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PubMed2004

Spinal epidural lipomatosis in children with renal diseases receiving steroid therapy.

Spinal epidural lipomatosis (SEL) in patients on steroid therapy may be explained by two hypotheses: (1) steroids induce SEL and (2) steroids cause the growth of a pre-existing SEL, especially in obese children. Steroid-induced SEL (SSEL) is rarely described in children, with only six cases reported elsewhere. However, we have already reported four nephrotic children with SSEL, including one child in another hospital, in addition to the six cases. We investigated the frequency of SSEL in 125 children with renal diseases treated with glucocorticoids in a single hospital over 16 years, and examined the risk factors in 62 patients with SSEL reported in the literature. When patients complained of symptoms at the early stage of SSEL, i.e., back pain or numbness, and patients were obese, we performed spinal magnetic resonance imaging (MRI). SSEL was detected in 5 of 125 children (4.0%). Of the 5 patients with SSEL, 3 had vertebral compression fractures, and all 5 patients were on methylprednisolone pulse therapy. Our study suggests that many more patients can be detected at the early stage of SSEL by performing spinal MRI for patients with early symptoms, obesity, and those who have received methylprednisolone pulse therapy.

Adolescent↗

PubMed2005

Multiple myeloma of the thoracic spine developed at the previous trauma site: case report.

The precise nature of the underlying plasma cell dyscrasias is not well understood. Even today, no causative factor has been found for this disease. It has been suggested that, several factors may act together in the development of this disease. This is a report of a 62-year-old man who initially had a T7 compression fracture and developed a multiple myeloma two years later at that site and at the adjacent vertebral level (T7-T8), respectively. Although the notion that trauma would initiate such a malignancy is speculative, the preceding trauma may be a causative factor in plasma cell dyscrasias.

Humans↗

PubMed2006

Misleading history of pain location in 51 patients with osteoporotic vertebral fractures.

The aim of this study was to investigate associations between the location of osteoporotic vertebral fractures and the patient's localization of pain. Fifty-one consecutive patients (m 6, f 45; average age 74.8 years) with diagnosed osteoporotic vertebral fractures between T8 and L2 were included in the study. Exclusion criteria were fractures above T8 and below L2, spondylolisthesis, disc herniations, tumors, infections, and instability. Pain location was assessed by pain drawing, subdivided into thoracic, lumbar, and thoracic plus lumbar pain areas, and pain intensity using a 101 numeric rating scale. Furthermore, the onset of back pain and the lack or the indication of a trigger event at the onset of pain were documented. Only four of 20 patients with thoracic fractures reported thoracic pain, while the other 16 (80%) reported only lumbar pain. The location of the fracture and the patient's pain report were not related (Cohens Kappa=0.046; P=0.438). Patients with thoracic or lumbar osteoporotic fractures report pain mainly in the lumbosacrogluteal area. Therefore, the complaint of low back pain (LBP) in persons at risk for osteoporotic fractures may require both thoracic and lumbar X-rays. LBP patients with a suspect history of an osteoporotic vertebral fracture should also be given an X-ray of the thoracic and lumbar spine. Patients with a thoracic vertebral fracture had more severe pain than patients with a lumbar vertebral fracture. Onset not related to a fall or a false movement related to a significantly longer pain duration.

Accidental Falls↗

PubMed2026

Outcomes of stereotactic radiosurgery for spine multiple myeloma-a systematic review.

Spinal involvement in multiple myeloma (MM) commonly results in pain, vertebral instability, epidural spinal cord compression, and neurological deficits. Although conventional external beam radiation therapy (EBRT) remains the standard radiation modality because of the radiosensitive nature of MM, stereotactic radiosurgery (SRS) has emerged as a highly conformal treatment option capable of delivering focal high-dose radiation while sparing adjacent spinal cord structures and uninvolved bone marrow. This systematic review evaluated the clinical outcomes and safety profile of SRS for spinal MM. A systematic review of the literature was performed to identify studies evaluating SRS for spinal MM. Extracted variables included patient demographics, tumor characteristics, treatment parameters, radiographic outcomes, pain response, neurological outcomes, local control, overall survival, and adverse events. Three retrospective studies comprising 133 patients and 181 treated spinal lesions met the inclusion criteria. Median patient age ranged from 59 to 65 years, with a slight male predominance across studies. Thoracic spine lesions represented the most treated region (55.5-67.7%). Median prescribed SRS dose was 14-16 Gy, predominantly delivered in a single fraction. Median follow-up ranged from 11.2 to 27.8 months. Local control rates ranged from 89.4 to 100%, with 6- and 12-month local control rates of 94% and 91%, respectively, in one study. Pain improvement was reported in 41-88% of treated patients/sites, with a median time to pain relief of 1.6 months in one cohort. Neurological improvement occurred in 56-71.4% of patients with preexisting deficits. Reported adverse events included vertebral compression fractures, fracture progression, pain flare, and tracheoesophageal fistula. De novo vertebral fractures ranged from 3.6 to 7%, while fracture progression ranged from 14 to 18%. SRS appears to provide excellent local control and meaningful pain and neurological improvement in patients with spinal MM, with acceptable toxicity profiles. The highly conformal nature of SRS may preserve uninvolved bone marrow and facilitate continuation of systemic therapy. However, the current evidence is limited to small retrospective studies with heterogeneous reporting, and further prospective comparative studies are needed to better define the role of SRS relative to conventional EBRT in spinal MM.

Humans↗

PubMed2005

Long-term outcome of patients with rheumatoid arthritis treated by multiple arthroplasty.

We conducted a study of 82 patients with rheumatoid arthritis (RA) who had undergone multiple arthroplasty and investigated their clinical findings and clinical courses. We reviewed the significance of multiple arthroplasty in the treatment of RA, its problems, and measures to solve them. All patients initially regained and maintained good walking capacity. However, the walking capacity of many patients again decreased over the long term; in the tenth year, 79% of patients were capable of a practical gait. The causes of decreased walking capacity included complications of artificial joints, cervical lesions, and vertebral compression fractures. Fractures were observed in as many as nine patients, indicating that it is important to prevent and treat their cause, that is, osteoporosis. The survival rate was 71% in 10 years. In RA patients, particularly those who have undergone multiple arthroplasty, the major causes of death are infection and rheumatic disease, suggesting that prevention of such diseases should be considered paramount. Appropriate systemic treatment of RA, patient education, and measures against osteoporosis for prevention of complications may preserve the worth of multiple arthroplasty for RA patients with multiple joint destruction.

Journal Article↗

PubMed1981

Immunoglobulin E (IgE) multiple myeloma: a case report and review of the literature.

A case of immunoglobulin E (IgE) myeloma with clinical features of "classic" myeloma is presented. Skeletal roentgenograms showed osteoporosis and compression fractures of the vertebrae but no osteosclerosis. Protein analyses revealed an M component of the IgE kappa type with a concentration of 3.1 g/dl. Although morphologic examination revealed that the plasma cells were not so differentiated, well-developed Golgi apparatus and abundant rough-surfaced endoplasmic reticulum were observed. An indirect immunofluorescence technique showed characteristic apple green fluorescence. The E myeloma protein of our patient had no antibody activity. Treatment with melphalan or cyclophosphamide resulted in a decrease in the serum IgE level and in the level of Bence Jones protein in the urine. The clinical and laboratory features of IgE myeloma were summarized and compared with those of other classes of myeloma.

Aged↗

PubMed1994

Post-traumatic cervical kyphosis in children cannot be prevented by non-operative methods.

Eleven children with a vertebral body flexion-compression fracture of the lower cervical spine were reviewed. Eight were treated non-operatively, two had a ventral interbody fusion and one a dorsal fusion. Follow-up time was 1 month to 12 years (mean 55 months). Following non-operative therapy six had a kyphotic deformity of more than 10 degrees at the last follow-up. Kyphosis cannot be prevented or cured by non-operative methods.

Adolescent↗

PubMed1980

Basal plasma immunoreactive calcitonin in postmenopausal osteoporosis.

Calcitonin (CT) deficiency has been suggested as an etiologic factor in postmenopausal osteoporosis (PM-OP). Basal immunoreactive calcitonin (iCT) was measured with a sensitive radioimmunoassay (RIA) in 62 PM-OP women with compression fractures (CF) and in 28 normal age-matched women. Mean iCT values in the two groups were not significantly different (43.5 and 45.1 pg/ml, p greater than 0.10). In the 62 PM-OP females, no significant correlation was noted between basal plasma iCT levels and (1) age; (2) severity of disease as assessed by number of CF; (3) serum calcium, phosphorus, alkaline phosphatase, and immunoreactive parathyroid hormone; and (4) total bone mass as assessed by neutron activation analysis determinations of total body calcium (TBC). In 20 PM-OP patients treated for 24 mo with 100 Medical Research Council (MRC) units daily of synthetic salmon CT, no correlation was observed between basal plasma iCT and response of bone mass (TBC) to therapy. These data suggest that basal CT is not decreased in women with PM-OP, and that the level of circulating CT does not influence therapeutic changes in bone mass during CT therapy. CT is probably not a major etiologic or pathogenetic factor in PM-OP.

Aged↗

PubMed1982

Bone matrix and mineral abnormalities in postmenopausal osteoporosis.

Iliac crest biopsies from 56 postmenopausal osteoporotic females with spontaneous compression fractures and decreased total body Ca were compared to similar tissue from 48 normal controls. Biopsies were analyzed for bone density, Na, Ca, Mg, P, Co3, and hydroxyproline (OH-P). From the results OH-P/matrix, % mineral, and the ion content of the mineral were calculated. osteoporotic subjects showed decreased bone density, % mineral in bone, and OH-P in the bone matrix. Within the mineral, CO3 and Ca/P were decreased, while Na and Mg were increased. Statistical analysis showed that matrix OH-P and % mineral varied independently, and therefore the patients were separated into 4 subgroups: Group Ia: decreased matrix OH-P with normal % mineral (n = 9), Group Ib: decreased matrix OH-P with decreased % mineral (n = 5), Group IIa: normal matrix OH-P with normal % mineral (n = 33), Group IIb: normal matrix OH-P with decreased % mineral (n = 9). Decreased % mineral was associated with decreased bone density and an increase in Na and Mg in the mineral, which suggests skeletal Ca deficiency. Decreased matrix OH-P was associated with decreased bone density and, in the low % mineral group, with decreased mineral CO3 and Ca/P, suggesting a mineral of decreased mean crystal size. When both abnormalities coexisted (Group Ib), the greatest reduction in total body Ca was seen. Patients with normal matrix and normal % mineral (Group IIa) still had decreased bone density. The results suggest that in a large, clinically homogeneous population of postmenopausal osteoporotic women, 4 subgroups can be identified by differences in chemical composition of iliac crest biopsies.

Adult↗

PubMed1983

Stanozolol in postmenopausal osteoporosis: therapeutic efficacy and possible mechanisms of action.

To assess the efficacy of the anabolic steroid stanozolol in the treatment of osteoporosis, a 29-month double-blind study was performed with 23 treated and 23 control postmenopausal osteoporotic women. Drug efficacy was assessed by serial determinations of total body calcium (TBC--total bone mass) by neutron activation analysis, regional bone mass (RBM) by single-photon absorptiometry, and by spinal roentgenograms. Total body calcium increased 4.4% from baseline values (P less than 0.01) in the treated group and remained unchanged in the control group; the difference in the change in TBC between the treated and control groups was significant (P less than 0.03). The effect of the drug on TBC persisted throughout the 29-month period. In contrast to TBC, measurements of RBM indicated no significant differences between the treated and placebo groups, suggesting a possible differential response to therapy at various skeletal sites. No new spinal compression fractures were noted in the treated group (compared with three new fractures in the control group). Assessment of serum and urine values indicated a decrease in the level of urinary calcium and an increase in the level of total urinary cyclic AMP in the treated group. These changes were observed even though the level of serum iPTH was significantly decreased during the study. An analysis of changes in bone biopsy specimens revealed no significant differences between the treated and control groups. Seventy-six percent of the treated subjects developed SGOT elevations or other side effects from the stanozolol therapy; at no time were these effects sufficiently severe to cause termination of medication. The data suggest that long-term use of stanozolol increases the net total bone mass above pretreatment levels.

Aged↗

PubMed1990

Bone mineral density and its association with inherited protein S deficiency.

Two unrelated children with thrombotic disease associated with inherited protein S deficiency and osteopenia have been identified. Measurement of protein S yielded markedly reduced levels of free protein S (less than 12.5%) in both propositi, a normal level of total protein S (79%) in propositus #1, and markedly reduced level of total protein S (34%) in propositus #2. Bone densitometry measurements of the two children revealed trabecular vertebral bone mineral content below two standard deviations. This defect is associated with vertebral body compression fractures in propositus #2. Therefore, it is hypothesized that protein S deficiency is associated with abnormalities of bone mineral density.

Adult↗

PubMed1991

The state of human bone tissue during space flight.

The results of studying the bone tissue of cosmonauts after the flights (4-8 month) have been compared to the data of investigating the healthy individuals during head-down tilt (HDT, 370 days). Noninvasive methods (computer tomography, gammaphoton absorptiometry) revealed a decrease in the vertebral spongy mineral density or a increase of this parameter by a similar magnitude versus the individual preflight values in some cosmonauts. During studies of clinical cases of osteoporosis it was shown that the vertebral mineral density ratios and presence or absence of vertebral compression fractures in different age groups are nonequal.

Absorptiometry, Photon↗

PubMed1989

Effects of cyclical therapy for osteoporosis using an oral regimen of inorganic phosphate and sodium etidronate: a clinical and bone histomorphometric study.

Cyclical therapy for osteoporosis has been proposed as a means to induce a coherently structured improvement in bone remodelling dynamics. This pilot study involved 37 osteoporotic patients with symptomatic vertebral compression fractures, treated with an oral protocol designed to activate endogenous bone turnover and selectively depress osteoclastic bone resorption, utilizing inorganic phosphate and sodium etidronate respectively in sequential 3 monthly cycles. Biochemical parameters were recorded during the first cycle, and quantitative bone histomorphometry was obtained from iliac crest biopsies before and after 23.4 +/- 8.5 (SEM) months of treatment. In addition, fracture rates (expressed as new vertebral fractures/1000 patient years) were studied by sequential lateral spinal radiographs. Lumbar bone mineral density (BMD) was assessed by sequential dual-beam photon densitometry. The results demonstrated equivocal biochemical evidence of 2 degrees hyperparathyroidism during the initial cycle of therapy with inorganic phosphate. However, fracture rates declined significantly from 640/1000 patient years during the first 15 months therapy to 242/1000 patient years during a further 20 months follow-up (P less than 0.01). Lumbar BMD increased over baseline by 8.38 +/- 2.87% after 12 months treatment (P less than 0.01). Bone histomorphometric analysis disclosed a modest increment in bone volume from 16.0 to 17.4% tissue volume, and a significant increase in eroded surface from 4.2 +/- 0.6 to 6.0 +/- 0.9% cancellous surface (P less than 0.05). However, histomorphometric parameters of bone formation deteriorated. It is concluded that this cyclical protocol resulted in short-term improvement in trabecular bone mass, but there is no evidence at a cellular level that long-term improvements in bone remodelling occurred.

Administration, Oral↗

PubMed1992

Can nandrolone add to the effect of hormonal replacement therapy in postmenopausal osteoporosis?

Thirty-six women with postmenopausal osteoporosis (31 of them with at least one non-traumatic vertebral compression fracture) were matched pair-wise as to age, years since menopause and body mass index and randomized to receive either cyclical estrogen-progestagen replacement treatment (group 1) or the same treatment plus nandrolone decanoate (group 2). During the first year of treatment in both groups the forearm BMC (SPA) rose proximally and distally 2-3%. Over 2 years the increments of forearm BMC in both groups were up to 4.5%. Lumbar BMC (DPA) rose in both groups nearly 10% over the first year and 12-12.5% over 2 years. The cancellous bone density of L3 (QCT) showed in 6 months an increase of 21% in group 1 and 29% in group 2 to subsequently stay at that level. All these changes from the basal levels were highly significant but there were no significant differences between the two groups. These two conclusions were also drawn with regard to the induced fall of serum alkaline phosphatase (-23%), osteocalcin (-35% to -44%) and procollagen I (-15% to -22%) and of the fasting urinary hydroxyproline (-33% to -36%). No significant increase in the number of newly deformed vertebrae occurred in 2 years.

Aged↗

PubMed1992

Which is more osteoporosis-inducing, menopause or oophorectomy?

The present study was designed to investigate in a comparative manner whether menopause or oophorectomy (OPX) would be a more osteoporosis-inducing factor with regard to sex steroids, bone metabolism and bone mineral density (BMD), including postmenopausal subjects, OPX subjects and age- and body-size-matched premenopausal controls. Serum levels of estradiol (E2), testosterone (TS) and dehydroepiandrosterone (DHEA) were found to decrease in both the postmenopausal and OPX subjects without any significant difference between them, while serum levels of estrone (E1) and androstenedione (delta 4), which have been reported to be related to bone metabolism, were significantly lower in the OPX subjects than in the postmenopausal subjects. According to the indices representing bone formation and bone resorption, as well as the changes in serum levels of Ca-regulating hormones, bone metabolic balance seemed to be slightly more negative in the former than in the latter. However, there was no difference between these two groups of subjects with regard to BMD in lumbar vertebral spongy portion which sensitively reflects the changes in total lumbar BMD and bone metabolism and in which compressive fracture is apt to occur. This fact suggests that these two groups of subjects may be managed in the same way in clinical practice. In other terms, the menopause, a natural event in women, influences BMD as much as OPX, which is the greatest risk factor in osteoporosis, does.

Androgens↗

PubMedDate not supplied

The assessment of postmenopausal osteoporosis by total body neutron activation analysis.

Total body calcium (TBCa) was measured using a cyclotron for in vivo neutron activation analysis (IVNAA) in 20 healthy women, 15 women with vertebral compression fractures, and 8 women with wrist fractures. The precision of the technique, using phantoms, was 1.8% for a dose of 13 mSv. A formula for predicted TBCa (TBCap) was derived from the 20 normal women based on span and years postmenopause. The coefficient of variation of TBCa after normalization in the normal women was 6.6%. The mean TBCa values for the vertebral and wrist fracture groups were 69% and 84% of TBCap for women at the time of the menopause. The low TBCa in the wrist fracture group was attributable to post-menopausal bone loss. Of the low TBCa in the vertebral fracture group, about half the loss could be attributed to postmenopausal age and half to other factors.

Aged↗

PubMedDate not supplied

Paget's disease of a vertebral body seen on computerized tomography.

The author presents a case of Paget's disease effecting a lumbar vertebral body that was seen on a computerized tomogram. It had an interesting appearance and showed no contrast enhancement. There was a moderate compression fracture to this vertebral body and there was encroachment on the spinal canal. The author knows of no other similar case presentation.

Aged↗

PubMed1995

Spinal cord concussion in previously undiagnosed osteogenesis imperfecta.

An 11-year-old boy was a victim of a motor vehicle accident. He initially presented with paraplegia and inability to detect pain below the fourth thoracic dermatome. Two hours later, he had full return of motor and sensory function. Thoracolumbar spine radiography and magnetic resonance imaging (MRI) showed multiple compression fractures and marked osteopenia of the vertebrae. The patient's family history is significant for osteogenesis imperfecta (OI), although the patient had not been previously diagnosed with this disorder. Although the patient had no prior fractures or any of the classic stigmata of OI except for short stature, plain radiographic and MRI findings in conjunction with his family history support the diagnosis of OI. A brief discussion of both OI and spinal cord concussion is presented.

Accidents, Traffic↗