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Creatine kinase (Ck) catalyzes the reversible transfer of high-energy phosphate groups between adenosine triphosphate and phosphocreatine. The brain isoform (Ckbb) is greatly induced in mature osteoclasts, playing an important role in bone-resorbing function during osteoclastogenesis. High Ckbb serum level has been found in patients with osteopetrosis and in patients with bisphosphonate (BP)-induced osteopetrosis. BPs are considered the treatment of choice for children with osteogenesis imperfecta (OI), acting as potent inhibitors of bone resorption by suppressing the activity of osteoclasts. METHODS We determined total serum Ck and isoform activity in 18 prepubertal children with type I OI, before and during treatment with the BP neridronate infusions. RESULTS Basal serum Ckbb levels were slightly elevated with respect to controls (mean ± SD = 3.0 ± 2.7 vs. 2.0 ± 2.2) and progressively increased after neridronate treatment (t0 vs. t4: mean ± SD = 3.0 ± 2.7 to 10.8 ± 8.1), with significant increment after first, second, and fourth infusions (P < 0.01). An inverse correlation was found between serum Ckbb and serum CTx at basal level. CONCLUSION Our results support previous observations that increased serum Ckbb reflects failure of osteoclasts or, at least, suppression of osteoclasts. Upon considering that BPs are long acting, this information could be useful to prevent the risk of overtreatment after long-term BP exposure in pediatric patients with OI.
Collapse
Affiliation(s)
| | | | - Ciro Villani
- Department of Orthopaedics and Traumatology, "Sapienza", University of Rome, Rome, Italy
| | - Anna Zambrano
- Department of Pediatrics, "Sapienza", University of Rome, Rome, Italy
| | - Valentina Lodato
- Department of Pediatrics, "Sapienza", University of Rome, Rome, Italy
| | - Marta Palombaro
- Department of Pediatrics, "Sapienza", University of Rome, Rome, Italy
| | - Enrico Properzi
- Department of Pediatrics, "Sapienza", University of Rome, Rome, Italy
| | - Mauro Celli
- Department of Pediatrics, "Sapienza", University of Rome, Rome, Italy
| |
Collapse
|
10
|
Borrego E, Farrington D, Downey F. Advances in bone dysplasias. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
11
|
[Advances in bone dysplasias]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:171-81. [PMID: 24731388 DOI: 10.1016/j.recot.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/12/2013] [Accepted: 12/16/2013] [Indexed: 11/24/2022] Open
Abstract
The prevalence of bone dysplasias is estimated to be one case per 1,000 inhabitants, which suggests that, at some point in the career of an orthopaedic surgeon, he will face with one of these patients. The aim of this paper is to review the general aspects of bone dysplasias and focus on those, which due to their frequency and importance, we consider most relevant (achondroplasia, multiple epiphyseal dysplasia, spondyloepiphyseal dysplasia, osteogenesis imperfecta), reviewing their fundamental features and the latest therapeutic advances. There is no cure for these diseases, so early diagnosis and appropriate therapeutic management, becomes the key to improving quality of life of these patients.
Collapse
|
12
|
Lin D, Zhai W, Lian K, Ding Z. Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta. Indian J Orthop 2013; 47:377-81. [PMID: 23960282 PMCID: PMC3745692 DOI: 10.4103/0019-5413.114922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Children with osteogenesis imperfecta (OI) can suffer from frequent fractures and limb deformities, resulting in impaired ambulation. Osteopenia and thin cortices complicate orthopedic treatment in this group. This study evaluates the clinical results of a bone splint technique for the treatment of lower limb deformities in children with type I OI. The technique consists of internal plating combined with cortical strut allograft fixation. MATERIALS AND METHODS We prospectively followed nine children (five boys, four girls) with lower limb deformities due to type I OI, who had been treated with the bone splint technique (11 femurs, four tibias) between 2003 and 2006. The fracture healing time, deformity improvement, ambulation ability and complications were recorded to evaluate treatment effects. RESULTS At the time of surgery the average age in our study was 7.7 years (range 5-12 years). The average length of followup was 69 months (range 60-84 months). All patients had good fracture healing with an average healing time of 14 weeks (range 12-16 weeks) and none experienced further fractures, deformity, or nonunion. The fixation remained stable throughout the procedure in all cases, with no evidence of loosening or breakage of screws and the deformity and mobility significantly improved after surgery. Of the two children confined to bed before surgery, one was able to walk on crutches and the other needed a wheelchair. The other seven patients could walk without walking aids or support like crutches. CONCLUSIONS These findings suggest that the bone splint technique provides good mechanical support and increases the bone mass. It is an effective treatment for children with OI and lower limb deformities.
Collapse
Affiliation(s)
- Dasheng Lin
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopedic Center of People's Liberation Army, Zhangzhou - 363000, China
| | - Wenliang Zhai
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopedic Center of People's Liberation Army, Zhangzhou - 363000, China
| | - Kejian Lian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopedic Center of People's Liberation Army, Zhangzhou - 363000, China
| | - Zhenqi Ding
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopedic Center of People's Liberation Army, Zhangzhou - 363000, China,Address for correspondence: Dr. Zhenqi Ding, Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopedic Center of People's Liberation Army, Zhangzhou - 363000, China. E-mail:
| |
Collapse
|
13
|
Vasconcelos ACU, de Azambuja Berti-Couto S, Figueiredo MA, Salum FG, Lopes TG, Cherubini K. Laboratory methods and biomarkers in the evaluation of bisphosphonate effects on body tissues: a literature review. J Oral Pathol Med 2012; 42:577-86. [PMID: 23278676 DOI: 10.1111/jop.12031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2012] [Indexed: 01/06/2023]
Affiliation(s)
- Ana Carolina Uchoa Vasconcelos
- Postgraduate Program; Dental College; Pontifical Catholic University of Rio Grande do Sul - PUCRS; Porto Alegre RS Brazil
| | - Soraya de Azambuja Berti-Couto
- Postgraduate Program; Dental College; Pontifical Catholic University of Rio Grande do Sul - PUCRS; Porto Alegre RS Brazil
| | - Maria Antonia Figueiredo
- Postgraduate Program; Dental College; Pontifical Catholic University of Rio Grande do Sul - PUCRS; Porto Alegre RS Brazil
| | - Fernanda Gonçalves Salum
- Postgraduate Program; Dental College; Pontifical Catholic University of Rio Grande do Sul - PUCRS; Porto Alegre RS Brazil
| | - Tiago Giuliani Lopes
- Department of Pathology; School of Medicine; Hospital São Lucas; Pontifical Catholic University of Rio Grande do Sul - PUCRS; Porto Alegre RS Brazil
| | - Karen Cherubini
- Postgraduate Program; Dental College; Pontifical Catholic University of Rio Grande do Sul - PUCRS; Porto Alegre RS Brazil
| |
Collapse
|
14
|
Ipach I, Kluba T, Wolf P, Pontz B, Mittag F. The influence of ibandronate treatment on bone density and biochemical bone markers in patients with osteogenesis imperfecta. Orthop Rev (Pavia) 2012; 4:e29. [PMID: 23066497 PMCID: PMC3470035 DOI: 10.4081/or.2012.e29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/21/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by different signs including increased bone fragility, short stature, blue sclera, abnormal tooth growth and often secondary immobility. No curative therapy has been found for this rare disease up to now, and different pharmacological substances have been tried as treatment for severe forms of OI. Promising results were seen with intravenous bisphosphonates in the treatment of patients with OI. The aim of present study was to show the effect of intravenous ibandronate therapy on bone density and bone metabolism markers. We analyzed the data of 27 patients with the diagnosis of OI who were treated off-label with intravenous ibandronate. Ibandronate was administered by intravenous infusion every three months at a dosage of 0.3-2 mg. Bone turnover markers and bone density were measured before starting therapy and every three months during treatment. Bone density was measured by using an ultrasound imaging system providing an accurate image of the calcaneus and by evaluating broadband ultrasound attenuation (BUA). Twenty-seven patients were treated with intravenous ibandronate during the observation period. 18 were female. The mean age of all patients was 23.9 years ± 19.6 (range 4-63). Seventeen patients were categorized to have OI Type I, 5 patients to have OI Type III and 5 patients to have OI Type IV. There was a statistically significant decrease in total alkaline phosphatase (P<0.0001). We detected also a statistically significant decrease in the ratio urinary deoxypyridinoline/urinary creatinine (P=0.0048) and the ratio urinary pyridinoline/urinary creatinine (P<0.0001) respectively. There was also a statistically significant increase in serum magnesium (P=0.034) and BUA (P=0.0071). No statistically significant changes were seen for total serum calcium (P=0.16), the ratio of urine calcium/urine creatinine (P=0.29), alkaline phosphatase (isoform bone) (P=0.3), procollagen-I-peptide (P=0.5), osteocalcin (P=0.9), serum phosphatase (P=0.71), parathormone (P=0.11) and the ratio urine phosphatase/urine creatinine (P=0.58) Therapy with ibandronate in patients with OI leads to a normalisation of bone turnover markers and increasing bone density. Therefore serum alkaline phosphatase and bone density are possible parameters to monitor bisphosphonate treatment in patients with OI.
Collapse
Affiliation(s)
- Ingmar Ipach
- Department of Orthopaedic Surgery, Tuebingen University Hospital, Tuebingen
| | - Torsten Kluba
- Department of Orthopaedic Surgery, Tuebingen University Hospital, Tuebingen
| | - Petra Wolf
- Department of Medical Statistics and Epidemiology, Technical University of Munich
| | - Bertram Pontz
- Technical University of Munich Children's Hospital, Munich, Germany
| | - Falk Mittag
- Department of Orthopaedic Surgery, Tuebingen University Hospital, Tuebingen
| |
Collapse
|
15
|
Hautmann AH, Elad S, Lawitschka A, Greinix H, Bertz H, Halter J, Faraci M, Hofbauer LC, Lee S, Wolff D, Holler E. Metabolic bone diseases in patients after allogeneic hematopoietic stem cell transplantation: report from the Consensus Conference on Clinical Practice in chronic graft-versus-host disease. Transpl Int 2011; 24:867-79. [PMID: 21557780 DOI: 10.1111/j.1432-2277.2011.01264.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
With improved outcome of allogeneic stem cell transplantation (allo-SCT) for hematologic malignancies, long-term complications gain greater importance. Skeletal complications such as osteoporosis or avascular necrosis (AVN) occur frequently in allogeneic recipients with a cumulative incidence of diminished bone mineral density of 24-50% between 2 and 12 months after allo-SCT and a cumulative incidence of AVN in as many as 19% of patients 3 years after allo-SCT. Here, we present a review as part of the German, Austrian, and Swiss Consensus Conference on clinical practice in chronic graft-versus-host disease, held 2009 in Regensburg. The Consensus Conference aimed to achieve a consensus on the current evidence of diagnosis, prevention, and therapeutic options of late complications after allo-SCT summarizing and discussing the literature on these topics. In this report, we provide recommendations for metabolic bone diseases agreed upon by the working party. This includes guidelines for diagnosis, prevention, and therapeutic options in patients with low bone mass or AVN.
Collapse
Affiliation(s)
- Anke Heidewig Hautmann
- Department of Hematology and Oncology, University of Regensburg, F.J Strauss Allee 11, Regensburg, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|