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1.
Medicine (Baltimore) ; 100(3): e24396, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546083

RESUMO

RATIONALE: Traumatic atlantoaxial anteroinferior subluxation associated with a dens fracture and a Hangman fracture is a very rare and complex injury. Therefore, appropriate surgical strategy is not established. PATIENT CONCERNS: An 85-year-old female presented with posterior neck pain and atypical neck position caused after rolling down a hill. Although neurological examinations for motor, sensory, gait, and reflex tests were normal, the patient complained of an abnormal neck posture. DIAGNOSES: Radiological examinations revealed an atlantoaxial anteroinferior subluxation with kyphosis, a type IIA dens fracture (Anderson and D'Alonzo classification) with an anterolateral rotatory angulation of type IIA dens fracture fragment, and a type I Hangman fracture (Levine and Edwards classification). Nevertheless, the transverse atlantal ligament was intact. INTERVENTIONS: We considered that the intact transverse atlantal ligament and kinking of the type IIA dens fracture fragment into the left lateral mass of C1 prevented a spinal cord injury by blocking a further displacement of C1 to C2. Due to the patient's osteoporosis and the anterolateral rotatory angulated type IIA dens fracture fragment, a forceful reduction of the atlantoaxial anteroinferior subluxation with kyphosis could pose a high risk of fixation failure and spinal cord injury. Therefore, we performed in-situ posterior C1-2 fusion using a C1 lateral mass screw and C2 lamina screw fixations. OUTCOMES: At 1 year after surgery, the bone union of all fractures was achieved in the kyphosis state. Furthermore, the patient's clinical symptoms were improved with no neurological deficit. LESSONS: A thorough radiological examination and appropriate surgical strategy are important for successful diagnosis and treatment of a complex C1-2 injury.


Assuntos
Articulação Atlantoaxial/lesões , Luxações Articulares/etiologia , Fraturas da Coluna Vertebral/etiologia , Acidentes por Quedas , Idoso de 80 Anos ou mais , Articulação Atlantoaxial/diagnóstico por imagem , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Cervicalgia/etiologia , Cervicalgia/psicologia , Fraturas da Coluna Vertebral/diagnóstico por imagem
2.
Medicine (Baltimore) ; 100(7): e24839, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607854

RESUMO

BACKGROUND: To systematically evaluate the efficacy of teriparatide and bisphosphonates in preventing fractures in postmenopausal women with osteoporosis. MATERIALS AND METHODS: We performed a systematic search of PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) that compared teriparatide and bisphosphonates for osteoporosis treatment. Searches were performed without language restrictions and included studies from beginning of time to March 2019. Two authors independently screened and extracted the selected article. The quality of the included studies was evaluated using the Cochrane system evaluation method. Data were extracted and analysed using RevMan 5.2 software. RESULTS: Nine RCTs were included for a total of 2990 postmenopausal women with osteoporosis. Of these, 1515 patients were treated with teriparatide and 1475 were treated with bisphosphonates. After pooling the data of 9 studies, there were significant differences between teriparatide and bisphosphonates [relative risk (RR): 0.61, 95% confidence interval (CI) (0.51, 0.74)] in the prevention of fractures according to different follow-up durations (P < .05), whatever alendronate [RR: 0.51, 95% CI (0.27, 0.95)] and other bisphosphonates [RR: 0.63, 95% CI (0.51, 0.77)]. In addition, we found significant differences between teriparatide and bisphosphonates in the prevention of vertebral fractures [RR: 0.47, 95% CI (0.35, 0.64)] and non-vertebral fractures [RR: 0.76, 95% CI (0.58,0.99)]. There were no significant differences in adverse effects between teriparatide and bisphosphonates [RR: 0.89, 95% CI (0.76, 1.03)]. CONCLUSIONS: Based on the results of our meta-analysis, teriparatide was better than bisphosphonates in preventing fractures in postmenopausal women with osteoporosis both in the short-term and long-term follow-up periods. Teriparatide was superior to bisphosphonates in preventing vertebral and non-vertebral fractures. These drugs did not differ in terms of their adverse effects. More high-quality studies are needed to compare other factors such as costs and adverse reactions.


Assuntos
Difosfonatos/uso terapêutico , Fraturas Ósseas/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Teriparatida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Casos e Controles , Difosfonatos/efeitos adversos , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Incidência , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Teriparatida/efeitos adversos , Resultado do Tratamento
3.
Arch Osteoporos ; 16(1): 36, 2021 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-33611644

RESUMO

OBJECTIVE: The incidence of fractures in pregnancy and lactation-associated osteoporosis (PLO) is very low. Some fracture cases of PLO are associated with vertebral compression fractures, while malleolar fractures in patients with PLO are rarely reported before. CASE REPORT: A 31-year-old Han Chinese patient presented with a malleolar fracture 3 months after delivery, while she was still breastfeeding. Temporary closed reduction and plaster external fixation were performed in the emergency room. Then the patient was admitted to the orthopedic trauma ward for surgery and diagnosed as PLO by dual-energy X-ray absorptiometry (DEXA). After preoperative evaluation, the patient underwent open reduction and internal fixation. With the diagnosis of PLO, the patient was treated with weaning, bisphosphonate, and supplementation of calcium carbonate and vitamin D. During the 12-month follow-up period, the results of DEXA and laboratory examination improved gradually, and the internal fixation was removed 12 months after surgery. CONCLUSION: Orthopedic doctors should not ignore the possibility of PLO to avoid misdiagnosis of perinatal women with fractures. Improvement of functional recovery of fractures can be achieved with accurate diagnosis and individual treatment.


Assuntos
Fraturas por Compressão , Osteoporose , Complicações na Gravidez , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Adulto , Densidade Óssea , Aleitamento Materno , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Lactação , Osteoporose/diagnóstico por imagem , Gravidez , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia
4.
Ann R Coll Surg Engl ; 103(2): e74-e75, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559547

RESUMO

We present a case of bilateral anterior superior iliac spine avulsion fractures in an adult patient who was involved in a road traffic collision. Her injuries were managed conservatively and she has had an uncomplicated recovery with a good outcome. This is, to our knowledge, the only reported case of bilateral simultaneous anterior superior iliac spine apophyseal avulsion fractures in an adult.


Assuntos
Acidentes de Trânsito , Tratamento Conservador , Fratura Avulsão/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Feminino , Fratura Avulsão/etiologia , Fratura Avulsão/terapia , Humanos , Ílio/diagnóstico por imagem , Ílio/lesões , Ílio/cirurgia , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Eur J Endocrinol ; 184(4): 597-606, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33606665

RESUMO

Objective: Several small studies reported increased prevalence and incidence of asymptomatic vertebral fractures in patients with non-functioning adrenal adenomas and adenomas with mild autonomous cortisol secretion. However, the risk of symptomatic fractures at vertebrae, and at other sites remains unknown. Our objective was to determine the prevalence and incidence of symptomatic site-specific fractures in patients with adrenal adenomas. Design: Population-based cohort study, Olmsted County, Minnesota, USA, 1995-2017. Methods: Participants were the patients with adrenal adenoma and age/sex-matched referent subjects. Patients with overt hormone excess were excluded. Main outcomes measures were prevalence and incidence of bone fractures. Results: Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years (20-96). At the time of diagnosis, patients had a higher prevalence of previous fractures than referent subjects (any fracture: 47.9% vs 41.3%, P = 0.003, vertebral fracture: 6.4% vs 3.6%, P = 0.004, combined osteoporotic sites: 16.6% vs 13.3%, P = 0.04). Median duration of follow-up was 6.8 years (range: 0-21.9 years). After adjusting for age, sex, BMI, tobacco use, prior history of fracture, and common causes of secondary osteoporosis, patients with adenoma had hazard ratio of 1.27 (95% CI: 1.07-1.52) for developing a new fracture during follow up when compared to referent subjects. Conclusions: Patients with adrenal adenomas have higher prevalence of fractures at the time of diagnosis and increased risk to develop new fractures when compared to referent subjects.


Assuntos
Adenoma/epidemiologia , Neoplasias das Glândulas Suprarrenais/epidemiologia , Fraturas Ósseas/epidemiologia , Adenoma/complicações , Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Fraturas Ósseas/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Adulto Jovem
6.
Osteoporos Int ; 32(3): 399-411, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33475820

RESUMO

Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS. • Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture. • Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA. • Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds. • Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment. • Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment decisions in younger or older FLS patients, consistent with recent IOF-ESCEO guidance on baseline-risk-stratified therapy, and provides a reliable baseline from which to define new, potentially therapy-altering, vertebral fracture events.


Assuntos
Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Idoso , Densidade Óssea , Humanos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 20-25, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448194

RESUMO

Objective: To investigate the risk factors of adjacent fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods: A total of 2 216 patients who received PVP due to symptomatic OVCF between January 2014 and January 2017 and met the selection criteria were selected as study subjects. The clinical data was collected, including gender, age, height, body mass, history of smoking and drinking, whether the combination of hypertension, diabetes, coronary arteriosclerosis, chronic obstructive pulmonary disease (COPD), bone mineral density, the number of fractured vertebrae, the amount of cement injected into single vertebra, the cement leakage, and whether regular exercise after operation, whether regular anti-osteoporosis treatment after operation. Firstly, single factor analysis was performed on the observed indicators to preliminarily screen the influencing factors of adjacent fractures after PVP. Then, logistic regression analysis was carried out for relevant indicators with statistical significance to screen risk factors. Results: All patients were followed up 12-24 months, with an average of 15.8 months. Among them, 227 patients (10.24%) had adjacent fractures. The univariate analysis showed that there were significant differences between the fracture group and non-fracture group in age, gender, preoperative bone density, history of smoking and drinking, COPD, the number of fractured vertebrae and the amount of bone cement injected into the single vertebra, as well as regular exercise after operation, regular anti-osteoporosis treatment after operation ( P<0.05). Further multivariate logistic regression analysis showed that the elderly and female, history of smoking, irregular exercise after operation, irregular anti-osteoporosis treatment after operation, low preoperative bone density, large number of fractured vertebrae, and small amount of bone cement injected into the single vertebra were risk factors for adjacent fractures after PVP in OVCF patients ( P<0.05). Conclusion: The risk of adjacent fractures after PVP increases in elderly, female patients with low preoperative bone mineral density, large number of fractured vertebrae, and insufficient bone cement injection. The patients need to quit smoking, regular exercise, and anti-osteoporosis treatment after PVP.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Cimentos para Ossos , Feminino , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos
8.
Medicine (Baltimore) ; 99(34): e21572, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846765

RESUMO

Traumatic end plate fractures (EPFs) refers to the EPF caused by trauma, rather than the pathological status of the end plate (EP). However, some old traumatic EPFs may be mistaken as osteoporotic in the elderly. The objective of this study is to describe the radiological features of traumatic EPF in different traumatic fracture type patients presenting in the Emergency department setting. And to compare the result with osteoporotic vertebral fracture (VF).This study retrospectively analyzed the anatomical location of acute thoracolumbar vertebral traumatic EPFs in males (age≤55 years) and females (age≤50 years). The anatomic distribution of EPFs, the anterior and posterior wall fracture were analyzed in patients, who were scanned with 1 or more of the following methods: radiography, CT, and magnetic resonance imaging.There were 194 cases of acute spine trauma involving at least 1 EPF, including 118 males and 76 females. The involved vertebra was mostly at L1 (29.7%), followed by T12 (18.3%), and then by L2 (12.9%). Excluding those with both upper and lower EP involvements, the ratio of superior EPF to inferior EPF was 33.5 for males and 45.5 for females. With the EP divided into 5 segments of equal length in the anteroposterior direction in different fracture types, fractures occurred mostly at a2 segment (71.48% for superior EPs and 7.60% for inferior EPs), followed by a1 segment (66.16% for superior EPs). The upper third of the anterior and posterior walls were most prone to fracture in traumatic vertebral fracture.Traumatic EPFs more likely involve the anterior EP more than the posterior EP and is correlated with fracture type. These characteristics may help radiologist differential diagnosis between traumatic and osteoporotic EPF.


Assuntos
Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/lesões , Adolescente , Adulto , China/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
9.
Eur J Endocrinol ; 183(4): 427-437, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688336

RESUMO

Objective: Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess results in both reversible and irreversible musculoskeletal damage, including increased vertebral fracture (VF) risk. The prevalence of VFs is approximately 60% in controlled acromegaly patients, and these VFs can progress in time. We aimed to identify the course of VFs in a cohort of acromegaly patients in long-term remission and their associated risk factors during prolonged follow-up. Methods: Thirty-one patients with acromegaly (49% female, median age 60 years (IQR 53-66)), who were in remission for ≥2 years, were included in this longitudinal, prospective, follow-up study. Spine radiographs of vertebrae Th4 to L4 were assessed for VFs using the Genant score, at baseline, after 2.6 years and 9.1 years. Progression was defined as either a new fracture or a ≥1-point increase in Genant score. Results: The prevalence of VF at baseline was 87% (27/31 patients). Progression of VFs was observed in eleven patients (35.5%) during the 9.1-year follow-up period, with a total incidence rate of 65.5 per 1000 person years (males 59.8 per 1000 person years vs females 71.6 per 1000 person years). Patients treated with surgery or radiotherapy had a higher risk of VF progression in this cohort (P = 0.030). Conclusions: In this cohort of long-term, well-controlled acromegalic patients, the prevalence and progression of VFs was high, showing that the deleterious effects of GH and IGF-1 excess on bone persist despite achievement of longstanding remission.


Assuntos
Acromegalia/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/patologia , Acromegalia/etiologia , Acromegalia/terapia , Adenoma/complicações , Adenoma/epidemiologia , Adenoma/terapia , Adulto , Idoso , Densidade Óssea , Sobreviventes de Câncer/estatística & dados numéricos , Estudos de Coortes , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/epidemiologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
10.
Medicine (Baltimore) ; 99(22): e20397, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481429

RESUMO

RATIONALE: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH. PATIENT CONCERNS: A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2). DIAGNOSIS: Two patients were diagnosed with spinal Mets and DISH. INTERVENTIONS: Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms. OUTCOMES: A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2. LESSONS: Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.


Assuntos
Hiperostose Esquelética Difusa Idiopática/complicações , Neoplasias da Coluna Vertebral/secundário , Idoso , Blefaroptose , Neoplasias da Mama/patologia , Anormalidades Congênitas , Descompressão Cirúrgica/métodos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Hiperostose Esquelética Difusa Idiopática/cirurgia , Região Lombossacral/anormalidades , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia
11.
Rev. osteoporos. metab. miner. (Internet) ; 12(2): 45-52, abr.-jun. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-193783

RESUMO

OBJETIVO: Valorar la asociación de las mediciones tridimensionales (3D) derivadas de la absorciometría de rayos X de energía dual (DXA) lumbar con las fracturas osteoporóticas en las vértebras dorsales. MATERIAL Y MÉTODOS: Analizamos retrospectivamente 32 mujeres postmenopáusicas: 16 con fracturas incidentes en las vértebras dorsales y 16 controles sin ningún tipo de fractura. Las DXA lumbares se adquirieron en la visita inicial (es decir, antes del evento de fractura) y se midió la densidad mineral ósea de área (DMOa) en las vértebras L1 a L4. Las mediciones 3D derivadas de la DXA se evaluaron utilizando un software de modelado 3D (3D-SHAPER). La densidad mineral ósea volumétrica (DMOv) se calculó en el hueso trabecular, cortical e integral. También se midió el grosor cortical y la DMO superficial (DMOs) cortical. Las diferencias en las mediciones derivadas de la DXA entre los grupos de fracturados y controles se evaluaron utilizando una prueba t de Student no pareada. También se calculó la razón de probabilidades (OR) y el área bajo la curva característica operativa del receptor (AUC). RESULTADOS: En el presente estudio caso-control ajustado por edad no se encontraron diferencias significativas entre los grupos de fracturados y controles en términos de peso (ρ = 0,44), altura (ρ = 0,25) y DMOa (ρ = 0,11). Sin embargo, sí se encontraron diferencias significativas (ρ < 0,05) en la DMOv integral y trabecular y en la DMOs cortical. La DMOv trabecular en el cuerpo vertebral fue la medida que mejor discriminó entre ambos grupos, con un AUC de 0,733, respecto a 0,682 para la DMOa. CONCLUSIÓN: Este estudio muestra la capacidad de los modelos 3D derivados de la DXA lumbar para discriminar entre sujetos con fracturas incidentes en las vértebras dorsales y controles. Es necesario analizar cohortes mayores para determinar si estas mediciones podrían mejorar la predicción del riesgo de fractura en la práctica clínica


OBJECTIVE: To assess the relation between three-dimensional (3D) measurements obtained by lumbar dual energy X-ray absorptiometry (DXA) and osteoporotic fractures in dorsal vertebrae. MATERIAL AND METHODS: We analysed retrospectively 32 postmenopausal women, allocated to two groups: 16 women in the experimental group, who presented incident fractures of the dorsal vertebrae, and 16 women in the control group, who did not show any type of fracture. Measurements of the (aBMD) of vertebrae L1 through L4 were taken at the initial visit (i.e., prior to the fracture event) by lumbar dual-energy x-ray absorptiometries (DXA). 3D measurements obtained by DXA were evaluated using 3D modelling software (3D-SHAPER). Volumetric bone mineral density (vBMD) was calculated in the trabecular, cortical and integral bone. Cortical thickness and cortical surface BMD (sBMD) were also measured. Differences in measurements derived from the DXA between the experimental and control groups were assessed using an unpaired Student t-test. The odds ratio (OR) and the area under the receiver operating characteristic curve (AUC) were also determined. RESULTS: In the present age-adjusted case-control study, no significant differences were found between the experimental and control groups in terms of weight (ρ = 0.44), height (ρ = 0.25) and aBMD (ρ = 0.11). However, significant differences (ρ < 0.05) were found in the integral and trabecular vBMD and in the cortical sBMD. Trabecular vBMD in the vertebral body was the measure that best discriminated between both groups, with an AUC of 0.733, compared to 0.682 of the aBMD. CONCLUSION: This study shows the ability of 3D models resultant from lumbar DXAs to discern between subjects with incident fractures in the dorsal vertebrae and control subjects. It is necessary to analyse larger cohorts to establish if these measurements could improve the prediction of fracture risk in clinical practice


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Estudos de Casos e Controles , Estudos Retrospectivos , Absorciometria de Fóton , Raios X
12.
Rev. osteoporos. metab. miner. (Internet) ; 12(2): 53-61, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193784

RESUMO

OBJETIVOS: Evaluar la prevalencia de calcificación vascular y fracturas vertebrales en una cohorte de pacientes sometidos a trasplante renal, y su asociación con mortalidad por todas las causas y disfunción del injerto, así como la relación con parámetros bioquímicos del metabolismo óseo y mineral. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional, unicéntrico, en el que se incluyeron 405 pacientes sometidos a trasplante renal, con recogida de parámetros clínicos, bioquímicos, epidemiológicos y de calcificación vascular radiológica y fracturas vertebrales mediante radiografía simple en el momento del trasplante, con un seguimiento mínimo de dos años, evaluando mortalidad cardiovascular y por todas las causas y descenso del filtrado glomerular. Se dispuso además de 39 estudios de densitometría ósea realizados en los meses previos al trasplante. RESULTADOS: La supervivencia de los pacientes fue significativamente menor en el grupo de pacientes con calcificación vascular (131 ± 1,5 meses sin calcificación frente a 110 ± 3,5 meses con calcificación vascular, p < 0,001). Se observó un mayor descenso del filtrado glomerular estimado (FGE) mediante la fórmula CKD-EPI en todos los pacientes que presentaban calcificación vascular, siendo esta un factor de riesgo independiente (OR = 2,7; IC 95%: 1,6-4,4; p < 0,001). La prevalencia de fracturas vertebrales fue significativamente mayor en el grupo de calcificación vascular (12%), independientemente de otros factores de riesgo (OR = 9,2; IC 95%: 1,2-73,4; p = 0,036). Se ha asociado la prevalencia de fracturas vertebrales con menor masa ósea en cadera evaluada mediante densitometría ósea (T-score -1,2 vs. -2,4, p = 0,02) CONCLUSIONES: La calcificación vascular previa al trasplante, evaluada mediante un método sencillo, barato y accesible como la radiografía simple, condiciona la morbimortalidad del paciente sometido a trasplante renal y tiene un gran impacto sobre la evolución de la función del injerto, independientemente de otros factores de riesgo tradicionales. La asociación entre la fragilidad ósea, la calcificación vascular y el pronóstico del paciente y del injerto renal nos debe hacer pensar en añadir la densitometría ósea en el protocolo de inclusión en lista de espera de trasplante. Es relevante promover no sólo la mejor salud vascular posible sino también promover el menor impacto en el tejido óseo en la progresión de la enfermedad renal crónica antes del momento del trasplante


OBJETIVE: To assess the prevalence of vascular calcification and vertebral fractures in a cohort of patients undergoing kidney transplantation and its association with all graft-related causes of mortality and dysfunction, as well as the relationship with biochemical parameters of bone and mineral metabolism. MATERIAL AND METHODS: Prospective, observational, single-center study, which included 405 patients undergoing kidney transplants, with collection of clinical, biochemical, epidemiological parameters, and of radiological vascular calcification and vertebral fractures by simple radiography at the time of transplantation, with a minimum follow-up of two years. We assessed cardiovascular mortality and all causes and decreased glomerular filtration. In addition, 39 bone densitometry studies carried out in the months prior to transplantation were reported. RESULTS: Patient survival was significantly lower in the group of patients with vascular calcification (131 ± 1.5 months without calcification compared to 110 ± 3.5 months with vascular calcification, p < 0.001). A greater decrease in the estimated glomerular filtration rate (GFR) was observed using the CKD-EPI formula in all patients who presented vascular calcification, this being an independent risk factor (OR = 2.7; 95% CI: 1.6-4, 4; p < 0.001). The prevalence of vertebral fractures was significantly higher in the vascular calcification group (12%), independently of other risk factors (OR = 9.2; 95% CI: 1.2-73.4; p = 0.036). The prevalence of vertebral fractures has been associated with lower hip bone mass assessed by bone densitometry (T-score -1.2 vs. -2.4, p = 0.02) CONCLUSIONS: Vascular calcification prior to transplantation, evaluated using a simple, cheap and accessible method such as plain radiography, determines the morbidity and mortality of the patient undergoing a kidney transplant and has a great impact on the evolution of graft function, regardless of other risk factors. traditional. The association between bone fragility, vascular calcification and the prognosis of the patient and the renal graft should make us think about adding bone densitometry to the protocol for inclusion in the transplant waiting list. It is relevant to promote not only the best possible vascular health but also to promote the least impact on bone tissue in the progression of chronic kidney disease before the time of transplantation


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Calcificação Vascular/etiologia , Fraturas da Coluna Vertebral/etiologia , Calcificação Vascular/mortalidade , Estudos de Coortes , Estudos Prospectivos , Densitometria , Fatores de Tempo , Fatores de Risco , Análise de Sobrevida
13.
Am J Med Sci ; 360(2): 206-207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387118

Assuntos
Fraturas por Compressão/etiologia , Fraturas Espontâneas/etiologia , Plasmocitoma/complicações , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Descompressão Cirúrgica , Dexametasona/administração & dosagem , Progressão da Doença , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Laminectomia , Lenalidomida/administração & dosagem , Mieloma Múltiplo/sangue , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/tratamento farmacológico , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/patologia , Plasmocitoma/cirurgia , Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
14.
PLoS One ; 15(5): e0232842, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384131

RESUMO

OBJECTIVE: The risk of complications of nonsurgical hypoparathyroidism in Asia is unclear. We estimated the prevalence and risk of complications in patients with nonsurgical hypoparathyroidism. METHODS: We performed a retrospective cohort study using a nationwide claims database from 2005 to 2016. Among the entire Korean population, we identified 897 patients diagnosed with nonsurgical hypoparathyroidism during 2005-2015. We selected 210 patients with nonsurgical hypoparathyroidism during 2005-2008 who had no complications at baseline and followed them to 2016. Control subjects (n = 2075) were matched using propensity scores based on age, sex, and comorbid disease with a 1:10 ratio and monitored until 2016. RESULTS: The age-standardized prevalence of nonsurgical hypoparathyroidism was 0.2 cases per 100,000 persons in 2005. During a mean follow-up period of 9.5 years, patients with nonsurgical hypoparathyroidism had a higher risk of cardiovascular disease, especially arrhythmia (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.11-3.70) and heart failure (HR, 2.43; 95% CI, 1.22-4.83). The risk of vertebral fracture was higher in patients than in controls (HR, 2.27; 95% CI, 1.09-4.72). Patients had a significantly increased risk of renal disease (HR, 2.57; 95% CI, 1.56-4.21), seizure (HR, 5.74; 95% CI, 3.34-9.86), depression and bipolar disease (HR, 1.82; 95% CI, 1.30-2.56), and cataract (HR, 1.90; 95% CI, 1.30-2.79) compared with controls. CONCLUSIONS: The prevalence of nonsurgical hypoparathyroidism was very low in Korea but was associated with a higher risk of incident cardiovascular disease and vertebral fracture as well as known complications including renal disease, seizure, and cataract.


Assuntos
Hipoparatireoidismo/epidemiologia , Adulto , Doenças Autoimunes/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Catarata/epidemiologia , Catarata/etiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Feminino , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/etiologia , Humanos , Hipoparatireoidismo/complicações , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Prevalência , Pontuação de Propensão , República da Coreia/epidemiologia , Convulsões/epidemiologia , Convulsões/etiologia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Cálculos Urinários/epidemiologia , Cálculos Urinários/etiologia , Adulto Jovem
15.
Radiologe ; 60(6): 498-505, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32410104

RESUMO

BACKGROUND: Pathologic fractures are fractures that occur without an adequate traumatic event due to focal benign or malignant skeletal lesions. The most common causes of pathologic fractures are cystic bone lesions, plasmocytoma or multiple myeloma, and the development of osseous metastases, which is increasing due to an aging general population and advances in cancer treatment. The differentiation of pathologic fractures from stress fractures, especially osteoporotic insufficiency fractures is crucial for correct treatment planning. OBJECTIVES: This review intends to explain the imaging characteristics of pathologic fractures. Moreover, it explains the role of imaging when pathologic fractures are suspected. In addition, the Mirels' score and the SINS (Spinal Instability Neoplastic Score), which are powerful yet easy-to-use tools for the assessment of the fracture risk of benign or malignant bony lesions of the extremities and the vertebral column, shall be introduced. MATERIALS AND METHODS: A PubMed literature search with the following terms was conducted: "pathologic fracture", "fatigue fracture", "insufficiency fracture", "treatment of pathologic fractures", "imaging of pathologic fractures", "fracture risk", "bone metastases", "MRI of pathologic fractures", "CT of pathologic fractures", "differentiation of pathologic and insufficiency fractures", "Mirels' score", "SINS" and "spinal instability neoplastic score". RESULTS: The definitions of pathologic, fatigue, and insufficiency fractures are explained. Moreover, the role of imaging in the clinical workup of suspected pathologic fractures and the differentiation of pathologic fractures from fatigue or insufficiency fractures as well as common scoring systems to assess the fracture risk of pathologic fractures are described.


Assuntos
Neoplasias Ósseas , Fraturas Espontâneas , Plasmocitoma , Fraturas da Coluna Vertebral , Neoplasias Ósseas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral
17.
World Neurosurg ; 139: 175-178, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311568

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare but well-documented cause of paralysis, often occurring after infection. Few cases have been reported in association with spinal cord injury (SCI), which masks the characteristic ascending paralysis. To our knowledge, this is the first reported case of confirmed GBS during the clinical course of thoracic paraplegia due to a gunshot wound (GSW). CASE DESCRIPTION: A 23-year-old male presented with a GSW to the right axilla that lodged in the spinal canal at the level of T4, causing right hemothorax and American Spinal Injury Association A paraplegia. He had full strength in bilateral upper extremities until 2 weeks after the injury, at which time he developed progressive weakness in the arms with associated paresthesias and dyspnea. Within 5 days, he was intubated and nearly quadriplegic. Cerebrospinal fluid analysis and electromyography led to a diagnosis of GBS. He was treated with plasmapheresis and experienced rapid and marked recovery in respiratory and upper extremity motor function. CONCLUSIONS: The differential diagnosis for new-onset weakness in patients with GSW-induced SCI is complicated by the inability to obtain magnetic resonance imaging. This unique case of GBS in a patient with T4 paraplegia highlights the importance of obtaining a thorough history and using diagnostic tools to explore possibilities beyond surgery.


Assuntos
Síndrome de Guillain-Barré/complicações , Paraplegia/etiologia , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas/lesões , Ferimentos por Arma de Fogo/complicações , Eletromiografia , Síndrome de Guillain-Barré/líquido cefalorraquidiano , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Plasmaferese , Canal Vertebral , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
World Neurosurg ; 139: 370-372, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32348896

RESUMO

BACKGROUND: We report a rare case of Hangman's fracture in a male child with osteopetrosis. CASE DESCRIPTION: A 7-year-old boy was earlier diagnosed to have 'osteopetrosis'. He presented with neck pain, restriction of neck movements and quadriparesis following a fall while playing at home. Investigations revealed fracture of the bilateral C2 pars interarticularis. Goel technique of lateral mass plate and screw fixation was done on one side and a C2 pedicular screw fixation that traversed across the fracture line was performed on the contralateral side. The patient recovered rapidly in all symptoms following surgery. CONCLUSION: Osteopetrosis can be a rare cause of Hangman's fracture.


Assuntos
Osteopetrose/complicações , Osteopetrose/cirurgia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Criança , Humanos , Masculino
19.
Arch Osteoporos ; 15(1): 56, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32291527

RESUMO

A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF). INTRODUCTION: Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds. PATIENTS AND METHODS: In this cross-sectional study, 209 consecutive women of 50-70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm2)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA). RESULTS: Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer's recommended P-EU threshold (DI 0.844 g/cm2) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm2 resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)). CONCLUSION: The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.


Assuntos
Programas de Rastreamento/métodos , Osteoporose/diagnóstico por imagem , Encaminhamento e Consulta/estatística & dados numéricos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Idoso , Densidade Óssea , Estudos Transversais , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Fraturas Ósseas/complicações , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Projetos Piloto , Testes Imediatos , Valores de Referência , Fraturas da Coluna Vertebral/etiologia , Ultrassonografia/métodos
20.
Medicine (Baltimore) ; 99(15): e18964, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282692

RESUMO

BACKGROUND: We performed a systematic review and meta-analysis of the efficacy and safety of teriparatide and bisphosphonates in managing postmenopausal osteoporosis. METHODS: PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for relevant randomized controlled trials that were published before April 2018 and compared teriparatide and bisphosphonates in treating postmenopausal osteoporosis. Stata 12.0 was used for the meta-analysis. The pooled risk ratio (RR) or weighted mean difference and 95% confidence interval (CI) were calculated using a fixed effects or random effects meta-analysis. RESULTS: A total of 14 randomized controlled trials were included in this meta-analysis. The teriparatide group was associated with a lower total occurrence of vertebral fractures (RR = 0.55, 95% CI: 0.40-0.77; P = .001) and nonvertebral fractures (RR = 0.65, 95% CI: 0.46-0.90; P = .009) than the bisphosphonate group. Moreover, compared with the bisphosphonate group, the teriparatide group had improved bone mineral density at the lumbar spine and femoral neck at the final follow-up (P < .05). There was no significant difference between the teriparatide and bisphosphonate groups in terms of complications (RR = 1.05, 95% CI: 0.90, 1.22, P = .516). CONCLUSIONS: Teriparatide significantly reduced the occurrence of vertebral and nonvertebral fractures in osteoporosis patients. More studies should focus on the quality of life of patients using these 2 drugs.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Osteoporose Pós-Menopausa/tratamento farmacológico , Teriparatida/uso terapêutico , Conservadores da Densidade Óssea/farmacologia , Difosfonatos/farmacologia , Colo do Fêmur/efeitos dos fármacos , Humanos , Vértebras Lombares/efeitos dos fármacos , Osteoporose Pós-Menopausa/complicações , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Teriparatida/farmacologia
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