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PubMed1977

Radiographic morphometry and osteopenia in spinal osteoporosis.

Measurements of bone mineral content and total-body calcium, normalized and expressed as ratios, were compared with radiographic morphometry in 45 women who had spinal osteoporosis. The radiographic indices examined included the femoral score, the femoral trabecular pattern, the biconcavity and metacarpal indices, and the total peripheral score. Both ratios and all the radiographic indices except the femoral trabecular pattern were found to be related to the number of dorsal spine fractures. The relationships observed support the following conclusions: (A) the femoral score and the metacarpal index are related to the degree of osteopenia; (B) the biconcavity index reflects the extraskeletal factors that are pathogenic in spinal osteoporosis; (C) a reduced femoral trabecular pattern index is associated with spinal osteoporosis, although this measurement is not related to the degree of osteopenia; and (D) it may be imprudent to diagnose osteoporosis from the presence of lumbar compression fractures.

Age Factors↗

PubMed1986

Symptomatic vertebral hemangiomas: a report of four cases.

Neural compression complicating vertebral hemangioma is associated with: compression fracture, hematoma, epidural extension of tumor, and/or bony expansion or "ballooning." Four cases of symptomatic vertebral hemangioma are presented. Discussion includes imaging modalities, preoperative embolization, and surgical approach.

Adult↗

PubMed2006

Randomized clinical stroke rehabilitation trials in 2005.

This article reviews randomized control trials (RCTs) undertaken in stroke rehabilitation in the year 2005. A Medline search generated 31 RCTs in stroke rehabilitation in the year 2005 in the English language. These trials were primarily efficacy studies of a number of treatments: medications such as folate, vitamin B12 and bisphosphonates in preventing osteoporotic related hip fractures, compression stockings in preventing deep vein thrombosis (DVT), use of mechanical robots and positioning of the upper limb to help improve function; and, transcranial magnetic coil stimulation, acupuncture and neural tissue transplant to enhance motor recovery in post-stroke patients.

Acupuncture↗

PubMed1996

An assessment of factors affecting neurological recovery after spinal cord injury with vertebral fracture.

In order to assess some of the variables associated with neurological recovery after traumatic spinal cord injury with vertebral fracture, a randomised sample of 100 patients (50 without neurological recovery, and 50 with several degrees of recovery) were selected out of 245 patients admitted to our hospital. Both groups were homogeneous with respect to time lapse to admission, hospitalization time and level of lesion. Of the variables considered, the intensity of the lesion (incomplete) and vertebral displacement (under 30%) were statistically associated with neurological recovery. An age under 30 years at the moment of the injury was also associated with neurological recovery but only in those patients with an incomplete lesion. No correlation was found between the other variables studied such as the degree of vertebral wedging, type of fracture (compression, flexion-rotation) and management (conservative, surgical) and the neurological evolution.

Adult↗

PubMed1979

Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature.

Of 300 patients who were hospitalized for acute cervical injuries, 216 lived, fifty-one died within four months of injury, and thirty-three were lost to follow-up. The important findings in a retrospective review were that laminectomy resulted in a high mortality rate and loss of motor function and that steroids did not improve neural recovery in quadriplegics and their use was associated with gastrointestinal hemorrhage. Closed or open reduction followed by posterior fusion for subluxations or dislocations, and anterior decompression and fusion for vertebral compression fractures, offered the best chance for recovery of neural function and restoration of stability. Massive epidural hemorrhage was found only in patients with ankylosing spondylitis.

Adolescent↗

PubMed2006

Investigation of cardiac status and bone mineral density in Turner syndrome.

This review highlights recent developments in the detection and management of congenital heart disease and osteoporosis in patients with monosomy X, or Turner syndrome (TS). Magnetic resonance angiography (MRA) using gadolinium as a contrast agent demonstrates a higher prevalence and greater diversity of congenital cardiovascular defects than previously recognized in TS. Almost 50% of girls and women with TS have marked tortuosity or ectasia of the aortic arch, suggesting that these individuals may be at greater risk for aneurysm formation or dissection and therefore require closer monitoring. MRA also reveals that major venous anomalies are common in TS, with partial anomalous pulmonary venous return and persistent left superior vena cava each found in about 13% of patients. MR imaging even without contrast is a valuable complement to routine cardiac ultrasound in detecting abnormalities of the aortic valve. Abnormal electrocardiographic findings, including prolongation of the QTc interval, have recently been documented in many individuals with TS. Conduction and repolarization abnormalities have not been associated with congenital anatomic defects and are as common in young girls as adults. The clinical significance of these electrophysiological findings is unknown at present, but attention to the ECG in TS is important, particularly in monitoring the QTc when prescribing drugs associated with QT prolongation. Patients with TS are at high risk for osteoporosis as a result of premature ovarian failure and intrinsic bone abnormalities specific to the syndrome. Low cortical bone mineral density (BMD) is apparent in prepubertal girls, and it remains low in adults, independent of estrogen treatment and other hormonal factors. The low mineralization of cortical bone in TS may be associated with a small increased fracture risk, but no treatments are known to increase cortical bone mineral content in TS. Trabecular BMD is normal in TS women who have received continuous estrogen treatment from their mid-teens, although areal densitometry scores may be misleadingly low in very small patients. However, young women with ovarian failure who have not received estrogen treatment for extended periods of time are at high risk for osteoporosis of trabecular bone of the spine, with associated compression fractures and height loss. Therefore, judicious management of estrogen therapy to prevent osteoporosis while minimizing estrogen-associated adverse events is a challenging aspect of care for girls and women with TS.

Bone Density↗

PubMed2000

Trabecular architecture in women and men of similar bone mass with and without vertebral fracture: II. Three-dimensional histology.

We recently developed a simple and inexpensive method that complements established bone histomorphometry procedures by enabling the two-dimensional imaging of cancellous bone to be viewed within its three-dimensional context with the marrow tissue in place and without detriment to the material for other histological purposes. The method, based on the preparation and superficial staining of slices 300 microm thick, enables "real" (i.e., unstained) trabecular termini to be separated from "artifactual" (i.e., stained) termini, providing a direct measure of cancellous connectivity in osteopenic bone. The technique was applied to osteopenic age-matched, white, postmenopausal women (31 with and 22 without vertebral compression fractures) with a similar bone status, as measured at the spine by absorptiometry and at the iliac crest by histology (see part I of this study). Despite the similarity in the mass of trabecular bone at either site, the results showed a significant difference (p < 0. 05) in the number of "real" trabecular termini between the groups, such that the fracture group had almost four times as many termini (mean +/- SE: 1.98 +/- 0.51/30 mm(2)) at the iliac crest as the nonfracture group (mean +/- SE: 0.53 +/- 0.31/30 mm(2)). Previous histomorphometry of the same material failed to detect a structural distinction between the two groups using established variables. It was concluded that a mass-independent trabecular discontinuity contributes to skeletal failure and that determination of the number of "real" disconnections (i.e., unstained termini) by the direct method proposed may provide a more sensitive discriminant of fracture than the present indirect procedures. A group of fracture and nonfracture men (see part I) suggested a similar distinction (fracture: 0.69 +/- 0.30/30 mm(2); nonfracture: 0.18 +/- 0.18/30 mm(2)), although the difference was not significant.

Aged↗

PubMed2006

The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study.

Chronic obstructive pulmonary disease (COPD) is a complex disease, where the initial symptoms are often cough as a result of excessive mucus production and dyspnea. With disease progression several other symptoms may develop, and patients with moderate to severe COPD have often multiorganic disease with severely impaired respiratory dysfunction, decreased physical activity, right ventricular failure of the heart, and a decreased quality of life. In addition osteoporosis might develop possibly due to a number of factors related to the disease. We wanted to investigate the prevalence of osteoporosis in a population of patients with severe COPD as well as to correlate the use of glucocorticoid treatment to the occurrence of osteoporosis in this population. Outpatients from the respiratory unit with COPD, a history of forced expiratory volume in 1s (FEV1) less than 1.3 L, with FEV1% pred. ranging from 17.3% to 45.3% (mean 31.4%, standard deviation (sd) 7.3%). Patients between 50 and 70 years were included. Other causes of osteoporosis were excluded before inclusion. At study entry spirometry, X-ray of the spine (to evaluate presence of vertebral fractures), and bone mineral density of lumbar spine and hip were performed. Of 181 patients invited by mail, 62 patients were included (46 females and 16 males). All had symptoms of COPD such as exertional dyspnea, productive cough, limitations in physical activity etc. The mean FEV1 was 0.90 L (sd: 0.43 L) and the mean FEV1% pred. of 32.6% (sd: 14.1%). All had sufficient daily intake of calcium and vitamin D. In 15 patients, X-ray revealed compression fractures previously not diagnosed. Bone density measurements showed osteoporosis in 22 patients and osteopenia in 16. In total, 26 of the COPD patients were osteoporotic as evaluated from both X-ray and bone density determinations. Thus 68% of the participants had osteoporosis or osteopenia, but glucocorticoid use alone could not explain the increased prevalence of osteoporosis. A large fraction of these needed treatment for severe osteoporosis in order to prevent further bone loss and to reduce future risk of osteoporotic fractures. Thus, there is a significant need to screen patients with COPD to select the individuals in risk of fracture and to initiate prophylaxis or treatment for the disease.

Aged↗

PubMed2003

Overview of osteoporosis: pathophysiology and determinants of bone strength.

Recent advances in both the pharmacological and surgical treatment of osteoporosis and vertebral compression fractures offer exciting new options for elderly patients. However, these treatments should be considered only with an indepth knowledge of osteoporosis as a metabolic disorder with complex effects on bone, its homeostatic regulation, and vertebral strength. Bone homeostasis is under the influence of both endogenous hormonal changes and external mechanical loads resulting from physical activity. These impart their effects through regulation of the relative activities of bone cells, in particular osteoblasts and osteoclasts, which control bone deposition and resorption, respectively. The strength of a vertebra is directly influenced by the amount and relative proportions of its components, with bone mineral density a useful measure of fracture risk. The purpose of this article is to discuss these issues, among others, in order to offer the reader a better understanding of the pathophysiology of osteoporosis and the determinants of bone strength as they relate to the aging skeleton.

Aged↗

PubMed1993

Spinal mobility and deformity after Harrington rod stabilization and limited arthrodesis of thoracolumbar fractures.

The results were reviewed for thirty patients in whom a thoracolumbar fracture had been treated with a Harrington rod placed three segments cephalad and two or three segments caudad to the injured vertebra and a short arthrodesis with removal of the Harrington rod after at least twelve months. The patients were evaluated with clinical examinations, lateral radiographs made with the spine in flexion and extension, and questionnaires at a median of thirty-two months after the stabilization. All of the arthrodeses were successful. The twenty patients who had a burst or compression fracture and who had posterior instrumentation lost only an average of 9 degrees of sagittal correction before attaining a solid fusion. For all thirty patients, the average motion in the sagittal plane at the vertebrae that had been spanned by the Harrington rod but not included in the arthrodesis ranged from 9 degrees at the third and fourth lumbar level to 2 degrees at the eighth and ninth thoracic level. The average total motion between five vertebrae that had been spanned by the rod but did not have an arthrodesis was 24 degrees; between four vertebrae, 23 degrees; and between three vertebrae, 19 degrees. In this series of thoracolumbar fractures treated with a longer Harrington rod than needed to span the level of the arthrodesis and a short arthrodesis, there was a documented return of motion to segments that had been previously spanned by the instrumentation but not included in the arthrodesis and good or excellent functional results over-all.

Adolescent↗

PubMed1993

The lateral atlanto-axial joints and their synovial folds: an in vitro study of soft tissue injuries and fractures.

Thirty victims of blunt cervical trauma, who did not survive (acute death group), were studied at autopsy as were 11 patients who survived trauma for more than 1 month and ten controls without any known cervical trauma. All specimens were sagitally sectioned in 2-mm slices and carefully examined for injuries to the lateral parts of the atlanto-axial joints. In the acute death group, five cases showed a rupture of the joint capsule, three of these with a massive hemarthrosis. In 17 cases there was bruising around the second cervical spinal nerve. Bruising of the intra-articular synovial fold was present in 15 cases, the posterior synovial fold being most commonly affected. There were five intra-articular fractures of the lateral masses, in three cases combined with a dens fracture. In two cases a bone fragment from the fracture compressed and obliterated the lumen of the vertebral artery. The findings are discussed in relation to pain after cervical trauma.

Adolescent↗

PubMed2006

Myeloma bone disease and treatment options.

Multiple myeloma (MM) is a B-cell malignancy characterized by enhanced bone loss commonly associated with a diffuse osteopenia, focal lytic lesions, pathologic fractures, hypercalcemia, and bony pain. Bone destruction in MM results from asynchronous bone turnover wherein increased osteoclastic bone resorption is not accompanied by a comparable increase in bone formation. Recent characterization of osteoclast-activating factors (OAFs), receptor activator of nuclear factor-kappaB (RANK) ligand (RANKL)-osteoprotegerin-RANK system, and inhibitors of Wnt signaling have provided a better understanding of myeloma bone disease in molecular level. The development of minimally invasive surgical procedures such as kyphoplasty and vertebroplasty allows myeloma patients with vertebral compression fractures to have immediate improvement in quality of life and shorter hospital stays. Monthly intravenous infusion of either pamidronate or zoledronic acid have reduced the skeletal complications among MM patients and are now a mainstay of myeloma therapy. Orally administered bisphosphonates, in contrast, have shown little ability to slow the development of skeletal complications in these patients. Although pre-clinical studies suggest nitrogen-containing bisphosphonates have potent anti-tumor effects, clinical trials will be necessary, probably at higher doses given more slowly, to establish their possible anti-tumor effects clinically. As our understanding of the pathophysiology of myeloma bone disease continues to increase, new target therapies will continue to emerge offering new and more advanced options for the management of myeloma bone disease.

Antineoplastic Agents↗

PubMed1982

Intracranial extension and spontaneous hemorrhage of a sphenoid plasmacytoma.

A 71-year-old woman with IgG multiple myeloma presented initially with a compression fracture of the thoracic spine. She responded to radiation therapy and chemotherapy with melphalan and prednisone. One year later, she died from a plasmacytoma eroding intracranially from the greater wing of the sphenoid bone with an associated subdural hematoma. Uncal herniation had been preceded for several weeks by facial numbness. Cranial and intracranial plasmacytomas may occur as isolated lesions or as part of multiple myeloma and can present clinically in a variety of ways, most frequently with cranial nerve palsies. Large intracranial extensions may produce cerebral compression and spontaneous hemorrhage similar to that seen with other malignant intracranial neoplasms. The differential diagnosis of changes in level of consciousness in myeloma patients should include increased intracranial extension and spontaneous hemorrhage.

Aged↗

PubMed1997

[The effect of hormone replacement therapy on bone mineral content and on fractures].

A review of five case-control- and eight prospective studies provides evidence of a decreased risk of fractures among postmenopausal women, who currently use or ever have used hormone replacement therapy. Twenty-three randomized clinically controlled studies provide evidence that hormone replacement therapy could increase bone mass or at least give a significantly higher bone mineral content than placebo or calcium in both the axial and peripheral skeleton. This is true for 1) healthy early postmenopausal 2) normal elderly women, 3) osteoporotic women, and 4) oophorectomized women. Moreover, one of these studies of osteoporotic women showed a significant decrease in the number of compression fractures of the spine after hormone replacement therapy.

Aged↗

PubMed1998

Injuries in adolescent spine exposed to compressive loads: an experimental cadaveric study.

In a cadaveric experiment, 16 functional spinal units (FSUs) obtained from 7 subjects with a mean age of 16.3 years were tested in compression to failure. The deformation rate was 5 mm/min. The bone mineral content (BMC) in the vertebrae was determined by using dual-photon absorptiometry (DPA). In 15 of the FSUs, traumatic changes were registered. Three different types of changes were seen. In nine vertebrae, there was a rupture in the cartilaginous end plate, in 12, a separation of the end plate from the vertebral body, and in three vertebrae, a compression fracture was registered. A close relation was found between BMC and the ultimate force (r2 = 0.63), the ultimate displacement (r2 = 0.73), and the energy absorption (r2 = 0.74). The weakest part of a spinal segment in this experimental situation is the growth plate.

Absorptiometry, Photon↗

PubMed2001

Plasma leptin concentrations are associated with bone mineral density and the presence of vertebral fractures in postmenopausal women.

OBJECTIVE: Although total fat body mass (FM) is considered to be one of the major determinants of bone mass, the mechanism by which FM and bone mass are positively correlated remains unclear. Leptin, the product of the obese (ob) gene, is secreted from adipocytes and its plasma levels are known to be positively correlated with %fat (FM divided by total body weight). There is recent evidence suggesting that leptin directly stimulates osteoblastic differentiation. Thus it is possible that the anabolic action of this hormone on bone may participate in the positive correlation between FM and bone mass. In this study, we analysed the relationships between either plasma leptin levels or %fat vs. bone mineral density (BMD) values as well as the presence of vertebral compression fractures, and evaluated whether or not plasma leptin levels were associated with BMD or bone fragility in a manner independent of FM. PATIENTS: One hundred and thirty-nine postmenopausal women (age 48-78 years, mean 62.5), who visited our outpatient clinic for the evaluation of osteoporosis. DESIGN AND MEASUREMENTS: Plasma concentrations of leptin after an overnight fast were measured by radioimmunoassay. BMD values were measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, femoral neck and whole body. Distal one-third of radius BMD was measured by single photon absorptiometry (SPA). Vertebral fractures were assessed by lateral thoracic and lumbar spine radiographs. RESULTS: Although neither plasma leptin levels nor %fat correlated with age, there was a significant positive correlation between plasma leptin levels and %fat (r = 0.563, P < 0.001). Plasma leptin levels were significantly and positively correlated with BMD values at all skeleton sites measured, and multiple regression analysis revealed that this positive relationship was still observed with BMD values of the femoral neck and of the whole body, even after %fat and age were taken into account. Moreover, plasma leptin levels but not %fat were significantly lower in women with vertebral fractures than in those without fractures. When multiple logistic regression analysis was performed with either plasma leptin value or %fat employed as independent variables, plasma leptin values but not %fat were selected as an index affecting the presence of vertebral fractures. CONCLUSION: Our study showed that plasma leptin levels but not %fat are associated with BMD and the presence of vertebral fractures in postmenopausal women, suggesting that circulating leptin might play a physiological role in maintaining bone mass as well as better bone quality.

Adipose Tissue↗

PubMedDate not supplied

Vertebroplasty: techniques to avoid complications.

BACKGROUND CONTEXT: The use of vertebroplasty for treatment of spinal fractures and spinal hemangiomas is increasing at a rapid pace. Although this is a minimally invasive procedure, complications have been reported. The most important of these is the unintentional migration of polymethylmethacrylate (PMMA). PURPOSE: The authors present methods, equipment, and principles that minimize occurrence of PMMA migration and other complications. STUDY DESIGN/SETTING: Patients in a private/university neurosurgery practice were studied retrospectively by chart review. PATIENT SAMPLE: During a 3-year period, 53 levels of vertebroplasty were performed on 35 patients presenting with indications of intractable pain resulting from vertebral body compression fractures. OUTCOME MEASURES: Pain assessment and outcome determination were made by the treating physician based on dialog with the patient, examination, and the patient's use of narcotics. The medical records of patients were reviewed for these factors as well as for signs of cerebrospinal fluid leak, PMMA migration, new radiculopathy, myelopathy, new fracture, pulmonary emboli, infection, or bleeding. METHODS: Criteria for inclusion consisted of disabling back pain corresponding to a recent fracture, pharmacotherapy, and medically stable for anesthesia. Vertebroplasty patients were followed up at 2 to 3 weeks and at 3 months after their procedure. RESULTS: Success rate for relief of pain was 89%. The overall complication rate was 6% per treated vertebral level. There were no deaths or delayed complications. Factors that reduce complications were identified and include the following: accurate needle placement, adequate barium radio-opacification of PMMA, viscous low pressure delivery of PMMA, and PMMA delivery under direct fluoroscopic visualization. CONCLUSION: Although vertebroplasty is considered a minimally invasive procedure, it can result in serious complications even without technical misadventures.

Adult↗

PubMed1985

Quantitative computed tomography for prediction of vertebral fracture risk.

Vertebral trabecular mineral content and peripheral cortical bone mineral were measured in 94 female and 44 male osteoporotic patients and compared to vertebral mineral values obtained for 323 control subjects in a cross-sectional study. The rate of change of spinal trabecular mineral with age (measured by quantitative computed tomography) in control females averaged 1.2% per year from age 20 to 80, with an accelerated loss demonstrated at the menopause. Trabecular bone mass in male controls declined an average 0.72% per year. Female osteoporotics had a mean decrement of 48 mg cm-3 (39%) compared to age-matched controls, whereas males were decreased 66 mg cm-3 (50%). Radial cortical bone was correlated with spinal mineral in osteoporotics for both males (r = 0.48) and females (r = 0.62). Vertebral compression fractures or wedging was generally absent in patients with vertebral mineral values above 110 mg cm-3, whereas almost all patients with values below 65 mg cm-3 had fractures. Quantitative computed tomography for measurement of vertebral trabecular bone mineral density is useful for defining those patients in whom the risk of vertebral fracture is increased.

Adult↗