Osteolysis of the patella occurs in benign or malignant bone tumors, metastatic disease, osteolytic infections, degenerative, or metabolic bone disease. Several cases of patellar destruction secondary to gout have been reported. However, there has only been one case of bipartite patellar bone destruction secondary to gout reported in the literature. We encountered a patient with an osteolytic lesion of the bipartite patella suggesting a bone tumor or metabolic bone disease. A biopsy and histology examination suggested a diagnosis of gout tophi. This case demonstrated bilateral bipartite patella with gout involvement on the plain roentgenograms.
Biopsy ; Bone Diseases, Metabolic ; Gout ; Humans ; Patella

Background: Breast cancer, chemotherapy and endocrine treatment are risk factors for osteoporosis. Dual-energy x-ray absorptiometry (DXA) remains the gold standard in the diagnosis of osteoporosis. A quantitative computed tomography (QCT) with a bone mineral density analysis software on the whole abdomen CT may be used for screening osteoporosis without additional radiation exposure or cost. Objective: To determine the accuracy of QCT in detecting osteoporosis among breast cancer patients using DXA as gold standard. Methods: This is a cross-sectional analytic study of 76 Filipino women with breast cancer who underwent both DXA and whole abdomen CT scans. The DXA measurements were obtained using Lunar iDXA manufactured by GE Healthcare while the QCT measurements were made using the BMD analysis software available in the Philips Extended Brilliance Workspace post-processing system. Results: Out of the 76 Filipino women with breast cancer, 92% were menopausal women with mean age of 58.9 (SD 8.7) years, 69.7% had IDCA and 94.7% had mastectomy. Majority had normal BMD (44.7%), 34.2% had osteopenia and 21.1% had osteoporosis based on DXA. QCT has 90% (95% CI: 55.5-99.8) sensitivity, 63.6% (95% CI: 30.1- 89.1) specificity, 69.2% (95% CI: 50.1-83.5) PPV, 87.5 (95% CI:50.8-97.9) NPV, 2.5 (95% CI:1.1-5.6) LR(+) and 0.16 (95% CI:0.02-1.06) LR (-). Conclusion The prevalence of osteoporosis and osteopenia among Filipino women with breast cancer was 21.1% and 34.2%. The sensitivity and specificity of QCT in detecting osteoporosis was 90% and 63.6%.
Osteoporosis ; Bone Diseases, Metabolic ; Breast Neoplasms

PURPOSE: To evaluate the usefulness of supine lateral bone mineral density (BMD) measurement using DXA bycomparing AP and lateral spine BMD in patients with degenerative change. MATERIALS AND METHODS: Six hundred andseventy-two women underwent AP and lateral BMD measurement of L-spine, using DXA. Spur changes and end-platesclerosis were considered as degenerative change, and osteoporosis was defined according to WHO criteria. Theratio of mid-lateral BMD to AP BMD was calculated and the differences in ratio were analyzed in the degenerativegroup and controls, according to aging and osteoporosis, using the t test and ANOVA. The correlation coefficiencybetween aging and AP BMD and lateral BMD, respectively, was calculated. RESULT: The mLat/AP ratio in the controland degenerative group was 0.710(0.005 / 0.622(0.028 (p=0.003) in the 40-49-year-old group, 0.663(0.006 /0.612(0.016 (p=0.002) in the 50-59-year-old group, 0.626(0.015 / 0.552(0.023 (p=0.007) in the 60-69 year-oldgroup, and 0.717(0.028 / 0.600(0.045 (p=0.076) in those aged over 70. The ratio was 0.656(0.015 / 0.598(0.038(p=0.099) in osteoporosis, 0.684(0.008 / 0.596(0.016 (p=0.000) in osteopenia, and 0.688(0.005 / 0.583(0.019(p=0.000) in normal subjects, showing that lateral BMD is more sensitive than AP BMD, especially in thedegenerative group. There was negative correlation between aging and AP BMD(r= -0.545), lateral BMD(r= -0.571),and mid-lateral BMD(r=-0.583). CONCLUSION: In a selective group of patients with degenerative change, supinelateral BMD measurement of L-spine is useful.
Aging ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Humans ; Osteoporosis ; Spine*

OBJECTIVES: To identify the prevalence rate of osteoporosis in the patients who underwent posterior instrumentation of degenerative lumbar spine and to identity the prescription rate of osteoporosis medication after operation, and to identify the importance of preoperative BMD. MATERIALS AND METHODS: This study was done with 354 patients who underwent posterior instrumentation of lumbar spine from January of 2006 to July of 2011. The patients were divided into 4 groups according to their pre-operative BMD, normal, osteopenia, osteoporosis (-2.5>T> or =-3.0) and severe osteoporosis (3.0>T). We evaluated the prevalence rate of osteopenia and osteoporosis and analyzed the prescription rate and treatment options of osteoporosis medication on the patients who underwent posterior instrumentation surgery within one year after surgery. RESULTS: BMD was performed on 85.5% of all patients. By group those with osteopenia were 85 patients, the osteoporosis group was 47 patients and the severe osteoporosis group included 30 patients. Among the osteopenia group, 7.0% were under osteoporosis treatment. Among the osteoporosis group, 74.5% were under osteoporosis treatment. Among the severe osteoporosis group, 83.3% were under osteoporosis treatment within 1 year, postoperatively. CONCLUSIONS: The prevalence rate of osteoporosis was 25.4% in the patients who underwent posterior instrumentation of degenerative lumbar spine. The correlation between the patient's preoperative bone mineral density and the stability of the instrumentation was significant. Therefore, determining the patient's BMD via preoperative DEXA is very important because it can decide the treatment methods for osteoporosis before the surgery and help advance the timing of the initiation of treatment.
Bone Density ; Bone Diseases, Metabolic ; Humans ; Osteoporosis ; Prescriptions ; Prevalence ; Spine

Humans ; Ossification, Heterotopic ; Skin Diseases, Genetic ; Bone Diseases, Metabolic

OBJECTIVE: The purpose of this study was to compare the results of three types of short segment screw fixation for thoracolumbar burst fracture accompanying osteopenia. METHODS: The records of 70 patients who underwent short segment screw fixation for a thoracolumbar burst fracture accompanying osteopenia (-2.5< mean T score by bone mineral densitometry <-1.0) from January 2005 to January 2008 were reviewed. Patients were divided into three groups based on whether or not bone fusion and bone cement augmentation procedure 1) Group I (n=26) : short segment fixation with posterolateral bone fusion; 2) Group II (n=23) : bone cement augmented short segment fixation with posterolateral bone fusion; 3) Group III (n=21) : bone cement augmented, short segment percutaneous screw fixation without bone fusion. Clinical outcomes were assessed using a visual analogue scale and modified MacNab's criteria. Radiological findings, including kyphotic angle and vertebral height, and procedure-related complications, such as screw loosening or pull-out, were analyzed. RESULTS: No significant difference in radiographic or clinical outcomes was noted between patients managed using the three different techniques at last follow up. However, Group I showed more correction loss of kyphotic deformities and vertebral height loss at final follow-up, and Group I had higher screw loosening and implant failure rates than Group II or III. CONCLUSION: Bone cement augmented procedure can be an efficient and safe surgical techniques in terms of achieving better outcomes with minimal complications for thoracolumbar burst fracture accompanying osteopenia.
Bone Diseases, Metabolic ; Congenital Abnormalities ; Densitometry ; Follow-Up Studies ; Humans

Sleeve fracture at the inferior pole of the patella in children is relatively common, yet it is rare for the superior pole to be affected. So, only a few such cases have currently been reported. We experienced a 15 years-old patient with a sleeve fracture at the superior pole of the patella secondary to disuse osteopenia after cast immobilization due to knee trauma. We report on this case and we review the relevant literature.
Bone Diseases, Metabolic ; Child ; Humans ; Immobilization ; Knee ; Patella

Intramedullary rodding has been the treatment of choice for long bone shaft fracture when operative fixation is necessary. The present technology on rodding has been the use of a single, rigid intramedullary rod. However, an undesirable consequence of the use of such a rigid rodding is the post-union osteopenia along the rod, which is believed to be secondary to the over-protection of the surrounding bone from normal stresses, the so called “stress bypass effect”. Another disadvantage of the rodding procedure is interruption of intramedullary vascularity by reaming which may contribute to non-union. To evalvate these parameters, experiments were performed on mature dogs, using flexible multiple rods which can be inserted without reaming. The fracture healing was studied biomechanically by measuring the nondestructive bending and torsion stiffness, maximum torque and energy absorption to failure. Using two expermental dogs a zero time test of the osteotomized femur in which one bone was fixed with multiple rods and the contralateral bone fixed with a Kiintscher rod, showed that the bending stiffness was higher in the Kuntscher rod than in the multiple rods fixed bone. This fact means the flexible multiple rods fixation gives more elastic fixation than Kiintscher rod. The bending and torsion stiffness of the femur as expressed by repair per control percentage showed the multiple rods were significantly higher than Kuntscher rod at 6 weeks study but not in 9 weeks study. In the six month study, the repaired femur of the multiple-rods had significantly high bending and torsion stiff-ness, maximum torque and energy. Through these results, it was found that there was some advantage to the multiple rods in terms of early fracture healing at the 6 weeks study but no significant difference between two rod systems at the 9 weeks study. And there was significant advantage in the late remodelling phase of fracture healing in flexible rod.
Absorption ; Animals ; Bone Diseases, Metabolic ; Dogs ; Femur ; Fracture Healing ; Torque

Otosclerosis is a primary metabolic bone disease of the otic capsule and ossicles. It is one of the causes of acquired hearing loss, with clinical manifestations occurring in approximately 1% of individuals in some populations in the Western countries. Although the cause of otosclerosis is undetermined, the disease has a well established hereditary predisposition, with approximately half of all affected individuals having family members known to be affected. Many genetic studies of otosclerosis support an autosomal dominant mode of inheritance with penetrance in the range of 20-40%. There have been a few reports of the clinically suspicious otosclerosis cases in Korea, but otosclerosis having familial forms have not been reported. We report one case of familial otosclerosis.
Bone Diseases, Metabolic ; Hearing Loss ; Humans ; Korea ; Otosclerosis* ; Penetrance ; Wills

Bone remodeling is the fundamental means by which the quality as well as quantity of the skeleton is maintained throughout adult life. When bone remodeling goes awry, a metabolic bone disease such as osteoporosis ensues. Among multiple phases of the complex remodeling process, we focus in this review on factors and mechanisms that are involved in the coupling of bone formation to preceding resorption.
Adult ; Bone Diseases, Metabolic ; Bone Remodeling ; Bone Resorption* ; Humans ; Osteoblasts* ; Osteoclasts* ; Osteogenesis ; Osteoporosis ; Skeleton