Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis

The adjusted incidence rate of hip fracture in Thailand has increased more than 31% from 1997 to 2006. Mortality and morbidity after hip fracture are also high. One year mortality after a hip fracture has increased from 18% in 1999 to 21% in 2007. The Thai Osteoporosis Foundation (TOPF) developed the first Clinical Practice Guideline (CPG) in 2002 and keeps updating the CPG since then. This latest version of the CPG is our attempt to provide comprehensive positional statement on the diagnosis, prevention and treatment of osteoporosis in Thailand. The study group who revised this position statement contains experts from the TOPF, Four Royal Colleges of Thailand, includes the Orthopaedic Surgeons, Gynecologists and Obstetricians, Physiatrists, Radiologists and 2 Associations of Endocrinologists and Rheumatologists which have involved in the management of patients with osteoporosis.

Causal relationship between the AHSG gene and BMD through fetuin-A and BMI: multiple mediation analysis

Using mediation analysis, a causal relationship between the AHSG gene and bone mineral density (BMD) through fetuin-A and body mass index (BMI) mediators was suggested.

INTRODUCTION

Fetuin-A, a multifunctional protein of hepatic origin, is associated with bone mineral density. It is unclear if this association is causal. This study aimed at clarification of this issue.

METHODS

A cross-sectional study was conducted among 1,741 healthy workers from the Electricity Generating Authority of Thailand (EGAT) cohort. The alpha-2-Heremans-Schmid glycoprotein (AHSG) rs2248690 gene was genotyped. Three mediation models were constructed using seemingly unrelated regression analysis. First, the ln[fetuin-A] group was regressed on the AHSG gene. Second, the BMI group was regressed on the AHSG gene and the ln[fetuin-A] group. Finally, the BMD model was constructed by fitting BMD on two mediators (ln[fetuin-A] and BMI) and the independent AHSG variable. All three analyses were adjusted for confounders.

RESULTS

The prevalence of the minor T allele for the AHSG locus was 15.2%. The AHSG locus was highly related to serum fetuin-A levels (P < 0.001). Multiple mediation analyses showed that AHSG was significantly associated with BMD through the ln[fetuin-A] and BMI pathway, with beta coefficients of 0.0060 (95% CI 0.0038, 0.0083) and 0.0030 (95% CI 0.0020, 0.0045) at the total hip and lumbar spine, respectively. About 27.3 and 26.0% of total genetic effects on hip and spine BMD, respectively, were explained by the mediation effects of fetuin-A and BMI.

CONCLUSIONS

Our study suggested evidence of a causal relationship between the AHSG gene and BMD through fetuin-A and BMI mediators.

The efficacy of I-131 metaiodobenzylguanidine (MIBG) treatment in previously heavily treated stage IV neuroblastoma patients (age more than 1 year): Preliminary experiences

20025

Background: The outcome of advanced stage neuroblastoma patients with multiple relapsed or refractory diseases is very dismal. We therefore would like to study the efficacy and the safety of I-131 MIBG treatment in this group of patients. Method: A retrospective study of six stage IV neuroblastoma patients (pts) (2 males and 4 females), age at the diagnosis range 3 to 8 years from January 2005 to December 2006 were studied. All pts were previously treated with multiple regimens of chemotherapy, high-dose chemotherapy with autologous peripheral stem cells (PBSCs) rescue, salvage surgery, and local radiation ( table ). All these patients had relapsed or refractory disease at the time of I-131 MIBG treatment. The therapeutic dose of I-131 MIBG activity per course was given on the basis of weight, the hematological parameter, and tumor response assessment. The cycle of treatment was more 4 weeks apart. The treatment response was evaluated by imaging. and neuron-specific enolase (NSE) levels. Results: A total of 21 courses of I-131 MIBG were administered: one patient received one course, two received three courses, two received four courses and one received six courses. The median therapeutic dose of I-131 MIBG was 5.5 GBq (range; 1.1–5.5). Median duration of response was 10 months (range, 1–19). A partial response achieved in 1, and stable response in 5 patients. Pain relief was observed in 1/1 patients with bone pain. The most common side effect found was thrombocytopenia which became more severe with increasing number of course, grade 2 thrombocytopenia occurring in 4/6 patients over 3 courses of therapy. Three children died whereas three are still alive. There is no morbidity from the therapy. Conclusion: It can be concluded that MIBG treatment is effective and less toxic in patients with relapsed or refractory neuroblastoma and further studies of the role of I-131 MIBG treatment in advanced neuroblastoma in Thailand are needed.

[Table: see text]

No significant financial relationships to disclose.

Detection of colorectal carcinoma by anti-CEA monoclonal antibody (IOR-CEA1) labeled with 99mTc scintigraphy

BACKGROUND/AIMS

This study shows that a new monoclonal antibody (IOR-CEA1) labeled with technetium-99m has high diagnostic efficacy for colorectal adenocarcinoma. This immunoscintigraphy is helpful in clinical management especially for patients whose serum carcinoembryonic antigen and computed tomography are questionable for recurrent diseases. The study aims to evaluate the efficiency of a new monoclonal antibody (IOR-CEA1) labeled with technetium-99m in the detection of colorectal carcinoma.

METHODOLOGY

Forty colorectal carcinoma patients were examined. They were divided into 2 groups: Group I (9 patients) with untreated primary tumor; and Group II (31 patients) who were suspected of recurrent or residual diseases from 1) equivocal computed tomography or magnetic resonance imaging, or 2) rising serum carcinoembryonic antigen but normal imaging or clinical findings. One milligram of the antibody labeled with 25mCi of technetium-99m was slowly infused intravenously and images were obtained by nuclear medicine techniques. Sensitivity, specificity, accuracy, positive and negative predictive values were determined.

RESULTS

99mTc-IOR-CEA1 had 86% sensitivity, 71% specificity, 83% accuracy, 94% positive predictive value and 50% negative predictive value for the detection of colorectal cancer in 42 studies (2 patients had repeated studies). Serum carcinoembryonic antigen had only 33% sensitivity for detection of the primary cancer and 58% sensitivity in detection of recurrent diseases. Carcinoembryonic antigen had 100% positive predictive value but only 31.3% negative predictive value for diagnosis of the recurrence of tumor. Fifty-two percent of the antibody scans provided more information than computed tomography scans with clinical impact on further management in group II patients.

CONCLUSIONS

The 99mTc-IOR-CEA1 scintigraphy is a promising investigative method which is safe and has high accuracy in the detection of recurrent colorectal carcinoma, especially in the patients whose serum carcinoembryonic antigen and computed tomography findings are equivocal for recurrent diseases.

Utilization of electron beam CT scan in diagnosis of pulmonary embolism

Pulmonary embolism is a difficult entity to diagnose clinically and pulmonary angiogram has been the gold standard for the diagnosis. Our objective was to evaluate the usefulness of electron beam (Ultrafast) CT scan in aiding the diagnosis of such an entity, thus avoiding an invasive procedure. Between April 1995 and March 1996 we prospectively studied 20 patients with clinical suspicion of pulmonary embolism by conventional perfusion scan of the lung, by invasive pulmonary angiography and by contrast enhanced electron beam CT scan. Simple statistic correlation between the 3 methods was obtained in regard to sensitivity and specificity utilizing the pulmonary angiogram as the gold standard. The sensitivity and specificity of contrast enhanced electron beam CT scanning was 95 per cent and 100 per cent respectively. The correlation of positive and negative result of all three imaging modalities was 60 per cent. Contrast enhanced electron beam (Ultrafast) CT scan is a good alternative diagnostic modality for pulmonary embolism.