1/66. Treatment of a patient with severe osteoporosis and chronic polyarthritis with fixed implant-supported prosthesis: a case report.This article reports the treatment and 5-year follow-up of an 80-year-old female with a history of severe osteoporosis and chronic polyarthritis. Treatment included methotrixate disodium and acemetacin. After the last tooth was removed from the mandible, the patient was successfully treated with a fixed mandibular prosthesis supported by 6 implants placed between the mental foramina. The implants have remained osseointegrated, and peri-implant smears have been negative for bacterial colonization. Radiographic follow-up examination has revealed bone loss that is slightly greater than expected. This article focuses on the placement of implants in a patient receiving medication for chronic polyarthritis and osteoporosis.- - - - - - - - - - ranking = 1keywords = mandible (Clic here for more details about this article) |
2/66. Mitochondrial dna deletion associated oxidative stress and severe male osteoporosis.We have screened the mitochondrial genome of 15 men with symptomatic vertebral fractures (median age 62 years, range 27-72 years) and 17 male control subjects (median age 61 years, range 40-73 years) for the presence of mitochondrial dna (mtDNA) deletions in peripheral monocyte dna. polymerase chain reaction analysis provided evidence of a common age-related (4.9 kb) mtDNA deletion situated between nucleotides 8470 and 13.460 of the genomic sequence in 5 of the 17 controls (29%) and 9 of the 15 patients (60%) investigated. Southern blotting and polymerase chain reaction revealed a novel 3.7 kb deletion in 2 patients. One of the affected patients, a 27-year-old man with severe osteoporosis (lumbar spine bone mineral density (BMD) 0.381 g/cm(2); Z-score -6.45) was found to harbor deletion in almost 50% of the mitochondria. The patient had a blood lactic acid level (4.6 nM) that was over 3 times the upper reference range (0-1.3 mM), thus confirming the presence of systemic oxidative stress. Further analysis by modified primer shift polymerase chain reaction showed the 5' breakpoint to be between the nucleotides 10.63 kb and 10.80 kb of the mtDNA. The second patient harboring the 3.7 kb deletion was older (62 years) with less severe osteoporosis (lumbar spine BMD 0.727/cm(2); Z-score -2.58) and the proportion of affected mitochondria was lower (25%). The significance of these findings is discussed and the possible relation between oxidative stress and accelerated bone loss is examined.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
3/66. A case of postpregnancy osteoporosis.A puerperant woman, who was previously healthy and had no disease known to affect bone metabolism, experienced lower back pain and lumbar vertebral fractures during lactation. Both bone formation markers and resorption markers were markedly elevated. Bone mineral density of the lumbar spine as measured by dual energy X-ray absorptiometry was extremely low. She stopped lactation through the use of bromocriptine because of the large volume of milk secretion. After treatment with calcitonin injections and the use of a corset, her back pain gradually disappeared. This case appears to be postpregnancy osteoporosis.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
4/66. Gross vertebral collapse associated with long-term disodium etidronate treatment for pelvic Paget's disease.Inhibition of skeletal mineralisation is a well-recognized complication of disodium etidronate therapy that was identified in the earliest studies of its use in osteoporosis and Paget's disease. The effect is seen at lower doses in Paget's disease than in osteoporosis. Several cases of spontaneous fractures occurring in unaffected bones of Paget's patients have been reported. However, we believe the case described here is the most severe example of etidronate-induced osteomalacia published in the literature, featuring widespread vertebral collapse occurring as a consequence of nearly 10 years of uninterrupted etidronate treatment for isolated hemipelvic Paget's disease.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
5/66. A case report of insufficiency fracture of the Fossa acetabuli in a patient with rheumatoid arthritis.Aside from vertebral compression fractures, the most common site of insufficiency fractures is the pelvis and lower extremities. In the pelvis, the fractures usually occur in the ilium, the pubis and the ischium, but rarely in the fossa acetabuli. We report a severe insufficiency fracture of the fossa acetabuli in a 78-year-old woman with rheumatoid arthritis (RA). She had associated insufficiency fractures of the rib, the thoracic spine and the sacrum. In our case, senile osteoporosis was present before the onset of the fracture was recognized on radiographs, and RA and corticosteroid therapy might have further aggravated the porosis, resulting in the destruction of the fossa acetabuli. Regarding treatment for the fracture, a cemented total hip replacement without bone graft was attempted for several reasons such as the patient's activities, postoperative rehabilitation and the bone mass of the acetabulum. The postoperative course was satisfactory during study period. However, further follow-up is needed to monitor carefully how the patient will be in the future.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
6/66. Decreased bone mineral density after therapy with alpha interferon in combination with ribavirin for chronic hepatitis c.BACKGROUND/AIMS: Several thousand patients with chronic hepatitis c have been treated with interferon plus ribavirin. After observing a male patient who developed severe bone loss during this treatment, we studied skeletal status and bone mineral metabolism in patients on therapy with interferon plus ribavirin. methods: Bone mineral density and biochemical bone markers were studied in 32 male patients (31-58 years old) treated for 12 months with either interferon alone (group 1; n=13) or interferon plus ribavirin (group 2; n= 19). RESULTS: Bone mineral density was significantly lower in group 2 (0.877-0.07 g/cm2) than in group 1 (1.108 /-0.08 g/cm2, p<0.001). Likewise, T- and Z-score values were also decreased in group 2 (T: -1.95 /-0.6. Z: -1.76 /-0.51) compared with group 1 (T: 0.19 /-0.6; p<0.001. Z: 0.26 /-0.6; p<0.001). serum and urine biochemical bone markers were normal in both groups. However, urinary calcium excretion was decreased in patients on combined therapy. CONCLUSION: Treatment of chronic hepatitis c with interferon plus ribavirin may induce bone loss. This secondary effect should be investigated during the follow-up of these patients, since they may require therapies aimed at prevention or amelioration of these defects.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
7/66. Pamidronate and calcitonin as therapy of acute cancer-related hypercalcemia in children.Severe symptomatic hypercalcemia is a rare event in children with malignancies. Up to now there is limited experience treating childhood hypercalcemia with bisphosphonates in addition to calcitonin. We report a 5-year-old boy with acute lymphoblastic lymphoma who presented with malignant hypercalcemia at diagnosis. The maximal serum calcium concentration was 15.2 mg/dl (3.81 mmol/l). Conventional therapy with forced diuresis and furosemide failed. calcitonin (10 IU/kg/24 h i.v. for 2 days) and pamidronate (1 mg/kg over 2 hours i.v.) were used successfully without adverse effect lowering the serum calcium level within 24 hours to normal values. We recommend the use of calcitonin and pamidronate as first-line therapy together with forced diuresis and furosemide in childhood hypercalcemia secondary to malignancies as it is rapidly effective and has no significant side effects.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
8/66. Acute autoimmune hemolytic anemia following unrelated cord blood transplantation as an early manifestation of chronic graft-versus-host disease.A 16-month-old girl diagnosed with osteopetrosis underwent an unrelated, partially matched (with major mismatch at A locus) cord blood stem cell transplant. Twelve months later she developed severe acute autoimmune hemolytic anemia (AIHA). Immunophenotype analysis of lymphocyte subsets 8 months post transplant showed a low number of T lymphocytes, with normal subsets, and with NK cells and B lymphocytes within normal ranges. When the hemolytic anemia developed, the lymphocytes subsets changed and analysis showed higher numbers of B lymphocytes than previously, lower CD3 T lymphocytes with inversion of the CD4/CD8 ratio and an abnormal proportion of T lymphocyte subsets. She was being treated with cyclosporine, and steroids and immunoglobulins were added. Initially the AIHA improved, but repeated infectious episodes led us to tail off the immunosuppressive treatment. The AIHA relapsed and cyclosporine was restarted. Currently, she is on cyclosporine and low-dose steroid treatment with no hemolytic features. During the 3 months when the AIHA was being treated, she developed extensive skin cGVHD and recurrent pneumothoraces. AIHA may be the first manifestation of abnormal reconstitution of immunity developing after a hematopoietic transplant. This abnormal reconstitution is also the basis of cGVHD. We suggest that aggressive immunosuppressive treatment with intensive measures against infection could give a better prognosis to such patients.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
9/66. vitamins D and K in the treatment of osteoporosis secondary to graft-versus-host disease following bone-marrow transplantation.We report a case of secondary osteoporosis treated with a combination of vitamins D3 and K2, administered orally. A 13-year-old male, diagnosed with highly differentiated acute myelogenous leukaemia, received an allogeneic bone-marrow transplantation. Chronic graft-versus-host disease persisted, thereafter, in the form of severe diarrhoea, rash and allergic conjunctivitis. Since the patient was then at risk from osteoporosis secondary to calcium malabsorption caused by the diarrhoea, dual-energy X-ray absorptiometry and ultrasound analysis were used to measure bone mineral density and bone stiffness, respectively. Both measurements were markedly lower than the average values from patients of matched age, gender and physical characteristics. The osteoporosis did not respond to active vitamin D3 0.1 microg/kg once daily, but when this therapy was combined with vitamin K2 15 mg once daily, an increase in bone mineral density and bone stiffness was observed. In conclusion, vitamin D3 and K2 combination therapy merits further evaluation for the treatment of various types of secondary osteoporosis, including steroid-induced osteoporosis.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
10/66. Recovery from severe glucocorticoid-induced osteoporosis in an adolescent boy.An 18-yr-old boy presented with extreme back pain as the result of multiple vertebral fractures. At age 16 he had developed a tumor of the mesencephalon. A ventriculoperitoneal shunt was established surgically. One year later, he developed progressive neurologic deficits in his upper and lower limbs with an increase in the size of the tumor. He was treated by irradiation and high doses of glucocorticoids. Although the neurologic deficits progressively improved, he developed severe back pain resulting in complete immobilization for 3 mo in spite of neurologic recovery. Multiple vertebral fractures were diagnosed by X-ray. bone density was extremely low (Z-score of -5.5 in the spine and -3.1 in the femoral neck). The patient was treated with calcium and vitamin d, calcitonin, bisphosphonates, physiotherapy, and progressive mobilization. glucocorticoids were decreased and could be stopped as the neurologic deficits fully recovered. After 1 yr of treatment with intermittent i.v. pamidronate, bone density had increased by 40% in the spine and by 25% in the femoral neck despite growth arrest. He progressively recovered from back pain and is now, at age 20, fully ambulant, studying mechanical engineering, without neurologic sequelaes and free of glucocorticoids. magnetic resonance imaging revealed that the tumor had disappeared. This case proves that treatment of symptomatic glucocorticoid-induced osteoporosis during puberty can be rewarding, even when multiple and invalidating vertebral fractures already exist.- - - - - - - - - - ranking = 0.20011064038374keywords = lower (Clic here for more details about this article) |
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