Bilateral Atypical Femur Fractures After Denosumab in a Bisphosphonate Naive Patient: A Case Report

A case report of bilateral atypical femur fractures (AFF) in a bisphosphonate naive patient. A 62-year-old female bisphosphonate naive patient was started on denosumab for osteoporosis. Approximately 3 years later she complained of right hip pain and was found to have a bilateral incomplete AFFs. She was asymptomatic on the left lower limb. Patient was managed conservatively and placed on protected weight bearing on both legs. Symptoms subsequently resolved over a period of 3 months, although radiographic findings remained at approximately 1 year. AFFs may be associated with patients on denosumab therapy even without a prior history of bisphosphonate use. Patients should be counselled appropriately and monitored for such complications.

Radiographic study of the axial and appendicular skeleton of Callithrix jacchus and Callithrix penicillata

BACKGROUND

Marmosets are small arboreal primates. Knowledge of normal radiographic parameters and frequent disorders is limited. The objectives of this study were to evaluate possible variations between quantitative analyses and injuries to the appendicular and axial skeleton of Callithrix jacchus and Callithrix penicillata and their relationship with the environment.

METHODS

Radiographic images of 29 marmosets were used. Skeletal lesions were described, long bones were measured, and pelvimetry, vertebrae, and sternebras were counted.

RESULTS

Measurements of long bones and pelvimetry were similar between species. Evaluation of vertebrae and sternebras exhibited variations relative to the literature. Lesions on the skull, spine, thoracic and pelvic limbs were present in 48%, 54%, 44%, and 52% of marmosets, respectively.

CONCLUSION

Skeletal disorders, especially of traumatic and metabolic origin, have a high prevalence in marmosets.

Identification and Characterization of a Novel Long Noncoding RNA that Regulates Osteogenesis in Diet-Induced Obesity Mice

As a precursor to type 2 diabetes mellitus (T2D), obesity adversely alters bone cell functions, causing decreased bone quality. Currently, the mechanisms leading to alterations in bone quality in obesity and subsequently T2D are largely unclear. Emerging evidence suggests that long noncoding RNAs (lncRNAs) participate in a vast repertoire of biological processes and play essential roles in gene expression and posttranscriptional processes. Mechanistically, the expression of lncRNAs is implicated in pathogenesis surrounding the aggregation or alleviation of human diseases. To investigate the functional link between specific lncRNA and obesity-associated poor bone quality and elucidate the molecular mechanisms underlying the interaction between the two, we first assessed the structure of the bones in a diet-induced obese (DIO) mouse model. We found that bone microarchitecture markedly deteriorated in the DIO mice, mainly because of aberrant remodeling in the bone structure. The results of in vitro mechanistic experiments supported these observations. We then screened mRNAs and lncRNAs from DIO bones and functionally identified a specific lncRNA, Gm15222. Further analyses demonstrated that Gm15222 promotes osteogenesis and inhibits the expression of adipogenesis-related genes in DIO via recruitment of lysine demethylases KDM6B and KDM4B, respectively. Through this epigenetic pathway, Gm15222 modulates histone methylation of osteogenic genes. In addition, Gm15222 showed a positive correlation with the expression of a neighboring gene, BMP4. Together, the results of this study identified and provided initial characterization of Gm15222 as a critical epigenetic modifier that regulates osteogenesis and has potential roles in targeting the pathophysiology of bone disease in obesity and potential T2D.

Middle east pain syndrome is a pollution-induced new disease mimicking rheumatoid arthritis

Musculoskeletal pains are sometimes misdiagnosed in some diseases, like rheumatoid and psoriatic arthritis, erosive OA, etc. Secondary hyperparathyroidism was not considered a differential diagnosis for RA, despite the fact that it can cause arthralgia or arthritis. Also, fibromyalgia is a psychosomatic condition marked by widespread pain and tenderness. This study included 400 patients attended certain outpatient clinics of Rheumatology in Egypt and Saudi Arabia, who were not fulfilling criteria for RA diagnosis. Criteria for classification of fibromyalgia syndrome were applied to all patients. We did lab tests and radiological imaging modalities for diagnosis or exclusion of suspected diseases were applied. All patients were fulfilling both old and new criteria of fibromyalgia syndrome, and not fulfilling any RA criteria, and had vitamin D3 deficiency or insufficiency. 75% of patients had abnormally high levels of PTH, without parathyroid gland pathology. Radiology showed subperiosteal and subchondral resorption of mainly thumbs, subchondral osteopenia of proximal and middle phalanges, mild subperiosteal resorption along the radial aspect of the middle phalanx and mild tuft erosions, besides changes in the carpus closely resembling those of rheumatoid arthritis, of ulnar styloid resorption, radiocarpal and scapho-trapezoid joint arthritis. Of special interest, the presence of tuft spur-like excrescences.

Spotted bones in an osteopoikilosis-related disease (Buschke Ollendorff Syndrome): Identifying this rare condition from the lab to the field

OBJECTIVE

To improve the differential diagnosis of osteopoikilosis in past populations using a clinical case as an example of this rare condition.

MATERIALS

A patient referred to our Genetic Service with suspected Buschke Ollendorff Syndrome after finding a connective nevus.

METHODS

Radiological images from different body regions were accompanied by a genetic study using next-generation sequencing.

RESULTS

Small circular-to-ellipsoid sclerotic lesions were found in the epiphysis and metaphysis of long bones, as well as in the pelvis. These lesions were bilaterally distributed and with well-defined margins, compatible with the characteristics of Buschke Ollendorff Syndrome, bone manifestation osteopoikilosis. A heterozygous mutation on LEMD3 (NM_001167614:c.1918 + 1G > C) was identified by next-generation sequencing. Based on this confirmed case, we have discussed the most probable causes of similar bone lesions found in the archaeological record.

CONCLUSION

It has been demonstrated how a current case of a rare disease can provide useful tools to improve the differential diagnosis of this disease in ancient skeletons.

SIGNIFICANCE

This work underlines the great need for multidisciplinary platforms that integrates clinical research into paleopathology in order to successfully address the study of rare diseases from the past.

LIMITATIONS

Since OPK is only detected by X-rays, suspected cases of this bone lesion will only be identified when radiographs are taken for other purposes.

SUGGESTIONS FOR FURTHER RESEARCH

Retrospective and large-scale studies of radiographs from other research in past populations.

Radiographic evaluation of the forelimbs and hind limbs of marmosets (Callithrix spp.)

BACKGROUND

The maintenance of marmosets in captivity may trigger various disorders. The objective of this study was to provide a radiographic evaluation of the forelimbs and hind limbs of marmosets rescued from illegal wildlife trade and maintained in captivity.

METHODS

Fourteen marmosets were studied.

RESULTS AND CONCLUSIONS

Three marmosets were apparently normal. Of the eleven marmosets with radiographic changes in the hind limbs, five had pelvic narrowing and bilateral varus deviation of the femur, with one suggestive of rickets and another of osteomalacia. The other marmosets showed changes such as malunion of acetabular fracture, transtibial amputation, tibial antecurvatum, and knee osteoarthritis. Six marmosets showed alterations in the forelimbs such as radius fracture, scapulohumeral subluxation, and elbow joint incongruence. In conclusion, 78.57% of the marmosets had bone and/or joint changes detected by plain radiography, which were found predominantly in the hind limbs and without impediment to locomotion in captivity.

Radiographic and histological evidence of metabolic bone disease in gliding leaf frogs (Agalychnis spurrelli)

Bone alterations due to metabolic bone disease in captive animal populations can have a negative impact on repopulation and research initiatives. This investigation has the purpose of describing the principal radiographic and anatomopathological findings present in nine gliding leaf frogs (Agalychnis spurrelli) kept in captivity with alterations in their spines and long bones. The observed histopathological findings were in the canalis vertebralis, paraspinal muscle and long bones, and included deformed bones with alteration of the adjacent tissues, alterations in the ossification process, bone degeneration and resorption, decreased number of osteocytes and deposition of osteoid and fibrous material in the compact bone tissue. Additionally, the spinal cord showed compressed white matter, chronic meningitis in the duramater, alteration in the number of glial cells and loss of delimitation between the gray and white matter. Radiographical changes were found mainly in the long bones and included moth-eaten osteolysis, solid periosteal reaction, bone deformities, cortical tunneling and inflammation of adjacent soft tissues. Also, pathological fractures of the femur and urostyle were observed together with spinal column deviations with increased bone density.