A multi-method assessment of bone maintenance and loss in an Imperial Roman population: Implications for future studies of age-related bone loss in the past.

OBJECTIVES: One of the hallmarks of contemporary osteoporosis and bone loss is dramatically higher prevalence of loss and fragility in females post-menopause. In contrast, bioarchaeological studies of bone loss have found a greater diversity of age- and sex-related patterns of bone loss in past populations. We argue that the differing findings may relate to the fact that most studies use only a single methodology to quantify bone loss and do not account for the heterogeneity and complexity of bone maintenance across the skeleton and over the life course. METHODS: We test the hypothesis that bone mass and maintenance in trabecular bone sites versus cortical bone sites will show differing patterns of age-related bone loss, with cortical bone sites showing sex difference in bone loss that are similar to contemporary Western populations, and trabecular bone loss at earlier ages. We investigated this hypothesis in the Imperial Roman population of Velia using three methods: radiogrammetry of the second metacarpal (N = 71), bone histology of ribs (N = 70), and computerized tomography of trabecular bone architecture (N = 47). All three methods were used to explore sex and age differences in patterns of bone loss. RESULTS: The suite of methods utilized reveal differences in the timing of bone loss with age, but all methods found no statistically significant differences in age-related bone loss. DISCUSSION: We argue that a multi-method approach reduces the influence of confounding factors by building a reconstruction of bone turnover over the life cycle that a limited single-method project cannot provide. The implications of using multiple methods beyond studies of bone loss are also discussed.

A multicenter, retrospective epidemiologic survey of the clinical features and management of bone metastatic disease in China.

BACKGROUND: Bone metastases are common in patients with advanced cancer. Bisphosphonates (BPs) could prevent or delay the development of skeleton-related events (SREs). The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases. METHODS: Consecutive cancer patients who had bone metastases and received BP treatment were enrolled. A questionnaire was developed to collect the patients' clinical data, as well as information on the diagnosis and management of bone metastases. Physicians' awareness of the guidelines and knowledge of the application of BP were also assessed. RESULTS: A total of 3223 patients with lung cancer (36.5%), breast cancer (30.9%), prostate cancer (8.5%), and gastrointestinal cancer (5.7%) were included in this study. The sites of bone metastases were the thoracic spine (56.0 %), lumbar spine (47.1%), ribs (32.6%), and pelvis (23.2%). The SRE frequency was the highest in patients with multiple myeloma (36.6%), followed by those with lung cancer (25.9%), breast cancer (20.2%), prostate cancer (18.2%), and gastrointestinal cancer (17.3%). Irradiation to the bone was the most frequent SRE (58% in lung cancer patients, 45% in breast cancer patients, and 48% in prostate cancer patients). Our survey also showed that 45.5% of patients received BP within 3 months after their diagnosis of bone metastases, whereas the remaining 54.5% of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases. The SRE frequency in the former group was significantly lower than that in the latter group (4.0% vs. 42.3%, P < 0.05). In patients with more than 6 months of continuous BP treatment, the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment (7.2 vs. 3.4 months, P < 0.05). In addition, 12.2% of the physicians were not aware of the efficacy of BP in preventing and delaying SRE. Only half (52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable. CONCLUSIONS: Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs. However, our survey also revealed that the proper application of BP was not as common as expected in China.

Assessment of maceration techniques used to remove soft tissue from bone in cut mark analysis.

Maceration techniques employed in forensics must be effective without compromising the bone's integrity and morphology, and prevent destruction of evidence. Techniques must also be fast, safe, easily obtainable and inexpensive; not all techniques currently employed are appropriate for forensic use. To evaluate the most suitable approach, seven techniques including current and new methodologies were applied to fresh, fleshed porcine ribs exhibiting cut marks. A sample size of 30 specimens per technique was examined under scanning electron microscopy at the cut mark and the surrounding uncompromised regions; a scoring system of effectiveness was applied. The previously unpublished microwave method fared best for bone and cut mark preservation. Sodium hypochlorite destroyed cut marks, and was deemed unsuitable for forensic analysis. No single technique fulfilled all criteria; however, this study provides a benchmark for forensic anthropologists to select the most appropriate method for their situation, while maintaining the high standards required by forensic science.

Radiographic, clinical, and patients' assessment of segmental direct vertebral body derotation versus simple rod derotation in main thoracic adolescent idiopathic scoliosis: a prospective, comparative cohort study.

PURPOSE: The application of vertebral body derotation (DVBD) is still controversial by now; the purpose of this prospective cohort study was to compare comprehensive outcomes between segmental DVBD and simple rod derotation (SRD) especially in main thoracic adolescent idiopathic scoliosis. METHODS: 36 patients in DVBD group and 45 patients in SRD group were with a 2-year follow-up. Among them, 19 DVBD patients and 16 SRD patients received CT scan examinations. RESULTS: There were no significant difference between the groups in preoperative main thoracic Cobb, apical vertebral rotation and rib hump. Apical vertebral rotation measured from CT scans was 9.7° ± 2.0° versus 15.3° ± 2.4° (p < 0.001) postoperatively in the DVBD and SRD patients, respectively. At 2-year follow-up, the main thoracic Cobb was 14.2° ± 1.6° versus 14.7° ± 1.7° (p = 0.18), rib hump was 6.4° ± 3.8° versus 6.8° ± 3.1° (p = 0.60) in DVBD group and SRD group. Patients' assessments of both groups were improved in Spinal Appearance Questionnaire (SAQ) and Scoliosis Research Society-22 Questionnaire (SRS-22), but showed no significant difference at follow-up (p = 0.47 and 0.60). CONCLUSION: Although segmental DVBD showed excellent radiographic correction of axial spinal deformity postoperatively, there was no more correction of clinical rib hump or better patients' assessment than SRD at follow-up in our data.

Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation.

OBJECTIVE: The present study was undertaken to determine which factors differentiate patients with a good outcome after treatment for Thoracic Outlet Syndrome (TOS) from patients with a poor outcome. METHODS: A total of 85 patients, who were examined during one year, had at least 6 months of follow up after treatment for TOS with either surgery or botulinum chemodenervation. RESULTS: Socioeconomic factors of work disability or workers' compensation claims did not differentiate treatment-responsive TOS from treatment-resistant cases. There was no difference between the 2 groups regarding the presence of anomalous anatomy detected by ultrasonography or regarding the presence of subclavian artery flow acceleration or occlusion detected by duplex sonography. Several factors were noted more frequently in treatment-resistant patients: sensory complaints extending beyond lower trunk dermatomes (42% vs. 10%), weakness extending beyond lower trunk myotomes (19% vs. 2%), histories of previous non-TOS surgery of the neck or upper limbs (50% vs.17%), comorbidities of fibromyalgia or complex regional pain syndrome (81% vs. 12%), and depression (35% vs. 10%). Treatment-resistant patients complained about more widespread functional impairments on a validated Cervical Brachial Symptom Questionnaire (CBSQ) than treatment-responsive patients. Resistant cases responded less often to a scalene test block (38% vs. 100%), which is designed to simulate the effects of targeted treatment. CONCLUSION: In summary, compared to patients with a good outcome after targeted treatment, patients with a poor outcome had more diffuse complaints and responded less often to a scalene test block.

Sensitivity of autopsy and radiological examination in detecting bone fractures in an animal model: implications for the assessment of fatal child physical abuse.

Skeletal injuries are often strong indicators of child abuse and their detection is therefore crucial. The aim of this study was to compare the sensitivity of three diagnostic approaches, namely autopsy, traditional (conventional) radiology, and computed tomography on "battered" piglets, in order to verify the sensitivity of each method, with respect to the true number of bone fractures assessed once the piglet was skeletonised (osteological control). Four newborn cadaver piglets who had died from natural causes were severely beaten post-mortem in every district of the body. Traditional radiography, computed tomography (CT) and autopsy were performed. The piglet was then macerated until skeletonised and the number of all fractures present recorded (osteological control). On the cranium, traditional radiology revealed only 35% circa of actual fractures, autopsy detected only 31% (P<0.01 for both comparisons versus osteological control), whereas CT imaging detected all fractures actually present. For ribs, radiology detected only 47% of all fractures present, and autopsy 65% circa (P>0.05 for both comparisons versus osteological control), while CT scans detected 34% (P<0.01). In suspected cases of fatal child abuse, we suggest that the bones of specific districts be directly analysed either at autopsy or by collecting specific diagnostic sites, such as parts of the rib cage, and subjecting them to maceration. The removed areas could be replaced with artificial material for cosmetic purposes. The authors stress the importance of combined radiological, CT scan, autopsy and osteological survey in the detection of perimortem bone fractures.

Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale.

OBJECTIVES: This study evaluates the Walter Reed Visual Assessment Scale (WRVAS) compared with clinical parameters and written descriptions of the deformity from idiopathic scoliosis patients and their parents. SUMMARY OF BACKGROUND DATA: The WRVAS demonstrates seven visible aspects of spinal deformity in an analogue scale. Higher scores reflect worsening deformity. MATERIALS AND METHODS: The WRVAS was administered to 182 idiopathic scoliosis patients at four centers in conjunction with open-ended questions about patients' and their parents' perceptions of their spinal deformity. The open-ended responses were categorized as either "deformity noted" or "no deformity noted." RESULTS: WRVAS scores strongly correlate with curve magnitude (P = 0.01) and clearly differentiates curves of 30 degrees or more from lesser curves. Among treatment groups, patients with surgery recommended had significantly higher scores than that of other patients. The instrument differentiated those noting no deformity from those noting a deformity. The correlation between patients' and parents' scores was high (Spearman's rho = 0.8). When a deformity was noted, parents gave higher scores than did their children for rib prominence, shoulder level, scapular rotation, and the total score, but not for the other dimensions. CONCLUSIONS: Increasing scores of the WRVAS are strongly correlated with curve magnitude lending construct validity to this type of assessment tool. Patients with "surgery recommended" report more visible deformity on the scale than observed, braced, and postoperative patients, supporting the hypothesis that surgery improves the perceived appearance. Parents perceive more deformity of the ribs and shoulders more than did the patients, but other aspects of the deformity are identified equally. WRVAS scores correlate significantly with curve magnitude and treatment. Parents and patients have similar scores, but with parents perceiving more deformity of the ribs and shoulders than patients.

Long-term follow-up assessment of vascularized rib pedicle graft for tuberculosis kyphosis.

This article reports a long-term follow-up assessment (10-15 years) of eight children treated with a vascularized rib pedicle graft after an anterior spinal decompression for paralysis resulting from tuberculosis. Neurologic recovery, fusion, and hypertrophy of the rib grafts were noted in all patients. The vascularized rib pedicle grafts were superior to autologous rib grafts in supporting and promoting early fusion of the anterior column in children with kyphosis resulting from tuberculosis.

Zygapophyseal and costovertebral/costotransverse joints: an anatomic assessment of arthritis impact.

Zygapophyseal articular surface cortical disruption noted radiologically in RA is at variance with the perception that it is an axial joint-sparing (cervical vertebrae excepted) disorder. However, the reliability of such radiologic assessment has been questioned. Direct visual examination of the zygapophyseal and costovertebral joints (of individuals with documented RA, spondyloarthropathy, diffuse idiopathic skeletal hyperostosis and normal controls) allowed these radiologic perceptions to be tested and placed in perspective. Articular surface cortical disruption/discontinuity was actually found to take two forms, indistinguishable by standard X-ray technique: 1. fronts of resorption, with reactive new bone formation; 2. exposed bare trabeculae, secondary to a 'wearing away' abrasion process. Zygapophyseal and costovertebral erosions were only found in skeletons of individuals with spondyloarthropathy, whereas the abrasion-related phenomenon was especially prevalent in RA and in normal controls. Inability to radiologically distinguish abraded or 'worn away' lesions from erosions explains past radiologic confusion. Radiologic evidence of zygapophyseal and costovertebral joint surface disruption/discontinuity does not appear specific for erosive disease.