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PubMedDate not supplied

[Complication after vertebroplasty in patient with senile osteoporosis: strategical therapy to revise?].

Compression fractures are common in patients with osteoporosis and they are crippling. By 1892, Julius Wolff et al. realized that mechanical loads can affect bone architecture in living beings, but the mechanisms responsible for this effect were unknown, and it had no known clinical applications. In 2003 we know how this effect occurs and some of its applications. Vertebroplasty and kyphoplasty are relatively new techniques used to treat painful vertebral compression fractures. Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure. The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of bone cement into a vertebral body for the relief of pain, and the strengthening of the bone. This procedure also carries a risk of complications, and the fracture risk of vertebrae adjacent to cement vertebrae may be increased. The authors describe a case of vertebrae's fractures adjacent to cement vertebrae that are occurred in a patient with senile osteoporosis.

Aged↗
PubMed2002

Spinal epidural lipomatosis.

Epidural lipomatosis is an uncommon disorder defined as a pathologic overgrowth of normal epidural fat. It is most often associated with administration of exogenous steroids of variable duration and dose. However, it can occur in the absence of exposure to steroids. We report two cases of spinal epidural lipomatosis following more than 20 years of steroid use due to asthma. Pathologic compression fracture due to osteoporosis and acute cord compression syndrome were found in these 2 cases. After emergent decompressive laminectomy and fusion surgery, neurological function recovered. From a review of literature, most patients received decompressive laminectomy surgery. But in our additional cases, we performed decompressive laminectomy and fusion surgery which might prevent further spinal deformity and improve the spinal stability, then patients' symptoms subsided completely. Therefore, decompression surgery and fusion surgery may be necessary in patients with symptomatic spinal epidural lipomatosis with compression fracture.

Adrenal Cortex Hormones↗
PubMed2002

[The clinical benefits to bone mineral density were shown by cyclical oral etidronate administration in steroid induced osteoporosis].

PURPOSE: To compare the bone-mass effects of intermittent cyclic etidronate administration in patients of various rheumatic disease patients with corticosteroid-induced osteoporosis. PATIENTS AND METHODS: We evaluated bone mineral density (BMD) of lumbar spine in 34 female patients (mean age: 46.4 +/- 13.7 y. o. 17-71) treated with long term corticosteroid (> 6 months). Eighteen patients cyclically received etidronate orally (400 mg or 200 mg etidronate daily for 2 weeks, followed by 10-12 weeks drug-free periods). Twelve in these 18 patients received 400 mg (group A) and another 6 patients were treated with 200 mg/day (group B). Sixteen patients free from etidronate administrations were analysed as a control group. RESULTS: Cyclical etidronate therapy showed significant increase in BMD. The BMD of lumbar spine increased from 0.760 +/- 0.10 g/cm 2 to 0.783 +/- 0.11 g/cm 2 (%change from baseline 2.91 +/- 2.56%/year) in group A treated patients after 12 months. Reduced BMD (%change from baseline 1.55 +/- 2.48%) was observed in 16 control group patients (P < 0.0012). The BMD in group A was significantly high compared to group B or control after the etidronate treatment. In 7 of group A, BMD increased significantly on 6 months but no more significant increase was shown on 12 months compared to the value on 6 months. On the other hand the BMD tend to increased for after 2 years in intermittent cyclic etidronate treatment in 8 cases of group A. There were no adverse effects and abnormal laboratory data related to the administration of etidronate. Although only 2 cases of group A showed the findings of compression fracture before the study, but no new compression fracture appeared in any group during this study. CONCLUSION: It was shown that cyclical etidronate therapy is effective for steroid induced osteoporosis.

Administration, Oral↗
PubMed2003

Adult spinal deformity in the osteoporotic spine: options and pitfalls.

Osteoporosis has received heightened attention over the past 2 decades because of its overwhelming cost to society. It is one of the most common diseases affecting both men and women. The key to treatment is early prevention accompanied by modification of risk factors and impact-oriented exercise, optimal medical management with antiresorptive medications, and addressing the complications of this disease such as compression fractures and spinal deformities. Most osteoporotic vertebral compression fractures can be treated nonsurgically, but new techniques such as vertebroplasty and kyphoplasty are producing good early clinical results with low complication profiles. The surgical treatment of deformities such as kyphosis and scoliosis can be very challenging given the poor bone quality and propensity for instrumentation cutout. The surgical treatment of spinal stenosis in the face of deformity in these patients requires keen surgical planning and a clear identification of the source of the patient's complaints--be it the deformity, the stenosis, or both. Several advances in instrumentation, such as the use of laminar fixation (if available), multisegment fixation, limited correction of the deformity, and augmentation of pedicle screw purchase through biologic and nonbiologic fillers have been developed.

Humans↗
PubMed1985

Structural scoliosis in osteoporotic women.

Fifty women (mean age 69 +/- 5 years) with biopsy-proven osteoporosis and back pain were radiographically studied for scoliosis, kyphosis, and compression fractures. Twenty-four (48%) osteoporotics had at least 10 degrees of structural scoliosis. Curves were indistinguishable from those of idiopathic scoliosis. Lumbar and thoracolumbar curves were most common. The kyphosis averaged 70 degrees +/- 17 degrees and spanned 9.8 +/- 1.75 vertebrae. Forty-seven patients had 140 compression fractures. Fractures occurred within, but were usually not the cause of, scoliotic curves. Scoliosis in elderly women is a clinical marker and may be a risk factor for osteoporosis and compression fractures. Adult scoliotic patients should be evaluated for osteoporosis with iliac bone biopsies and aggressively treated.

Aged↗
PubMed2002

Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up.

PURPOSE: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with vertebral body compression fractures. MATERIALS AND METHODS: One hundred patients (79 women, 21 men; mean age, 73.7 y) underwent 156 percutaneous injections of polymethylmethacrylate (PMMA) into a vertebra (68 thoracic and 88 lumbar) under fluoroscopic guidance over a 35-month period. Before the procedure and at follow-up, patients were asked to quantify their pain on a visual analog scale (VAS) and complete a follow-up questionnaire of our own design. RESULTS: The procedure was technically successful in all patients. There were two complications. One patient sustained a sternal fracture and one experienced a transient radiculopathy. Ninety-seven patients (97%) reported significant pain relief 24 hours after treatment. Mean follow-up duration was 21.5 months (6-44 mo) in 99 patients. Ninety-two patients (93%) reported significant improvement in back pain previously associated with their compression fractures as well as improved ambulatory ability. Before vertebroplasty, the VAS score for the 99 patients was 8.91 +/- 1.12 compared to a score of 2.02 +/- 1.95 at follow-up. The mean difference in VAS scores was significant (P <.0001). CONCLUSION: Percutaneous vertebroplasty of symptomatic vertebral body compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain.

Adult↗
PubMedDate not supplied

Missed cervical spine fracture: chiropractic implications.

OBJECTIVE: To discuss the case of a patient with an anterior compression fracture of the cervical spine, which had been overlooked on initial examination. CLINICAL FEATURES: A 36-year-old man was seen at a chiropractic clinic 1 month after diving into the ocean and hitting his head on the ocean floor. He chipped a tooth but denied loss of consciousness. Initial medical examination in the emergency department did not include radiography, but an anti-inflammatory medication was prescribed. Radiographs taken at the chiropractic clinic 1 month later revealed an anterior compression fracture of the C7 vertebra, with migration of the fragment noted on flexion and extension views. INTERVENTION AND OUTCOME: The patient was referred back to his medical doctor for further evaluation and management.He was instructed to wear a Philadelphia collar for 4 weeks. During this time period, he reported "shooting" pain and tingling from his neck into his arms. The patient reported resolution of his neck and arm symptoms at 2.5 months after injury. Follow-up radiographs at 6 months after injury revealed fusion of the fracture fragment with mild residual deformity. At that time, the patient began a course of chiropractic treatment. CONCLUSION: After head trauma, it is essential to obtain a radiograph of the cervical spine to rule out fracture. Chiropractors should proceed with caution, regardless of any prior medical or ancillary evaluation, before commencing cervical spine manipulation after head and neck trauma.

Adult↗
PubMed1993

Age-dependent vitamin D status and vertebral condition of white women living in Curaçao (The Netherlands Antilles) as compared with their counterparts in The Netherlands.

Plasma vitamin D metabolites and parathyroid hormone concentrations of two groups of white women, aged 26-46 and 63-83 y, in Curaçao were studied to evaluate the effect of yearlong abundant sunlight on frequency of vertebral compression fractures in elderly women. 25-Hydroxyvitamin D of the younger group (median, 116 nmol/L) was higher than that of the older group (75 nmol/L). Both groups had higher 25-hydroxyvitamin D compared with approximately age-matched counterparts in The Netherlands during autumn and winter (50 and 25 nmol/L, respectively). Similar differences were found for 1,25-dihydroxyvitamin D, although to a lesser extent. Parathyroid hormone concentrations of older women in Curaçao (4.3 pmol/L) were higher than those of the younger women (2.3 pmol/L). Roentgenographic analyses of the spines of the older women did not show vertebral compression fractures commonly encountered in women living at higher latitudes. Uninterrupted high plasma concentrations of vitamin D metabolites may reduce vertebral compression fractures in postmenopausal white women.

Adult↗
PubMed1988

A comparison of the risk of vertebral fracture in menopausal osteopenia and other metabolic disturbances.

The risk of atraumatic compression fracture in postmenopausal women increases as vertebral trabecular bone density decreases. To determine whether the risk is similar for patients who have other metabolic disorders, we compared eight-nine patients who had various disturbances affecting bone and sixty-three postmenopausal women who had no evidence of underlying disease. Trabecular bone density was measured by quantitative computed tomography of the lumbar spine. The relationship between frequency of fracture and bone density was modeled mathematically with spline threshold, quadratic polynomial, and decaying exponential functions. Analysis of covariance showed that the diagnostic category did not influence the relationship between frequency of fracture and bone density in any of the three models. We concluded that the risk of atraumatic compression fracture, as assessed by measurement of vertebral trabecular bone density using quantitative computerized tomography, is independent of the underlying metabolic disturbance.

Adult↗
PubMed1981

The diagnosis of osteoporosis.

A rational approach to the diagnosis of osteoporosis by the primary care physician is outline, with emphasis on the patient who presents with chronic back pain and a vertebral compression fracture. The basic information includes data from the patient's history and physical examination, laboratory, x-ray and bone biopsy studies, and determination of bone mineral content (BMC) by photon absorptiometry. Characteristic radiologic features associated with bone loss, BMC changes, and bone biopsy findings are illustrated. This diagnostic approach, summarized in a flow diagram, poses a series of questions; the answer to each question leads either ot a diagnostic conclusion or to further questions which must be answered. This permits decision as to whether a compression fracture is due to trauma, local osteoporosis, osteomalacia, secondary osteoporosis or primary osteoporosis. In te study population (150 subjects), 80 percent of patients presenting with vertebral compression fractures had primary osteoporosis.

Adult↗
PubMed1983

Postmenopausal bone loss at multiple skeletal sites: relationship to estrogen use.

Bone mineral content (BMC) was measured in the distal radius, proximal radius, and os calcis in 608 postmenopausal women, and the values were compared to vertebral osteoporosis and compression fractures determined radiographically, as well as to history of estrogen use. Current estrogen users had significantly higher BMC at all appendicular sites as compared to non-users. Prior estrogen users had lower appendicular BMC's than current users, but they were still significantly higher than non-users. However, radiographic assessment of the lumbar spine showed no difference in osteoporosis or compression fracture prevalence between prior users and non-users of estrogen, whereas current estrogen users had a significantly lower prevalence of osteoporosis in the spine. These findings suggest that estrogen effect on trabecular bone in the os calcis may be more transient than on cortical, appendicular bone. They also suggest that long term or permanent estrogen replacement is required to prevent spinal compression fractures.

Adult↗
PubMed1991

Effect of cyclical therapy with phosphorus and etidronate on axial bone mineral density in postmenopausal osteoporotic women.

Forty seven women with postmenopausal osteoporosis and at least one but no more than four vertebral compression fractures received sequential and cyclical therapy with phosphorus and etidronate (p/etid). During the same 2-year period of observation, three other groups of patients received either sodium fluoride (n = 12), estrogen replacement therapy (n = 12), or vitamin D and calcium (Ca++) alone (n = 15). Axial bone mineral density (BMD) was measured by means of dual-photon absorptiometry. Lateral thoracic and lumbar spine radiographs were taken to assess fractures. Bone mineral density increased from baseline during p/etid therapy: Mean 15.7 +/- 1.6% (SD) (P less than 0.001). During the same time, the patients in the sodium fluoride group showed a comparable increase in their BMD from baseline: mean 15.7 +/- 1.1% (P less than 0.001). During the first year of therapy, patients in the estrogen replacement group had an increase in their BMD from baseline: mean: 4.6% +/- 1.1% (P less than 0.05). No change in BMD was seen in the control group that received vitamin D and Ca++ alone. No patient who received p/etid, sodium fluoride, or estrogen replacement therapy had any new vertebral compression fractures or height loss, whereas in the control group that received vitamin D and Ca++ alone 6 out of 15 had height loss and at least one new vertebral fracture (P less than 0.01). p/etid therapy increases BMD in women with postmenopausal osteoporosis comparable to sodium fluoride but without side effects or toxicity and stabilizes vertebral compression fractures.

Aged↗
PubMed1993

Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression.

The major factors determining the mechanical milieu of a healing fracture are the rigidity of the selected fixation device, the fracture configuration, the accuracy of fracture reduction, and the amount and type of stresses occurring at the bone ends dictated by functional activity and loading at the fracture gap. Of the effects of these factors on fracture healing and remodeling in the canine tibia under unilateral external fixation, the two most significant factors in promoting periosteal callus formation were the amount of physiologic loading as dictated by the body weight and the presence of a significant fracture gap. Uniform axial loading and motion, performed at two or four weeks, did not increase callus formation but did reduce the existing fracture gap. The time-related diminution of periosteal callus (external remodeling) was related to the progress of cortical healing. Cortical reconstruction was fast in stable transverse fractures and delayed in unstable oblique fractures. Motion with loading tended to promote external callus maturation in secondary bone healing. Intracortical new bone formation and porosity were related to the healing pattern and not to the loading magnitude. Endosteal new bone formation showed a strong correlation with the presence of a fracture gap. In terms of torsional strength and energy absorption at failure, the fractures healing through a combination of primary and secondary bone union mechanisms showed the mechanical strength of the healing bone closest to intact bone.

Animals↗
PubMed1993

[Injuries of the cervical spine in children and adolescents].

Ligamentous and osseous injuries of the cervical spine during growth are extremely rare and therapeutic principles for such lesions are ill-defined. In order to help solve some diagnostic and therapeutic problems a retrospective study of 30 children was carried out. There were 5 discoligamentous injuries, 5 fractures of the atlas, 1 fracture of the arcus C2, 8 fractures of the odontoid, and 11 vertebral body compression fractures. The injuries were caused by motor vehicle accident in 9, by diving into shallow water in 7, by falling from a height in 7, by a sports accident in 6, and by a direct trauma in 1 patient. Four children died, three of them due to concomitant brain injury. Two patients suffered permanent neurologic disability due to spinal cord trauma. Five patients underwent an operation. Conservative therapy of flexion-compression fractures of the vertebral bodies caused kyphotic deformity. Ventral interbody fusion in two patients had excellent long-term results. All odontoid fractures were treated by applying a plaster cast and healed promptly. Diagnostic problems were mainly caused by the hypermobility of the upper cervical spine.

Adolescent↗
PubMed1985

The coexistence and characteristics of osteoarthritis and osteoporosis.

We defined the clinical features and radiographic coexistence of osteoarthritis and osteoporosis in fifty women with primary coxarthrosis and fifty age-matched women (average age, 69 +/- 5 years) with idiopathic osteoporosis. The patients with osteoarthritis had undergone total hip replacement. The diagnosis of primary osteoarthritis was established by clinical, radiographic, and histological criteria, and the diagnosis of osteoporosis was confirmed by histomorphometric analysis of specimens taken at iliac-bone biopsy. In the arthritic patients, spinal osteoporosis was identified by radiographic evidence of compression fractures, kyphosis, and scoliosis. Femoral osteoporosis was demonstrated by the index of Singh et al. and the femoral canal-shaft ratio. In the osteoporotic patients coxarthrosis was measured radiographically by the scale of Kellgren and Lawrence. On the average, the osteoporotic patients were twelve kilograms lighter than the osteoarthritic patients. Fifty-eight per cent of the osteoporotic and 18 per cent of the osteoarthritic patients had a scoliotic curve of at least 10 degrees. The prevalence of osteoarthritis of the hip in the osteoporotic women was 4 per cent, and the prevalence of compression fractures in the arthritic women was 6 per cent, which was approximately one-quarter of the expected incidence. These results show that: (1) osteoporosis does not protect against the development of coxarthrosis, (2) coxarthrosis is a negative risk factor for osteoporotic compression fractures, and (3) scoliosis and an ectomorphic habitus are clinical markers that identify a risk for osteoporosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Systemic mastocytosis presenting as osteoporosis: a clinical and histomorphometric study.

Ten patients with systemic mastocytosis (SM) were evaluated for their metabolic bone disease (4 men and 6 women; mean +/- SD, 59 +/- 13 yr). All patients presented with generalized osteopenia and/or atraumatic vertebral compression fractures. Three patients had long-standing urticaria pigmentosa; in these, the diagnosis of cutaneous mastocytosis had been established by skin biopsy. One of the 3 and 2 of the other 7 individuals had symptoms suggestive of SM. Although six patients had previously undergone decalcified bone marrow trephine core biopsy (DBMB), findings were consistent with SM in only 2 of them. X-Ray survey revealed generalized osteopenia in all 10 patients and vertebral compression fractures in 9. No patient had sclerotic bone lesions. Histological findings of undecalcified transiliac crest biopsy (UTBB) specimens from 9 patients (5 patients underwent both DBMB and UTBB, 4 underwent only UTBB, and 1 had only DBMB) disclosed bone marrow that contained nodules characteristic of mast cell granulomas and numerous scattered oval- and spindle-shaped mast cells. The trabecular bone contained abundant newly synthesized bone matrix and a significant increase in osteoblastic, osteoclastic, and resorptive surfaces. Dynamic histomorphometric parameters revealed a significantly increased mineral apposition rate. Our study suggests that SM may be a more frequent cause of osteoporosis than previously recognized. Generalized osteopenia with compression fractures may be the only presentation of SM. Undecalcified bone biopsy is useful in the diagnosis of SM. Accelerated bone remodeling is a characteristic histomorphometric feature of SM with diffuse osteopenia.

Adult↗