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Haumann SK, Sørensen JR, Schmidt JH, Folkestad L. The PATCH study: Prevalence of Hearing Loss During Ageing and Treatment Choices in Osteogenesis Imperfecta: A Danish Nationwide Register-Based Cohort Study. Calcif Tissue Int 2024:10.1007/s00223-024-01253-w. [PMID: 39012488 DOI: 10.1007/s00223-024-01253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/27/2024] [Indexed: 07/17/2024]
Abstract
Osteogenesis imperfecta (OI) is a group of rare hereditary collagen disorders. Hearing loss (HL) is a known complication linked to changes in the bones of the middle ear seen in OI. We aimed to determine the prevalence, age at debut, incidence, and risk of HL, surgery on bones of the middle ear, and use of hearing aids. A Danish nationwide, register-based cohort study. Data were extracted from the Danish National Patient register. Anyone with an OI diagnosis between January 1st 1977 and December 31st 2018, matched 1:5 with a reference population (Ref.Pop) on birthyear and sex, were included. 864 persons (487 women) with OI were included in the study and 4276 (2330 women) in the Ref.Pop. The sub-hazard ratio (SHR) for any HL was 4.56 [95% CI 3.64-5.71], with a prevalence of 17.0% and 4.0% in the OI cohort and Ref.Pop. Median age at debut was 42 and 58 years, respectively. The risk of otosclerosis and/or surgery was higher in the OI cohort (SHR 22.51 [95% CI 12.62-40.14]), with a median age at debut of 43 and 32 years in the OI cohort and Ref.Pop, respectively. Hearing aid use was more frequent in the OI cohort (SHR 4.16 [95% CI 3.21-5.40]) than in the Ref.Pop. The median age at debut was 45 and 60 years in the OI cohort and Ref.Pop, respectively. Persons with OI have a higher risk and prevalence of HL, hearing aids, and surgery, debuting younger, and prevalence increases with age.
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Affiliation(s)
- Sara Kretzschmar Haumann
- Department of Endocrinology, Bone and Mineral Unit, Odense University Hospital, Kløvervænget 6, 5 Floor, 5000, Odense C, Denmark
| | - Jesper Roed Sørensen
- Department of ORL-Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Hvass Schmidt
- Department of ORL-Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Bone and Mineral Unit, Odense University Hospital, Kløvervænget 6, 5 Floor, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Eylon S, Kornitzer E, Wever C, Rigbi A, Weiss PL, Meyer S. Reducing fracture incidence in children with osteogenesis imperfecta: contribution of orthotics to bisphosphonates treatment. Disabil Rehabil 2024; 46:1416-1421. [PMID: 37067232 DOI: 10.1080/09638288.2023.2198259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/25/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To determine whether there was a reduction in fracture incidence amongst children with OI who were treated with both bisphosphonates and orthoses. OBJECTIVE Was there an additional reduction in fracture incidence amongst children with Osteogenesis Imperfecta (OI) treated with both bisphosphonates and Hip-Knee-Ankle-Foot-Orthosis (HKAFO)? MATERIALS AND METHODS Of the 129 OI patients treated from 1990 to 2017, retrospective data from 48 patients who participated in the bisphosphonates-orthosis regime were analyzed including the incidence of fractures and modalities of fracture treatment. RESULTS Bisphosphonates usage was more frequent than bracing and there were more positive changes (smaller or equal number of fractures each year) than negative changes (more fractures each year); negative changes were scarce, explained by non-compliance with the use of bracing. Poisson regression models were significant for positive changes, whereas the interaction between them was borderline significant. The main finding is that the association between bisphosphonates usage and the number of positive changes was stronger among the patients who used braces more frequently and weaker among patients who used bracing less frequently. CONCLUSIONS Bracing of OI patients has an additive effect on bisphosphonate treatment in fracture prevention which should lead to the reconsideration of a hybrid approach to OI management.
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Affiliation(s)
- S Eylon
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - E Kornitzer
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - C Wever
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - A Rigbi
- Beit Berl College, Faculty of Education, Kfar-Saba, Israel
| | - P L Weiss
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - S Meyer
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
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Dattagupta A, Petak S. Osteoporosis Improved by Romosozumab Therapy in a Patient With Type I Osteogenesis Imperfecta. AACE Clin Case Rep 2023; 9:209-212. [PMID: 38045794 PMCID: PMC10690408 DOI: 10.1016/j.aace.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background/Objective Osteogenesis imperfecta (OI) is a genetic disorder that affects type 1 collagen synthesis causing increased bone fragility, low bone mass, and skeletal deformity. Bisphosphonates are recommended for treatment of OI patients; however, the efficacy of sclerostin inhibitors such as romosozumab has not been determined in OI patients with osteoporosis. Case Report A 52-year-old G2P2 clinically diagnosed with OI, with a history of multiple fractures beginning in childhood presented with low bone mass. On physical examination, blue sclera was observed. She was previously treated with alendronate therapy from April 2014 to June 2015 without significant improvement in bone mineral density (BMD). After the onset of menopause, she began romosozumab 210 mg subcutaneous therapy once a month for 12 months. Repeat dual-energy X-ray absorptiometry showed an increase of 10.3% in BMD of the spine and a 5.4% increase in BMD of the right hip. The trabecular bone score increased by 5.2%. Discussion Current literature is limited regarding the use of sclerostin inhibitors in OI patients. Our patient's improvement in BMD of the spine and right hip after romosozumab therapy was significant at a 95% confidence level, compared to treatment initiation. Her trabecular bone score also improved significantly. Six months into our patient's treatment course, a case in Japan of a male with severe osteoporotic OI and recurrent fractures showed improvement in BMD after romosozumab therapy. Conclusion This case highlights our patient's significant response to romosozumab and warrants further investigation of romosozumab as a potential treatment option for OI patients with osteoporosis.
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Affiliation(s)
- Antara Dattagupta
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Houston Methodist Hospital, Houston, Texas
- Washington University School of Medicine, Department of Medicine, St. Louis, Missouri
| | - Steven Petak
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Houston Methodist Hospital, Houston, Texas
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Storoni S, Treurniet S, Maugeri A, Pals G, van den Aardweg JG, van der Pas SL, Elting MW, Kloen P, Micha D, Eekhoff EMW. Prevalence and Hospital Admissions in Patients With Osteogenesis Imperfecta in The Netherlands: A Nationwide Registry Study. Front Endocrinol (Lausanne) 2022; 13:869604. [PMID: 35546999 PMCID: PMC9082351 DOI: 10.3389/fendo.2022.869604] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/25/2022] [Indexed: 11/21/2022] Open
Abstract
Osteogenesis Imperfecta (OI) is a complex disease caused by genetic alterations in production of collagen type I, and collagen-related proteins. Bone fragility is the most common patient issue, but extraskeletal complications also present an adverse factor in the quality of life and prognosis of patients with OI. However, still little is known about the morbidity and mortality of these patients. The objective of this paper is to determine and describe to what extent OI impacts patients' life in terms of hospitalization and complications describing the incidence and prevalence of the Dutch cohort of OI patients and the characteristics of their hospital admissions. Information regarding OI patients and their hospital admission was extracted from the Statistics Netherlands Database and matched to the OI Genetics Database of Amsterdam UMC. Hospital admission data was available for 674 OI patients. This OI nationwide registry study shows that the life expectancy of OI patients is adversely affected by the disease. The median annual incidence risk of OI between 1992 and 2019 was 6.5 per 100,000 live births. Furthermore, patients with OI had a 2.9 times higher hospitalization rate compared to the general Dutch population. The highest hospitalization rate ratio of 8.4 was reported in the patient group between 0 and 19 years old. OI type and severity had impact on extraskeletal manifestations, which play a key role in the numerous hospital admissions. More awareness about the impact of OI on patients' life is needed to improve and implement prevention and follow-up guidelines.
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Affiliation(s)
- Silvia Storoni
- Department of Internal Medicine, Section Endocrinology, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Sanne Treurniet
- Department of Internal Medicine, Section Endocrinology, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Alessandra Maugeri
- Department of Human Genetics, Amsterdam Movement Sciences, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Gerard Pals
- Department of Human Genetics, Amsterdam Movement Sciences, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Joost G. van den Aardweg
- Department of Respiratory Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, Netherlands
| | - Stéphanie L. van der Pas
- Department of Epidemiology and Data Science (EDS), Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Mariet W. Elting
- Department of Human Genetics, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Peter Kloen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location AMC, Amsterdam, Netherlands
| | - Dimitra Micha
- Department of Human Genetics, Amsterdam Movement Sciences, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Elisabeth Marelise W. Eekhoff
- Department of Internal Medicine, Section Endocrinology, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
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I D, Aysina V. The coincidence of benign non-familial infantile seizures type 2 with osteogenesis imperfecta type 1. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:128-131. [DOI: 10.17116/jnevro2022122051128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Storoni S, Treurniet S, Micha D, Celli M, Bugiani M, van den Aardweg JG, Eekhoff EMW. Pathophysiology of respiratory failure in patients with osteogenesis imperfecta: a systematic review. Ann Med 2021; 53:1676-1687. [PMID: 34569391 PMCID: PMC8477932 DOI: 10.1080/07853890.2021.1980819] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/09/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Respiratory failure is a major cause of death in patients with Osteogenesis Imperfecta. Moreover, respiratory symptoms seem to have a dramatic impact on their quality of life. It has long been thought that lung function disorders in OI are mainly due to changes in the thoracic wall, caused by bone deformities. However, recent studies indicate that alterations in the lung itself can also undermine respiratory health. OBJECTIVES Is there any intrapulmonary alteration in Osteogenesis Imperfecta that can explain decreased pulmonary function? The aim of this systematic literature review is to investigate to what extent intrapulmonary or extrapulmonary thoracic changes contribute to respiratory dysfunction in Osteogenesis Imperfecta. METHODS A literature search (in PubMed, Embase, Web of Science, and Cochrane), which included articles from inception to December 2020, was performed in accordance with the PRISMA guidelines. RESULTS Pulmonary function disorders have been described in many studies as secondary to scoliosis or to thoracic skeletal deformities. The findings of this systematic review suggest that reduced pulmonary function can also be caused by a primary pulmonary problem due to intrinsic collagen alterations. CONCLUSIONS Based on the most recent studies, the review indicates that pulmonary defects may be a consequence of abnormal collagen type I distorting the intrapulmonary structure of the lung. Lung function deteriorates further when intrapulmonary defects are combined with severe thoracic abnormalities. This systematic review reveals novel findings of the underlying pathological mechanism which have clinical and diagnostic implications for the assessment and treatment of pulmonary function disorders in Osteogenesis Imperfecta.KEY MESSAGESDecreased pulmonary function in Osteogenesis Imperfecta can be attributed to primary pulmonary defects due to intrapulmonary collagen alterations and not solely to secondary problems arising from thoracic skeletal dysplasia.Type I collagen defects play a crucial role in the development of the lung parenchyma and defects, therefore, affect pulmonary function. More awareness is needed among physicians about pulmonary complications in Osteogenesis Imperfecta to develop novel concepts on clinical and diagnostic assessment of pulmonary functional disorders.
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Affiliation(s)
- S. Storoni
- Section Endocrinology, Department of Internal Medicine, Amsterdam Bone Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - S. Treurniet
- Section Endocrinology, Department of Internal Medicine, Amsterdam Bone Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D. Micha
- Department of Human Genetics, Amsterdam Movement Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M. Celli
- Department of Rare Bone Metabolism Center, Pediatric Department, Sapienza University of Rome, Rome, Italy
| | - M. Bugiani
- Department of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - J. G. van den Aardweg
- Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - E. M. W. Eekhoff
- Section Endocrinology, Department of Internal Medicine, Amsterdam Bone Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Oral health-related quality of life in children with osteogenesis imperfecta. Eur Arch Paediatr Dent 2021; 23:261-270. [PMID: 34799841 PMCID: PMC8994709 DOI: 10.1007/s40368-021-00664-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/27/2021] [Indexed: 11/03/2022]
Abstract
Purpose Osteogenesis imperfecta (OI) results from mutations in the genes involved in the modification or biosynthesis of collagen. This study aimed to assess the oral health-related quality of life (OHRQoL) in children with OI. Methodology Participants were recruited from a highly specialised OI centre for children. The Child Oral-Health Impact Profile—Short Form (COHIP-SF) was used, adding demographic and qualitative questions. Children aged 8–16 years participated between January and October 2019. Statistical analysis was carried out. A higher COHIP-SF score indicates better OHRQoL (maximum score, 76). Results One hundred and six (106) children participated (44 female, mean age 11.93 years). COHIP-SF median score was 59. Children reporting mild OI (n = 55) had higher median scores (62) compared to severe OI (n = 7) with median scores of 55 (P = 0.087). When comparing mixed (< 12 years, n = 46) and permanent dentition (≥ 12, n = 60), no significant difference in OHRQoL was seen (P = 0.977). There was no significant difference between severities for each COHIP-SF domain. Limited data on the presence of dentinogenesis imperfecta did not impact overall score (P = 0.109), but was significant in the oral-health domain (P = 0.033). Qualitative Common themes were the need for braces, discolouration, pain and function. Conclusion This study confirmed that children with OI have dental concerns in areas including oral health, functional well-being and socio-emotional well-being. This was related to severity of OI.
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Lai Y, Lu W, Mao H, Zhang Y, Ming WK, Wu Y. Knowledge, attitude and practices regarding health self-management among patients with osteogenesis imperfecta in China: an online cross-sectional survey. BMJ Open 2021; 11:e046286. [PMID: 34580090 PMCID: PMC8477317 DOI: 10.1136/bmjopen-2020-046286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Assessing the knowledge, attitude and practices (KAP) regarding health self-management among patients with osteogenesis imperfecta (OI) in China. DESIGN An online cross-sectional survey. SETTING A structured questionnaire was distributed online through China-Dolls Center for Rare Disorders (CCRD), a non-governmental charity in China. PARTICIPANTS Participants were all patients with OI from CCRD. After stratified sampling according to the economic level of residential city, 901 patients were proportionally selected and 869 patients completed the survey (response rate: 96.4%). MAIN OUTCOME MEASURES Demographic characteristics and KAP information were gathered using a 5-point Likert scale. The score of each dimension of KAP was the sum of the scores of all included items. Χ2 test or Fisher's exact test was used to compare scores of different items. Ordinal regression was employed to determine the significant factors influencing KAP. RESULTS A total of 802 questionnaires were included for analysis. Male respondents accounted for 57.1%, and 29.1% of respondents were of 26~30 years. More than half (50~60%) of patients knew the main symptoms of OI and the treatment of OI-related complications. Almost 80% of patients showed positive attitude. Nearly 60~70% of the patients were relatively able to take appropriate practice regarding OI management. There was a significant correlation between scores of knowledge and attitude, attitude and practice, as well as knowledge and practice. Patients aged 26~30 years, from urban areas and big cities, had higher KAP scores. Male patients showed better performance in knowledge, and highly educated patients perform better in practice. CONCLUSIONS Patients with OI did not have sufficient knowledge on disease care and up-to-date caring guidelines, and their practice regarding health self-management also needs to be improved. Gender, age, educational level and economic level of residence can affect the level of KAP for patients, thus developing targeted and tailored programmes for patients with OI is highly recommended.
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Affiliation(s)
- Yongjie Lai
- School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong, China
| | - Wenchao Lu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Beijing, China
| | - Huijia Mao
- School of Pharmaceutical Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Yueyang Zhang
- School of Public Health, Shandong University, Jinan, Shandong, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Yibo Wu
- Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Health Culture Research Center of Shaanxi, Xi'an, Shaanxi, China
- School of Public Health, Peking University, Beijing, China
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Tse MY, Porter IR, Demeter E, Behling-Kelly E, Wakshlag JJ, Miller AD. Osteogenesis Imperfecta in Two Finnish Lapphund Puppies. VETERINARY MEDICINE-RESEARCH AND REPORTS 2021; 12:177-185. [PMID: 34168973 PMCID: PMC8216744 DOI: 10.2147/vmrr.s308418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022]
Abstract
Two 8-week-old Finnish Lapphund dogs presented with pain on manipulation, abnormal long bone conformation, retrognathism, and stunted growth compared to their litter mates. Multiple long bone fractures were evident on radiographs. Clinical pathology showed an atypically normal serum alkaline phosphatase activity for dogs this age. Due to poor quality of life, the dogs were humanely euthanized and subjected to a complete necropsy. On necropsy, all bones were soft and easily broken. Histologic examination revealed that the secondary spongiosa was diminished with abnormal bony trabeculae embedded in abundant loose vascular stroma. No Haversian canals were observed and the cortices contained abundant woven bone separated by fibrovascular tissue consistent with the diagnosis of osteogenesis imperfecta (OI). Inbreeding of the sire and female offspring led to a suspicion of recessive inheritance and the particular genetic collagen disorder remains to be identified in this breed.
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Affiliation(s)
- Ming Yi Tse
- City University of Hong Kong, Jockey Club College of Veterinary Medicine and Life Sciences, Hong Kong, 999077, People's Republic of China
| | - Ian R Porter
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY, 14850, USA
| | - Elena Demeter
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Section of Anatomic Pathology, Ithaca, NY, 14853, USA
| | - Erica Behling-Kelly
- Cornell University College of Veterinary Medicine, Department of Population Medicine, Ithaca, NY, 14853, USA
| | - Joseph J Wakshlag
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY, 14850, USA
| | - Andrew D Miller
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Section of Anatomic Pathology, Ithaca, NY, 14853, USA
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Kolovos S, Javaid MK, Pinedo-Villanueva R. Hospital admissions of patients with osteogenesis imperfecta in the English NHS. Osteoporos Int 2021; 32:1207-1216. [PMID: 33411004 PMCID: PMC8128734 DOI: 10.1007/s00198-020-05755-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
UNLABELLED Hospital use by patients with osteogenesis imperfecta was largely unknown. This study found that the English NHS provides a significant number of hospital admissions to these patients, translating into large costs to the NHS. Admissions and costs both increased over time. Children under 14 years old accounted for more of the admissions and costs than any other age group. INTRODUCTION The aim of this study was to characterise hospital use by patients with osteogenesis imperfecta (OI) in the English National Health Service (NHS). METHODS Routinely collected aggregate data about all inpatient hospital records from patients with OI were used for the period 1 April 2014 to 31 March 2018. Information was extracted on number of admissions, number of patients, length of stay, and costs. Hospital use was summarised using descriptive statistics, categorising patients into 5-year age groups. RESULTS There were 16,245 hospital admissions for OI patients during the analysis period, with a total cost to the NHS of £24,052,451. Of the 4370 patients involved, 2700 (62%) were female. Female patients averaged 3.3 admissions per year and male patients 4.4 admissions per year. Patients aged 0 to 14 years old accounted for 54% of all admissions. Those aged 90 to 94 years had the longest average length of stay per admission (10.5 days) of any age group. Elective admissions cost on average £1260 and non-elective admissions £2529. Over the 4-year study period, number of admissions increased on average by 2.1% per year and number of patients by 6.4% per year. CONCLUSION The treatment of patients with OI is associated with a significant number of hospital admissions at an important cost for the NHS, with both number of admissions and costs increasing over time. Children below the age of 14 years had more admissions at a greater total cost than other ages, while the oldest adults had longer average stays and higher costs per admission.
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Affiliation(s)
- S Kolovos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - R Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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Duangchan T, Tawonsawatruk T, Angsanuntsukh C, Trachoo O, Hongeng S, Kitiyanant N, Supokawej A. Amelioration of osteogenesis in iPSC-derived mesenchymal stem cells from osteogenesis imperfecta patients by endoplasmic reticulum stress inhibitor. Life Sci 2021; 278:119628. [PMID: 34015290 DOI: 10.1016/j.lfs.2021.119628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022]
Abstract
AIM Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder primarily caused by mutations in COL1A1 or COL1A2, which encode type I collagen. These mutations affect the quantity and/or quality of collagen composition in bones, leading to bone fragility. Currently, there is still a lack of treatment that addresses disease-causing factors due to an insufficient understanding of the pathological mechanisms involved. MAIN METHODS Induced pluripotent stem cells (iPSCs) were generated from OI patients with glycine substitution mutations in COL1A1 and COL1A2 and developed into mesenchymal stem cells (iPS-MSCs). OI-derived iPS-MSCs underwent in vitro osteogenic induction to study cell growth, osteogenic differentiation capacity, mRNA expression of osteogenic and unfolded protein response (UPR) markers and apoptosis. The effects of 4-phenylbutyric acid (4-PBA) were examined after treatment of OI iPS-MSCs during osteogenesis. KEY FINDINGS OI-derived iPS-MSCs exhibited decreased cell growth and impaired osteogenic differentiation and collagen expression. Expression of UPR genes was increased, which led to an increase in apoptotic cell death. 4-PBA treatment decreased apoptotic cells and reduced expression of UPR genes, including HSPA5, XBP1, ATF4, DDIT3, and ATF6. Osteogenic phenotypes, including RUNX2, SPP1, BGLAP, and IBPS expression, as well as calcium mineralization, were also improved. SIGNIFICANCE MSCs differentiated from disease-specific iPSCs have utility as a disease model for identifying disease-specific treatments. In addition, the ER stress-associated UPR could be a pathogenic mechanism associated with OI. Treatment with 4-PBA alleviated OI pathogenesis by attenuating UPR markers and apoptotic cell death.
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Affiliation(s)
- Thitinat Duangchan
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Tulyapruek Tawonsawatruk
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chanika Angsanuntsukh
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Objoon Trachoo
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Narisorn Kitiyanant
- Stem Cell Research Group, Institute of Molecular Biosciences, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Aungkura Supokawej
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand.
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Supnet I, Abiera JE, Alcausin MML, Sumpaico CE. Functional outcomes of an adult with osteogenesis imperfecta after rehabilitation post bilateral Girdlestone procedure. BMJ Case Rep 2021; 14:14/4/e239884. [PMID: 33820804 PMCID: PMC8029881 DOI: 10.1136/bcr-2020-239884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a case of a 54-year-old woman managed as a case of osteogenesis imperfecta type 1 who sustained a left subtrochanteric fracture and eventual ankylosis of both hips after surgery and immobilisation. These injuries rendered her bedridden, maximally assisted in transitions and transfers, and unable to be positioned past 30° of backrest elevation. The patient underwent a bilateral Girdlestone procedure and had tailored progressive postoperative rehabilitation in both the inpatient and outpatient settings. The patient also continued to receive bisphosphonates during her preoperative and postoperative period, to improve bone stock and aid in relieving pain. Through the efforts of a team of physiatrists, geneticists and orthopaedic surgeons, the patient was able to achieve pain-free sitting, independent transitions and short-distance ambulation, which have allowed her to care for herself more effectively and return to her work and activities of daily living.
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Affiliation(s)
- Isabella Supnet
- Rehabilitation Medicine, Philippine General Hospital, Manila, Philippines
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Vammi S, Bukyya JL, Ck AA, Tejasvi MLA, Pokala A, Hp C, Talwade P, Neela PK, Shyamilee TK, Oshin M, Pantala V. Genetic Disorders of Bone or Osteodystrophies of Jaws-A Review. Glob Med Genet 2021; 8:41-50. [PMID: 33987622 PMCID: PMC8110367 DOI: 10.1055/s-0041-1724105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bone is a specialized form of connective tissue, which is mineralized and made up of approximately 28% type I collagen and 5% noncollagenous matrix proteins. The properties of bone are very remarkable, because it is a dynamic tissue, undergoing constant renewal in response to mechanical, nutritional, and hormonal influences. In 1978, "The International Nomenclature of Constitutional Diseases of Bone" divided bone disorders into two broad groups: osteochondrodysplasias and dysostoses. The osteochondrodysplasia group is further subdivided into two categories: dysplasias (abnormalities of bone and/or cartilage growth) and osteodystrophies (abnormalities of bone and/or cartilage texture). The dysplasias form the largest group of bone disorders, hence the loose term "skeletal dysplasia" that is often incorrectly used when referring to a condition that is in reality an osteodystrophy or dysostosis. The word "dystrophy" implies any condition of abnormal development. "Osteodystrophies," as their name implies, are disturbances in the growth of bone. It is also known as osteodystrophia. It includes bone diseases that are neither inflammatory nor neoplastic but may be genetic, metabolic, or of unknown origin. Recent studies have shown that bone influences the activity of other organs, and the bone is also influenced by other organs and systems of the body, providing new insights and evidencing the complexity and dynamic nature of bone tissue. The 1,25-dihydroxyvitamin D3, or simply vitamin D, in association with other hormones and minerals, is responsible for mediating the intestinal absorption of calcium, which influences plasma calcium levels and bone metabolism. Diagnosis of the specific osteodystrophy type is a rather complex process and various biochemical markers and radiographic findings are used, so as to facilitate this condition. For diagnosis, we must consider the possibility of lesions related to bone metabolism altered by chronic renal failure (CRI), such as the different types of osteodystrophies, and differentiate from other possible neoplastic and/or inflammatory pathologies. It is important that the dentist must be aware of patients medical history, suffering from any systemic diseases, and identify the interference of the drugs and treatments to control them, so that we can able to perform the correct diagnosis and propose the most adequate treatment and outcomes of the individuals with bone lesions.
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Affiliation(s)
- Sirisha Vammi
- Private Practitioner, Oral Medicine and Radiology, Vishakapatnam, Andhra Pradesh, India
| | - Jaya Lakshmi Bukyya
- Department of Oral Medicine and Radiology, Tirumala Institute of Dental Sciences, Nizamabad, Telangana, India
| | - Anulekha Avinash Ck
- Department of Prosthodontics, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - M L Avinash Tejasvi
- Department of Oral Medicine and Radiology, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - Archana Pokala
- Department of Oral Medicine and Radiology, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - Chanchala Hp
- Department of Pedodontics and Preventive Dentistry, JSS Dental College, Mysore, Karnataka, India
| | - Priyanka Talwade
- Department of Pedodontics and Preventive Dentistry, JSS Dental College, Mysore, Karnataka, India
| | - Praveen Kumar Neela
- Department of Orthodontics, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - T K Shyamilee
- Private Practitioner, MDS in Oral Pathology, Hyderabad, Telangana, India
| | - Mary Oshin
- Department of Oral Pathology, Tirumala Institute of Dental Sciences, Nizamabad, Telangana, India
| | - Veenila Pantala
- Department of Oral Pathology, Tirumala Institute of Dental Sciences, Nizamabad, Telangana, India
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Comparable Effects of Strontium Ranelate and Alendronate Treatment on Fracture Reduction in a Mouse Model of Osteogenesis Imperfecta. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4243105. [PMID: 33506016 PMCID: PMC7810565 DOI: 10.1155/2021/4243105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023]
Abstract
Alendronate (Aln) has been the first-line drug for osteogenesis imperfecta (OI), while the comparable efficacy of Aln and strontium ranelate (SrR) remains unclear. This study is aimed at comparing the effects of SrR and Aln treatment in a mouse model of OI. Three-week-old oim/oim and wt/wt female mice were treated with SrR (1800 mg/kg/day), Aln (0.21 mg/kg/week), or vehicle (Veh) for 11 weeks. After the treatment, the average number of fractures sustained per mouse was significantly reduced in both SrR- and Aln-treated oim/oim mice. The effect was comparable between these two agents. Both SrR and Aln significantly increased trabecular bone mineral density, bone histomorphometric parameters (bone volume, trabecular number, and cortical thickness and area), and biomechanical parameters (maximum load and stiffness) as compared with the Veh group. Both treatments reduced bone resorption parameters, with Aln demonstrating a stronger inhibitory effect than SrR. In contrast to its inhibitory effect on bone resorption, SrR maintained bone formation. Aln, however, also suppressed bone formation coupled with an inhibitory effect on bone resorption. The results of this study indicate that SrR has comparable effects with Aln on reducing fractures and improving bone mass and strength. In clinical practice, SrR may be considered an option for patients with OI when other medications are not suitable or have evident contraindications.
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Sánchez Márquez E, Gómez Triguero J, Arribas Cordero MT, Martínez Caballero I, Lerma Lara S. Análisis cinemático de la articulación de tobillo y las articulaciones del mediopié en población pediátrica afectada de Osteogénsis Imperfecta. REVISTA ESPAÑOLA DE PODOLOGÍA 2021. [DOI: 10.20986/revesppod.2021.1603/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hong P, Liu R, Rai S, Li J. Case Report: Locking Plate for Cubitus Varus Correction in a 7-Year-Old Girl With Osteogenesis Imperfecta. Front Pediatr 2021; 9:781703. [PMID: 35096704 PMCID: PMC8790532 DOI: 10.3389/fped.2021.781703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Cubitus varus deformity is a common complication of untreated elbow fractures in children. However, cubitus varus in osteogenesis imperfecta (OI) children is a rare but challenging situation. To the author's knowledge, this is the first study discussing the correction of cubitus varus deformity in patient with OI. Case Presentation: Here we report a case of a 7-year-old OI girl with cubitus varus deformity due to a supracondylar fracture of humerus 3 year ago. The patient's parent gave a history of supracondylar fracture of left humerus in 2015. Without medical intervention, the patient was admitted into our institution for corrective surgery with the diagnosis of osteogenesis imperfecta and cubitus varus deformity in the left arm. Result: Medications including calcium, vitamin D and bisphosphonates were administered before the corrective surgery of cubitus varus, and a single locking plate was used to fixate the osteotomy. After the surgery, the appearance and range of motion (ROM) of the left arm was almost normal. Combined with gradual rehabilitation, the ROM of the left arm was normal without pain during daily use within the 1-year follow up. The hardware was removed as the nailing of the forearm fractures was performed at the same time. In the latest follow-up in September 2021, the appearance and ROM of the left arm was normal. Conclusion: Cubitus varus is a common deformity in children with elbow injuries, but it presents a challenging situation in compound fractures in OI patients. Locking plate combined with meticulous pharmacological intervention provides a good option for corrective surgery of cubitus varus in patients with OI.
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Affiliation(s)
- Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Blue Cross Hospital, Kathmandu, Nepal
| | - Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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The Characteristics of Adjacent Anatomy of Mandibular Third Molar Germs: A CBCT Pilot Study in Patients with Osteogenesis Imperfecta. Healthcare (Basel) 2020; 8:healthcare8040372. [PMID: 33008080 PMCID: PMC7711831 DOI: 10.3390/healthcare8040372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 01/20/2023] Open
Abstract
(1) Objectives: The aim of our study was to investigate the anatomical features of lower third molar and its adjacent anatomical connections in type I Osteogenesis Imperfecta (OI) patients through cone beam computed tomography (cbct). (2) Methods: The study was conducted among 25 patients, 13 patients with type I OI and 12 control patients (individuals with no disorders and no treatment); average age was 15.44 ± 2.06, 23 third molar germs for each group. The germs have been compared to the parameters using the Mann-Whitney test. A chi-square test was also used to investigate the correlation between the status case/control and tooth development stage. (3) Results: Mann-Whitney test showed significant differences between cases and controls: diameter of the tooth germ in toto (U = 93.5; p < 0.001), tooth development stage, (U = 145; p < 0.01), roots length (U = 44.5; p < 0.01), cementoenamel junction diameter (U = 157.5; p < 0.05), size of the pulp chamber (U = 95.5; p < 0.05). Type I OI is not associated with the relationship between the germ of mandibular third molar and alveolar canal on axial plane (χ2 = 4.095; p = 0.129), and parasagittal (χ2 = 4.800; p = 0.091). The association between type I OI and relationship with the germ of mandibular third molar and alveolar canal on the coronal plane has been significant (χ2 = 9.778; p < 0.05) as the perforation of the lingual cortical bone in the region of mandibular third molar tooth germ (χ2 = 11.189; p < 0.01). (4) Conclusions: The results confirm the cbct accuracy in the evaluation of bone density in type I OI patients giving also the opportunity to study the tridimensional anatomy of germs and the adjacent anatomical structures in order to avoid any perioperative complications.
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Cronjé L, Mohmmad M, Kusel B. A retrospective study to evaluate the anaesthetic choices and complications for patients with osteogenesis imperfecta at a quaternary referral hospital. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.1.2324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zhytnik L, Simm K, Salumets A, Peters M, Märtson A, Maasalu K. Reproductive options for families at risk of Osteogenesis Imperfecta: a review. Orphanet J Rare Dis 2020; 15:128. [PMID: 32460820 PMCID: PMC7251694 DOI: 10.1186/s13023-020-01404-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Osteogenesis Imperfecta (OI) is a rare genetic disorder involving bone fragility. OI patients typically suffer from numerous fractures, skeletal deformities, shortness of stature and hearing loss. The disorder is characterised by genetic and clinical heterogeneity. Pathogenic variants in more than 20 different genes can lead to OI, and phenotypes can range from mild to lethal forms. As a genetic disorder which undoubtedly affects quality of life, OI significantly alters the reproductive confidence of families at risk. The current review describes a selection of the latest reproductive approaches which may be suitable for prospective parents faced with a risk of OI. The aim of the review is to alleviate suffering in relation to family planning around OI, by enabling prospective parents to make informed and independent decisions. Main body The current review provides a comprehensive overview of possible reproductive options for people with OI and for unaffected carriers of OI pathogenic genetic variants. The review considers reproductive options across all phases of family planning, including pre-pregnancy, fertilisation, pregnancy, and post-pregnancy. Special attention is given to the more modern techniques of assisted reproduction, such as preconception carrier screening, preimplantation genetic testing for monogenic diseases and non-invasive prenatal testing. The review outlines the methodologies of the different reproductive approaches available to OI families and highlights their advantages and disadvantages. These are presented as a decision tree, which takes into account the autosomal dominant and autosomal recessive nature of the OI variants, and the OI-related risks of people without OI. The complex process of decision-making around OI reproductive options is also discussed from an ethical perspective. Conclusion The rapid development of molecular techniques has led to the availability of a wide variety of reproductive options for prospective parents faced with a risk of OI. However, such options may raise ethical concerns in terms of methodologies, choice management and good clinical practice in reproductive care, which are yet to be fully addressed.
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Affiliation(s)
- Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.
| | - Kadri Simm
- Institute of Philosophy and Semiotics, Faculty of Arts and Humanities, University of Tartu, Tartu, Estonia.,Centre of Ethics, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Institute of Genomics, University of Tartu, Tartu, Estonia.,COMBIVET ERA Chair, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Maire Peters
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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20
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Mehta R, Mahajan U. Tibial-tubercle avulsion and patellar-tendon rupture in pre-pubertal child with osteogenesis imperfecta(OI): Case report and review of current treatment in OI. J Clin Orthop Trauma 2020; 11:339-343. [PMID: 32099308 PMCID: PMC7026616 DOI: 10.1016/j.jcot.2020.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/27/2020] [Indexed: 01/20/2023] Open
Abstract
Very few cases of simultaneous occurrence of tibial tuberosity fracture with lower pole patella and distal patellar tendon rupture type injuries have been reported in adolescent athletic age group, but its occurrence in osteogenesis imperfecta (OI)* has not been reported to the best of our knowledge in a literature search of last 5 years in the English Language. The mechanism of avulsion injury after low-velocity trauma and the underlying pathology is a unique combination in our patient and a note on updates in general management of osteogenesis imperfecta is discussed.
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Affiliation(s)
- Rujuta Mehta
- Department of Orthopaedics, Dr. Balabhai Nanavati Hopsital, S.V. Road, Vile Parle (West), Mumbai, 400 056, India,Corresponding author.
| | - Uday Mahajan
- Trauma and Orthopaedics, Glan Clwyd Hospital, Rhuddlan Rd, Bodelwyddan, Rhyl, LL18 5UJ, United Kingdom
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21
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Constantino CS, Krzak JJ, Fial AV, Kruger KM, Rammer JR, Radmanovic K, Smith PA, Harris GF. Effect of Bisphosphonates on Function and Mobility Among Children With Osteogenesis Imperfecta: A Systematic Review. JBMR Plus 2019; 3:e10216. [PMID: 31687649 PMCID: PMC6820458 DOI: 10.1002/jbm4.10216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic connective tissue disorder that results in bone fragility and deformity. Management is multi-disciplinary. Although pharmacologic intervention with bisphosphonates (BP) is a standard of care for individuals with severe OI, no consensus or reviews were found that focus on the effects of bisphosphonates on function and mobility. PubMed, CINAHL, Cochrane Library, Web of Science, and PEDro databases were searched for eligible articles for this review. Methodological quality was assessed using the Cochrane Collaboration's tool for risk of bias. Twenty-six studies (801 children) were reviewed and five showed a low risk of bias. Included studies showed significant variability among clinical protocols for administering BP. Randomized controlled trials did not demonstrate a significant improvement in function and mobility with oral BP administration, while non-randomized open-label uncontrolled studies demonstrated that oral and intravenous BP administration objectively improved function and mobility. The most common outcome measure used by the studies included in this review was the Bleck score. Effect sizes (d = 0.28 - 4.5) varied among studies. This systematic review also summarized the apparent confounding variables affecting results of previous studies and provided suggestions to improve the quality of future studies.
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Affiliation(s)
- Christopher S. Constantino
- Orthopedic and Rehabilitation Engineering Center, Marquette University & Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Joseph J. Krzak
- Motion Analysis Laboratory, Shriners Hospital for ChildrenChicagoIllinoisUSA
- Midwestern University, Physical Therapy Program, College of Health SciencesDowners GroveIllinoisUSA
| | - Alissa V. Fial
- Research and Instructional Services, Raynor Memorial Libraries, Marquette UniversityMilwaukeeWisconsinUSA
| | - Karen M. Kruger
- Orthopedic and Rehabilitation Engineering Center, Marquette University & Medical College of WisconsinMilwaukeeWisconsinUSA
- Motion Analysis Laboratory, Shriners Hospital for ChildrenChicagoIllinoisUSA
| | - Jacob R. Rammer
- Orthopedic and Rehabilitation Engineering Center, Marquette University & Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Katarina Radmanovic
- Orthopedic and Rehabilitation Engineering Center, Marquette University & Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Peter A. Smith
- Motion Analysis Laboratory, Shriners Hospital for ChildrenChicagoIllinoisUSA
| | - Gerald F. Harris
- Orthopedic and Rehabilitation Engineering Center, Marquette University & Medical College of WisconsinMilwaukeeWisconsinUSA
- Motion Analysis Laboratory, Shriners Hospital for ChildrenChicagoIllinoisUSA
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Qadar LT, Ochani RK, Shaikh A, Arsalan Q, Ali R. A Unique Association of Osteogenesis Imperfecta with Bilateral Renal Osteodystrophy and Gastroenteritis in a Three-year-old Boy. Cureus 2019; 11:e4467. [PMID: 31249745 PMCID: PMC6579323 DOI: 10.7759/cureus.4467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe a three-year-old male child who presented to the pediatrics out-patient department with a history of decrease in appetite, generalized weakness, on and off loose motions for one year, inability to walk and sit for eight months with a loss of neck holding for 14 days. On examination, the patient had a classic frog-shaped leg posture. X-rays of chest, skull, pelvis and long bones were performed which showed osteopenic bones, frontal bossing and multiple microfractures, which were classic for osteogenesis Imperfecta but the child did not have other salient features such as blue sclera, otosclerosis, and respiratory difficulty. The patient also had urinary complaints due to which ultrasound of kidney ureters and bladder (KUB) was performed, which showed bilateral renal calculi and grade 2 renal parenchymal changes. This case report illustrates the evaluation of the child with osteogenesis imperfecta, as well as the unique association of renal osteodystrophy and gastroenteritis with it.
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Affiliation(s)
- Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Asim Shaikh
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Qazi Arsalan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ramsha Ali
- Pediatrics, Dow University of Health Sciences, Karachi, PAK
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Identification of a de novo fetal variant in osteogenesis imperfecta by targeted sequencing-based noninvasive prenatal testing. J Hum Genet 2018; 63:1129-1137. [PMID: 30131598 DOI: 10.1038/s10038-018-0489-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/14/2018] [Accepted: 06/26/2018] [Indexed: 11/08/2022]
Abstract
Noninvasive prenatal testing (NIPT), which involves analysis of circulating cell-free fetal DNA (cffDNA) from maternal plasma, is highly effective for detecting feto-placental chromosome aneuploidy. However, recent studies suggested that coverage-based shallow-depth NIPT cannot accurately detect smaller single or multi-loci genetic variants. To assess the fetal genotype of any locus using maternal plasma, we developed a novel genotyping algorithm named pseudo tetraploid genotyping (PTG). We performed paired-end captured sequencing of the plasma cell-free DNA (cfDNA), in which case a phenotypically healthy woman is suspected to be carrying a fetus with genetic defect. After a series of independent filtering of 111,407 SNPs, we found one variant in COL1A1 graded with high pathogenic potential which might cause osteogenesis imperfecta (OI). Then, we verified this mutation by Sanger sequencing of fetal and parental blood cells. In addition, we evaluated the accuracy and detection rate of the PTG algorithm through direct sequencing of the genomic DNA from maternal and fetal blood cells. Collectively, our study developed an intuitive and cost-effective method for the noninvasive detection of pathogenic mutations, and successfully identified a de novo variant in COL1A1 (c.2596 G > A, p.Gly866Ser) in the fetus implicated in OI.
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Rosemberg DL, Goiano EO, Akkari M, Santili C. Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur. J Child Orthop 2018; 12:97-103. [PMID: 29456761 PMCID: PMC5813132 DOI: 10.1302/1863-2548.12.170009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To introduce a new model of telescopic intramedullary rod (TIR), evaluate its effects on treating patients presenting with moderate and severe osteogenesis imperfecta (OI) and to compare the findings with those of other telescopic rods. METHODS A total of 21 patients (nine girls and 12 boys; mean age at first operation, 6.6 years, 1.52 to 13.18) who underwent 52 femoral operations were monitored during a mean of 9.96 years (3.39 to 14.54). Patient characteristics, telescoping rod capability and its complications were examined. RESULTS According to the Sillence classification, we investigated one patient with type I, nine with type III and 11 with type IV OI. Revision rates at up to five years (36%) were inferior to those found for the Fassier-Duval rod (46%). The main cause of revision was fracture (15 patients), followed by rod migration (nine), and infection (two). The rod exhibited higher telescopic capacity in boys than girls. Type III most commonly required an operation; the age group with the highest number of procedures was five to ten years. Male migration was the main cause of rod migration. CONCLUSION The TIR has a satisfactory cost-benefit ratio with less complication rates and low production costs. The TIR is a feasible alternative to the commonly used Fassier-Duval rod. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D. L. Rosemberg
- Santa Casa de Sao Paulo School of Medical Sciences, School of Medicine, São Paulo, SP, Brazil,Correspondence should be sent to D. L. Rosemberg, Santa Casa de Sao Paulo School of Medical Sciences, School of Medicine, R. Dr. Gabriel dos Santos, 559, ap 201, São Paulo, SP, Brazil. E-mail:
| | - E. O. Goiano
- Santa Casa de Sao Paulo School of Medical Sciences, Dpto. De Ortopedia, Vila Buarque, São Paulo, SP, Brazil
| | - M. Akkari
- Santa Casa de Sao Paulo School of Medical Sciences, Dpto. De Ortopedia, Vila Buarque, São Paulo, SP, Brazil
| | - C. Santili
- Santa Casa de Sao Paulo School of Medical Sciences, Dpto. De Ortopedia, Vila Buarque, São Paulo, SP, Brazil
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25
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Abstract
PURPOSE OF REVIEW Several bone disorders affecting the skeleton often are manifest in the maxillofacial region. This review presents the most common bone disorders in children and their dental-oral manifestations: fibrous dysplasia, Paget's disease, osteogenesis imperfecta, renal osteodystrophy, hypophosphatasia, and osteoporosis. The specific intraoral characteristics will reviewed in detail. RECENT FINDINGS Recent studies confirmed the close relationship between the mandible and the maxilla with the most prevalent systemic bone disorders in children. This review will help practitioners to integrate the oral health into the systemic health and improve the multidisciplinary approach of pediatric patients between medicine and dentistry.
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Affiliation(s)
- Juan F Yepes
- Department of Pediatric Dentistry, Attending Riley Hospital for Children, Indiana University School of Dentistry, Indianapolis, IN, USA.
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26
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Ierardo G, Bossù M, D'Angeli G, Celli M, Sfasciotti G. Bisphosphonates therapy in children with Osteogenesis imperfecta: clinical experience in oral surgery. ACTA ACUST UNITED AC 2017; 10:311-316. [PMID: 29285334 DOI: 10.11138/orl/2017.10.3.311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To define the possible complications of oral surgery in childhood in patients affected by type 1 Osteogenesis imperfecta (OI) and treated with bisphosphonates (BP). Methods The study was conducted among 20 patients in childhood with an age range 8-14 (12 ♂ e 8 ♀) affected by OI. Patients were initially evaluated at the Policlinico Umberto I, University Hospital of Rome, Rare Disease Center Skeletal Dysplasia-Bone Metabolic Pathologies and after at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry. Results From this experience, we showed that a proper patient management from the medical and dental point of view can protect these patients from the risk of post-operative problems, such as onj, soft tissue flogos, intraoral and extraoral fistulas, failure to heal the post-extractive alveolus, infections, post-operative pain and pathological fractures. The follow-up, ranging from a minimum of 2 years to a maximum of 5 years, have not demonstrated the presence of particular complications or healing defects. Conclusions The clinical experiences observed in these patients are encouraging because no postoperative complications have been observed compared to patients non-affected by OI.
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Affiliation(s)
- G Ierardo
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
| | - M Bossù
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
| | - G D'Angeli
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
| | - M Celli
- Rare Disease Center Skeletal Dysplasia Bone, Department of Oral and Maxillo Facial Science, DAI Head and Neck UOC Pediatric Dentistry (Dir.: Prof. Antonella Polimeni)
| | - G Sfasciotti
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
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Abstract
Osteogenesis imperfecta is a common heritable connective tissue disorder. Nearly ninety percent are due to Type I collagen mutations. Type I-IV are autosomal dominant, and Type VI-XIII are autosomal recessive. They are Graded 1-5 based on severity. Genomic testing is done by collagen analysis from fibroblasts. The mainstay of treatment is bisphosphonate therapy. The prognosis is variable.
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Affiliation(s)
- Justin Easow Sam
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Mala Dharmalingam
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, Karnataka, India
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Jia M, Shi R, Zhao X, Fu Z, Bai Z, Sun T, Zhao X, Wang W, Xu C, Yan F. Confirmation of the pathogenicity of a mutation p.G337C in the COL1A2 gene associated with osteogenesis imperfecta. Medicine (Baltimore) 2017; 96:e7783. [PMID: 28953610 PMCID: PMC5626253 DOI: 10.1097/md.0000000000007783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Mutation analysis as the gold standard is particularly important in diagnosis of osteogenesis imperfecta (OI) and it may be preventable upon early diagnosis. In this study, we aimed to analyze the clinical and genetic materials of an OI pedigree as well as to confirm the deleterious property of the mutation.A pedigree with OI was identified. All family members received careful clinical examinations and blood was drawn for genetic analyses. Genes implicated in OI were screened for mutation. The function and structure of the mutant protein were predicted using bioinformatics analysis.The proband, a 9-month fetus, showed abnormal sonographic images. Disproportionately short and triangular face with blue sclera was noticed at birth. She can barely walk and suffered multiple fractures till 2-year old. Her mother appeared small stature, frequent fractures, blue sclera, and deformity of extremities. A heterozygous missense mutation c.1009G>T (p.G337C) in the COL1A2 gene was identified in her mother and her. Bioinformatics analysis showed p.G337 was well-conserved among multiple species and the mutation probably changed the structure and damaged the function of collagen.We suggest that the mutation p.G337C in the COL1A2 gene is pathogenic for OI by affecting the protein structure and the function of collagen.
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Affiliation(s)
| | | | | | | | - Zhijing Bai
- Linyi County Traditional Chinese Medicine Hospital, Dezhou
| | - Tao Sun
- Department of Pain Management
| | | | - Wenbo Wang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University
- Institute of Endocrinology, Shandong Academy of Clinical Medicine
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
| | - Chao Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University
- Institute of Endocrinology, Shandong Academy of Clinical Medicine
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, China
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Marr C, Seasman A, Bishop N. Managing the patient with osteogenesis imperfecta: a multidisciplinary approach. J Multidiscip Healthc 2017; 10:145-155. [PMID: 28435282 PMCID: PMC5388361 DOI: 10.2147/jmdh.s113483] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a heterogeneous heritable connective tissue disorder characterized by low bone density. The type and severity of OI are variable. The primary manifestations are fractures, bone deformity, and bone pain, resulting in reduced mobility and function to complete everyday tasks. OI affects not only the physical but also the social and emotional well-being of children, young people, and their families. As such, medical, surgical, and allied health professionals’ assessments all play a role in the management of these children. The multidisciplinary approach to the treatment of children and young people living with OI seeks to provide well-coordinated, comprehensive assessments, and interventions that place the child and family at the very center of their care. The coordinated efforts of a multidisciplinary team can support children with OI to fulfill their potential, maximizing function, independence, and well-being.
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Affiliation(s)
| | | | - Nick Bishop
- Academic Unit of Child Health, Department of Human Metabolism, University of Sheffield, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Nishida K, Choi D, Bostrom M. Custom hemiarthroplasties for retention of existing hardware associated with osteogenesis imperfecta. Arthroplast Today 2017; 3:89-92. [PMID: 28695180 PMCID: PMC5485223 DOI: 10.1016/j.artd.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/23/2022] Open
Abstract
Osteogenesis imperfecta is a rare genetic disorder that presents with heterogeneous phenotypes ranging from brittle bones to impaired hearing. Because of the decreased bone mineral density frequently observed in this patient population, many patients experience recurring and long-term fractures, which often require orthopaedic management. With the advancement of nonsurgical and surgical management and increased longevity of patients with osteogenesis imperfecta, the incidence of osteoarthritis has risen, presenting new orthopaedic challenges. However, compromised bone integrity and size combined with frequent existing hardware render traditional surgical therapies for osteoarthritis technically challenging in this patient population. In this report, we present a case in which we retained a portion of the patient's existing hardware, while performing staged bilateral custom hemiarthroplasties in a patient with osteogenesis imperfecta.
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Affiliation(s)
- Kevin Nishida
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Choi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Mathias Bostrom
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
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Rijks EBG, Bongers BC, Vlemmix MJG, Boot AM, van Dijk ATH, Sakkers RJB, van Brussel M. Efficacy and Safety of Bisphosphonate Therapy in Children with Osteogenesis Imperfecta: A Systematic Review. Horm Res Paediatr 2016; 84:26-42. [PMID: 26021524 DOI: 10.1159/000381713] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To systematically assess contemporary knowledge regarding the effectiveness and safety of bisphosphonates (BPs) in children with osteogenesis imperfecta (OI). METHODS PubMed/MEDLINE, Embase, and Cochrane were searched for eligible articles up to June 2014. Studies eligible for inclusion were (randomized) controlled trials assessing the effects of BPs in children with OI. Methodological quality was assessed independently by 4 reviewers using the Cochrane Collaboration's tool for risk of bias. RESULTS Ten studies (519 children) were included. Four studies (40%) showed a low risk of bias. All studies investigating lumbar spine areal bone mineral density indicated a significant increase as a result of BP treatment. Most studies observed a significant decrease in fracture incidence. The most frequently reported adverse events were gastrointestinal complaints, fever, and muscle soreness. A significant decrease in (bone) pain due to BP treatment was observed in more than half of the studies. Most studies measuring urinary markers of bone resorption reported a significant decrease. The majority of studies with intravenous treatment showed a significant increase in lumbar projection area, whereas studies with oral treatment did not. CONCLUSIONS Treatment with oral or intravenous BPs in children with OI results in an increase in bone mineral density and seems to be safe and well tolerated.
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Affiliation(s)
- Ester B G Rijks
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Fluoroscopy-guided Sacroiliac Joint Steroid Injection for Low Back Pain in a Patient with Osteogenesis Imperfecta. W INDIAN MED J 2015; 64:432-4. [PMID: 26624601 DOI: 10.7727/wimj.2014.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteogenesis imperfecta, also known as 'brittle bone disease', is a genetic connective tissue disease. It is characterized by bone fragility and osteopenia (low bone density). In this case, a 57-year old female presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation Clinic with left low back pain rated 6/10 on the numeric rating scale (NRS). Clinically, the patient had sacroiliac joint mediated pain although X-rays did not show the sacroiliac joint changes. Fluoroscopy-guided left sacroiliac joint steroid injection was done. METHODS Numeric rating scale and Oswestry Disability Index (ODI) questionnaire were used to evaluate outcome. This was completed at baseline, one week follow-up and at eight weeks post fluoroscopy-guided sacroiliac joint steroid injection. RESULTS Numeric rating scale improved from 6/10 before the procedure to 0/10 post procedure, and ODI questionnaire score improved from a moderate disability score of 40% to a minimal disability score of 13%. Up to eight weeks, the NRS was 0/10 and ODI remained at minimal disability of 15%. CONCLUSION Fluoroscopy-guided sacroiliac joint injection is a known diagnostic and treatment method for sacroiliac joint mediated pain. To our knowledge, this is the first case published on the use of fluoroscopy-guided sacroiliac joint steroid injection in the treatment of sacroiliac joint mediated low back pain in a patient with osteogenesis imperfecta.
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Abstract
Osteogenesis imperfecta (OI) is an uncommon genetic bone disease associated with brittle bones and fractures in children and adults. Although OI is most commonly associated with mutations of the genes for type I collagen, many other genes (some associated with type I collagen processing) have now been identified. The genetics of OI and advances in our understanding of the biomechanical properties of OI bone are reviewed in this article. Treatment includes physiotherapy, fall prevention, and sometimes orthopedic procedures. In this brief review, we will also discuss current understanding of pharmacologic therapies for treatment of OI.
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Affiliation(s)
- Joseph L Shaker
- Endocrinology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carolyne Albert
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA ; Shriners Hospitals for Children, Chicago, IL, USA
| | - Jessica Fritz
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gerald Harris
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA ; Shriners Hospitals for Children, Chicago, IL, USA
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Are Changes in Composition in Response to Treatment of a Mouse Model of Osteogenesis Imperfecta Sex-dependent? Clin Orthop Relat Res 2015; 473:2587-98. [PMID: 25903941 PMCID: PMC4488219 DOI: 10.1007/s11999-015-4268-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a genetic disease characterized by skeletal fragility and deformity. There is extensive debate regarding treatment options in adults with OI. Antiresorptive treatment reduces the number of fractures in growing oim/oim mice, an animal model that reproducibly mimics the moderate-to-severe form of OI in humans. Effects of long-term treatments with antiresorptive agents, considered for treatment of older patients with OI with similar presentation (moderate-to-severe OI) are, to date, unknown. QUESTIONS/PURPOSES Fourier transform infrared (FTIR) imaging, which produces a map of the spatial variation in chemical composition in thin sections of bone, was used to address the following questions: (1) do oim/oim mice show a sex dependence in compositional properties at 6.5 months of age; (2) is there a sex-dependent response to treatment with antiresorptive agents used in the treatment of OI in humans; and (3) are any compositional parameters in oim/oim mice corrected to wild-type (WT) values after treatment? METHODS FTIR imaging data were collected from femurs from four to five mice per sex per genotype per treatment. Treatments were 24 weeks of saline, alendronate, or RANK-Fc; and 12 weeks of saline+12 weeks RANK-Fc and 12 weeks of alendronate+RANK-Fc. FTIR imaging compositional parameters measured in cortical and cancellous bones were mineral-to-matrix ratio, carbonate-to-mineral ratio, crystal size/perfection, acid phosphate substitution, collagen maturity, and their respective distributions (heterogeneities). Because of the small sample size, nonparametric statistics (Mann-Whitney U- and Kruskal-Wallis tests with Bonferroni correction) were used to compare saline-treated male and female mice of different genotypes and treatment effects by sex and genotype, respectively. Statistical significance was defined as p<0.05. RESULTS At 6.5 months, saline-treated male cortical oim/oim bone had increased mineral-to-matrix ratio (p=0.016), increased acid phosphate substitution (p=0.032), and decreased carbonate-to-mineral ratio (p=0.016) relative to WT. Cancellous bone in male oim/oim also had increased mineral-to-matrix ratio (p=0.016) relative to male WT. Female oim/oim mouse bone composition for all cortical and cancellous bone parameters was comparable to WT (p>0.05). Only the female WT mice showed a response of mean compositional properties to treatment, increasing mineral-to-matrix after RANK-Fc treatment in cancellous bone (p=0.036) compared with saline-treated mice. Male oim/oim increased mineral-to-matrix cortical and cancellous bone heterogeneity in response to all long-term treatments except for saline+RANK-Fc (p<0.04); female oim/oim cortical mineral-to-matrix bone heterogeneity increased with ALN+RANK-Fc and all treatments increased cancellous female oim/oim bone acid phosphate substitution heterogeneity (p<0.04). CONCLUSIONS Both oim/oim and WT mice, which demonstrate sex-dependent differences in composition with saline treatment, showed few responses to long-term treatment with antiresorptive agents. Female WT mice appeared to be more responsive; male oim/oim mice showed more changes in compositional heterogeneity. Changes in bone composition caused by these agents may contribute to improved bone quality in oim/oim mice, because the treatments are known to reduce fracture incidence. CLINICAL RELEVANCE The optimal drug therapy for long-term treatment of patients with moderate-to-severe OI is unknown. Based on bone compositional changes in mice, antiresorptive treatments are useful for continued treatment in OI. There is a reported sexual dimorphism in fracture incidence in adults with OI, but to date, no one has reported differences in response to pharmaceutical intervention. This study suggests that such an investigation is warranted.
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Drefus LC, Cassady S, Raggio CL. Interdisciplinary Care Improves Functional Mobility in an Individual with Type IX Osteogenesis Imperfecta. HSS J 2015; 11:84-9. [PMID: 25737674 PMCID: PMC4342404 DOI: 10.1007/s11420-014-9429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/28/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Lisa C. Drefus
- />Hospital for Special Surgery Pediatric Rehabilitation and Orthopedics, 535 East 70th Street, New York, NY 10021 USA
| | | | - Cathleen L. Raggio
- />Hospital for Special Surgery Pediatric Rehabilitation and Orthopedics, 535 East 70th Street, New York, NY 10021 USA
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36
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[Osteogenesis imperfecta]. DER ORTHOPADE 2014; 43:764-71. [PMID: 25116245 DOI: 10.1007/s00132-013-2229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is the most common genetic disease of bone and is characterized by fragile bones and growth disorders of varying severity. Most cases of OI are inherited autosomal dominant and caused by a mutation in the collagen type I gene. DIAGNOSTICS Indications for OI are bone fragility, stunted growth, scoliosis, skull deformities, blue sclera, loss of hearing, dentinogenesis imperfecta and increased laxity of ligaments and skin. In most cases it is possible to make a clinical diagnosis but a skin biopsy or genetic testing can be useful; however, negative results for these tests do not exclude OI. THERAPY Therapy must be carried out in a multidisciplinary team and includes conservative (e.g. physiotherapy, rehabilitation programs and orthopedic aids), operative (e.g. intramedullary stabilization procedures) and pharmaceutical (e.g. biphosphonates and growth hormones) procedures. PROGNOSIS The prognosis depends on the type of OI and ranges from normal life expectations for type 1 patients up to up to perinatal mortality for type II patients.
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Cañete R, Caballero-Villarraso J, Aguilar-Quintero M, Vázquez-Rueda F. Beneficial effects of growth hormone therapy for ossification defects after bone distraction in X linked hypophosphataemic rickets. BMJ Case Rep 2014; 2014:bcr-2013-203069. [PMID: 25115781 DOI: 10.1136/bcr-2013-203069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A report on two homozygous twin girls affected by X linked hypophosphataemic rickets. They were examined due to short stature and genu varum of both tibias. They were treated with calcitriol and Joulie's solution, whereon it was observed that serum parathyroid hormone and phosphaturia decreased while phosphataemia increased. They underwent a tibial osteotomy (by means of the insertion of Kirchner needles) at 7.7 years of age for correction of genu varum and a normal consolidation was reached 1 month later. Nonetheless, height was percentile <1 after menarche, so both sisters asked for bone lengthening. Because of this, at 15 years of age femoral distraction was performed, but no bone callus was observed 14 months later. Consequently, they were treated with subcutaneous growth hormone, showing bone callus at 6 months. Finally, the external fixators were removed due to ossification in the lengthened segments.
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Affiliation(s)
- Ramón Cañete
- Pediatric Endocrinology Unit, IMIBIC/Reina Sofía Hospital/Córdoba University, Córdoba, Spain
| | | | - María Aguilar-Quintero
- Pediatric Endocrinology Unit, IMIBIC/Reina Sofía Hospital/Córdoba University, Córdoba, Spain
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The collagenopathies: review of clinical phenotypes and molecular correlations. Curr Rheumatol Rep 2014; 16:394. [PMID: 24338780 DOI: 10.1007/s11926-013-0394-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic defects of collagen formation (the collagenopathies) affect almost every organ system and tissue in the body. They can be grouped by clinical phenotype, which usually correlates with the tissue distribution of the affected collagen subtype. Many of these conditions present in childhood; however, milder phenotypes presenting in adulthood are increasingly recognized. Many are difficult to differentiate clinically. Precise diagnosis by means of genetic testing assists in providing prognosis information, family counseling, and individualized treatment. This review provides an overview of the current range of clinical presentations associated with collagen defects, and the molecular mechanisms important to understanding how the results of genetic testing affect medical care.
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Ren J, Xu X, Jian X, Wang J. Osteogenesis imperfecta type I: A case report. Exp Ther Med 2014; 7:1535-1538. [PMID: 24926339 PMCID: PMC4043568 DOI: 10.3892/etm.2014.1653] [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] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Abstract
A 15-year-old male patient was admitted to hospital having experienced repeated fractures over the previous three years, predominantly due to falling down or overexertion. The clinical signs and radiological features, such as recurrent fractures, blue sclera and low bone mineral density (BMD) level, all led to the diagnosis of a mild form of osteogenesis imperfecta (OI) type I. The patient began treatment with a regular intake of calcium (1,000 mg/day), an adequate intake of vitamin D (800 U/day) and intravenous pamidronate (60 mg). Following four months of treatment, the symptoms and quality of life of the patient improved. This patient appears to be a rare case of OI type I.
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Affiliation(s)
- Jianmin Ren
- Department of Endocrine and Metabolic Diseases, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaojie Xu
- Department of Endocrine and Metabolic Diseases, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jieru Wang
- Department of Poisoning and Occupational Diseases, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Allele-specific Col1a1 silencing reduces mutant collagen in fibroblasts from Brtl mouse, a model for classical osteogenesis imperfecta. Eur J Hum Genet 2013; 22:667-74. [PMID: 24022296 DOI: 10.1038/ejhg.2013.198] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/17/2013] [Accepted: 08/09/2013] [Indexed: 11/08/2022] Open
Abstract
Gene silencing approaches have the potential to become a powerful curative tool for a variety of monogenic diseases caused by gain-of-function mutations. Classical osteogenesis imperfecta (OI), a dominantly inherited bone dysplasia, is characterized in its more severe forms by synthesis of structurally abnormal type I collagen, which exerts a negative effect on extracellular matrix. Specific suppression of the mutant (Mut) allele would convert severe OI forms to the mild type caused by a quantitative defect in normal collagen. Here, we describe the in vitro and ex vivo investigation of a small interfering RNA (siRNA) approach to allele-specific gene silencing using Mut Col1a1 from the Brtl mouse, a well-characterized model for classical human OI. A human embryonic kidney cell line, which expresses the firefly luciferase gene, combined with either wild-type or Mut Brtl Col1a1 exon 23 sequences, was used for the first screening. The siRNAs selected based on their specificity and the corresponding short hairpin RNAs (shRNAs) subcloned in a lentiviral vector were evaluated ex vivo in Brtl fibroblasts for their effect on collagen transcripts and protein. A preferential reduction of the Mut allele of up to 52% was associated with about 40% decrease of the Mut protein, with no alteration of cell proliferation. Interestingly, a downregulation of HSP47, a specific collagen chaperone known to be upregulated in some OI cases, was detected. Our data support further testing of shRNAs and their delivery by lentivirus as a strategy to specifically suppress the Mut allele in mesenchymal stem cells of OI patients for autologous transplantation.
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Aftab SAS, Reddy N, Owen NL, Pollitt R, Harte A, McTernan PG, Tripathi G, Barber TM. Identification of a novel heterozygous mutation in exon 50 of the COL1A1 gene causing osteogenesis imperfecta. Endocrinol Diabetes Metab Case Rep 2013; 2013:130002. [PMID: 24616757 PMCID: PMC3922149 DOI: 10.1530/edm-13-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/30/2013] [Indexed: 11/17/2022] Open
Abstract
A 19-year-old woman was diagnosed with osteogenesis imperfecta (OI). She had sustained numerous low-trauma fractures throughout her childhood, including a recent pelvic fracture (superior and inferior ramus) following a low-impact fall. She had the classical blue sclerae, and dual energy X-ray absorptiometry (DEXA) bone scanning confirmed low bone mass for her age in the lumbar spine (Z-score was −2.6). However, despite these classical clinical features, the diagnosis of OI had not been entertained throughout the whole of her childhood. Sequencing of her genomic DNA revealed that she was heterozygous for the c.3880_3883dup mutation in exon 50 of the COL1A1 gene. This mutation is predicted to result in a frameshift at p.Thr1295, and truncating stop codon 3 amino acids downstream. To our knowledge, this mutation has not previously been reported in OI.
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Affiliation(s)
- S A S Aftab
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
| | - N Reddy
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
| | - N L Owen
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
| | - R Pollitt
- Connective Tissue Disorders Service, Sheffield Diagnostic Genetics Service Sheffield Children's NHS Foundation Trust, Western Bank Sheffield, S10 2TH UK
| | - A Harte
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
| | - P G McTernan
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
| | - G Tripathi
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
| | - T M Barber
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, University of Warwick Clifford Bridge Road, Coventry, CV2 2DX UK
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Chiarello E, Donati D, Tedesco G, Cevolani L, Frisoni T, Cadossi M, Hoque M, Spazzoli B, Giannini S. Conservative versus surgical treatment of osteogenesis imperfecta: a retrospective analysis of 29 patients. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2012; 9:191-194. [PMID: 23289037 PMCID: PMC3535993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of our study was to compare the surgical and conservative treatment of patients affected by fragility fractures and deformities of long bones in osteogenesis imperfecta (OI).Our series consisted of 29 consecutive OI patients treated at our Institute. The series comprised 14 females and 15 males of different ages. The mean age at the time of the first treatment was 8 years (median 6 years; SD ± 15; range 1 to 75). The mean follow-up was 88 months. The Sillence classification was used to classify OI. Fifteen patients were classified as Type I; five as Type III and nine as Type IV.A total number of 245 procedures were recorded. Of these, 147 were surgical (pinning; intramedullary nailing and plating) while 98 were conservative (cast, braces and bandages). Bisphosphonate use was a major variable in the study. Clinical charts and radiographic films were analyzed for complications (delayed union, nonunion, malunion, hardware loosening). We recorded 58 complications: 13 in Type I; 28 in Type III and 17 in Type IV OI. The rate of each complication was: 15/245 nonunions (6.1%), 14/245 delayed unions (5.7%), 14/245 malunions (5.7%) and 15/245 hardware loosenings (6.1%).We found no statistically significant differences between surgical and conservative treatments. Type III OI, which is a very crippling form of the disease, was associated with radiographically poorer results than the other types. In our analysis, the two groups were unbalanced and only five patients were treated with bisphosphonates. Nevertheless, bisphosphonate use can be considered a good adjuvant to both the conservative and surgical treatment of OI in order to reduce the rate of complications.
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Affiliation(s)
- Eugenio Chiarello
- Address for correspondence: Eugenio Chiarello, MD, Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy, Phone/Fax: +39 051 6366581, E-mail:
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van Dijk FS, Cobben JM, Kariminejad A, Maugeri A, Nikkels PGJ, van Rijn RR, Pals G. Osteogenesis Imperfecta: A Review with Clinical Examples. Mol Syndromol 2011; 2:1-20. [PMID: 22570641 DOI: 10.1159/000332228] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2011] [Indexed: 12/15/2022] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by susceptibility to bone fractures, with a severity ranging from subtle increase in fracture frequency to prenatal fractures. The first scientific description of OI dates from 1788. Since then, important milestones in OI research and treatment have, among others, been the classification of OI into 4 types (the 'Sillence classification'), the discovery of defects in collagen type I biosynthesis as a cause of most cases of OI and the use of bisphosphonate therapy. Furthermore, in the past 5 years, it has become clear that OI comprises a group of heterogeneous disorders, with an estimated 90% of cases due to a causative variant in the COL1A1 or COL1A2 genes and with the remaining 10% due to causative recessive variants in the 8 genes known so far, or in other currently unknown genes. This review aims to highlight the current knowledge around the history, epidemiology, pathogenesis, clinical/radiological features, management, and future prospects of OI. The text will be illustrated with clinical descriptions, including radiographs and, where possible, photographs of patients with OI.
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Affiliation(s)
- F S van Dijk
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
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