Osteopetrosis is a rare genetic bone disease characterized by increased bone density but prone to breakage due to defective osteoclastic function. Among two primary types of autosomal dominant osteopetrosis (ADO), osteopetrosis type II is characterized by sclerosis of bones, predominantly involving the spine, the pelvis, and the skull base. Fragility of bones and dental abscess are leading complications. This report presents a case of osteopetrosis in a 52-years-old female, which was complicated by the development of cavernous sinus thrombophlebitis and meningitis. She was suffered from multiple fractures since one year ago. Laboratory data revealed elevated serum levels of tartrate resistant acid phosphatase (TRAP) without carbonic anhydrase II DNA mutation. A thoracolumbar spine X-ray showed, typical findings of ADO type II (ADO II; Albers-Schonberg disease), prominent vertebral endplates so called the 'rugger jersey spine'. Her older sister also showed same typical spine appearance. We report a case of ADO II with cavernous sinus thrombophlebitis and meningitis that was successfully treated with long-term antibiotics with right sphenoidotomy.
Abscess ; Acid Phosphatase ; Anti-Bacterial Agents ; Bone Density ; Bone Diseases ; Carbonic Anhydrase II ; Cavernous Sinus Thrombosis* ; DNA ; Female ; Humans ; Meningitis* ; Osteoclasts ; Osteopetrosis* ; Pelvis ; Sclerosis ; Siblings ; Skull Base ; Spine

Paget's disease (PD) of bone is characterized by increase of bone resorption by atypical osteoclasts, followed by rapid new bone formation resulting in a disorganized mosaic bone. Although the pathophysiology is not fully understood, bisphosphonate, which is a potent anti-resorptive agent for treatment of osteoporosis, have been the most effective agents available for the treatment of PD. We report a case of PD of bone in a 49-year-old woman patient, who was treated with intravenous zoledronate.
Bone Density Conservation Agents ; Bone Resorption ; Diphosphonates ; Female ; Humans ; Middle Aged ; Osteitis Deformans ; Osteoclasts ; Osteogenesis ; Osteoporosis

After discontinuation of bisphosphonate therapy, an antiresorptive effect and antifracture protection persist for an undefined period. Patients are encouraged to continue calcium and vitamin D supplementation, during a bisphosphonate drug holiday. However, assessment of adequate calcium intake during the bisphosphonate drug holiday is difficult. Therefore, we measured the serum intact parathyroid hormone (PTH) level as a surrogate marker. A premenopausal woman discontinued bisphosphonate therapy, after 7.5 years of treatment. Two months later, blood calcium and phosphorus levels were normal, serum 25-hydroxyvitamin D level was 31.3 ng/mL, but serum PTH level had increased to 94.9 pg/mL. The elemental calcium supplement dose was increased to 600 mg/day, with no change in the cholecalciferol dose (400 IU). Her serum PTH levels decreased to 49.1 after 4 months and 32.9 pg/mL after 5 months. The serum PTH level may be helpful in assessing adequate calcium intake during a bisphosphonate drug holiday.
Biomarkers ; Calcium ; Cholecalciferol ; Female ; Holidays* ; Humans ; Parathyroid Hormone* ; Phosphorus ; Vitamin D

BACKGROUND: Subclinical thyroid dysfunction might influence a bone health. We evaluated whether subclinical hypothyroidism adversely affects bone health including bone mineral density (BMD), level of vitamin D, and bone turnover status in patients with hip fracture. METHODS: We evaluated 471 patients aged 50 years or older, who underwent hip fracture surgeries. BMD, level of vitamin D, bone turnover status, and one-year mortality were compared between subclinical hypothyroidism group and control group. RESULTS: BMD of femur and the level of 25-hydroxy-vitamin D (25-[OH]D) were similar in the two groups. There were no significant differences in bone turnover markers according to thyroid function. No significant differences were observed between the groups in utilization of intensive care unit (ICU), length of hospital stay, mobility, and one-year mortality. CONCLUSIONS: Subclinical hypothyroidism was not associated with reduced bone health, including BMD, the level of 25-(OH)D, and bone turnover marker.
Bone Density ; Femur ; Hip Fractures ; Hip* ; Humans ; Hypothyroidism* ; Intensive Care Units ; Length of Stay ; Mortality ; Thyroid Gland ; Vitamin D

INTRODUCTION: Bone mineral density (BMD) is an important index in diagnosis of osteoporosis and other metabolic bone diseases, prediction of fractures, and monitoring treatment. This study was to find a more feasible technique for prediction of osteoporotic fracture between dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and to reveal the actual change of bone strength when BMD was changed. METHODS: Ten of these 20 specimens were used as the demineralized group and the other 10 as the control. Each specimen was immersed in HCl solution at for a period of at least 10 minutes, up to 100 minutes, at an interval of 10 minutes for different levels of demineralization. BMD was measured using DXA and QCT. Uniaxial compression tests were conducted to measure biomechanical parameters. Pearson correlation analysis was used respectively between BMD and biomechanical parameters and between DXA and QCT. RESULTS: Elastic modulus (r=0.87) and yield stress (r=0.84) showed a statistically significant correlation with DXA BMD. Through correlation analysis with QCT BMD and elastic modulus, correlation coefficient showed hemi-vertebra (r=0.80) and trabecular (r=0.68). In yield stress, there was a statistically significant correlation in hemi-vertebra (r=0.87) and trabecular bone (r=0.84). CONCLUSION: DXA is a current standard technique not only for diagnosis of osteoporosis but also for prediction of fracture risk compared to QCT. Actual decrease of bone strength was much greater than that of BMD by both DXA and QCT.
Absorptiometry, Photon* ; Biomechanical Phenomena ; Bone Density* ; Bone Diseases, Metabolic ; Diagnosis ; Elastic Modulus ; Osteoporosis ; Osteoporotic Fractures

BACKGROUND: Malnutrition among inflammatory bowel disease (IBD) may arise from factors including inadequate dietary intake, malabsorption, and progression of disease. IBD has been reported an increased prevalence of low bone mass. The aims of the present study were to evaluate the nutritional status and to investigate the correlation between bone mineral density (BMD) and nutrient factors in patients with IBD. METHODS: A total of 41 subjects were classified into normal group (n=21) and malnourished group (n=20) by the subjective global assessment result. We surveyed the dietary habit, nutrient intake, and BMD. RESULTS: Subjects' average age was 36.7 years old, and included 26 ulcerative colitis and 15 Crohn's disease. The serum C-reactive protein (CRP) was significantly higher and serum calcium was significantly lower in the malnourished group. Lower bone density subjects were more in the malnourished group but no significant difference. Intake of energy, protein, carbohydrate, fiber, iron, sodium, potassium, zinc, vitamin B6, vitamin C and folate were significantly lower in the malnourished group. The BMD of malnourished group showed correlation with triceps skin fold thickness (TSF), CRP, dietary calcium, phosphorous, iron, animal iron, zinc and vitamin. CONCLUSIONS: The results suggested that adequate intake of nutrients is important to prevent bone loss and systemic education programs are need for IBD patients.
Animals ; Ascorbic Acid ; Bone Density* ; C-Reactive Protein ; Calcium ; Calcium, Dietary ; Colitis, Ulcerative ; Crohn Disease ; Education ; Folic Acid ; Food Habits ; Humans ; Inflammatory Bowel Diseases* ; Iron ; Malnutrition ; Nutritional Status* ; Potassium ; Prevalence ; Skin ; Sodium ; Vitamin B 6 ; Vitamins ; Zinc

BACKGROUND: Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. METHODS: This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. RESULTS: There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. CONCLUSIONS: We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD.
Absorptiometry, Photon ; Bone Density ; Continental Population Groups ; Female* ; Femoral Neck Fractures ; Femur ; Femur Neck ; Hip Fractures ; Hip* ; Humans ; Neck ; Odds Ratio ; Osteoporosis ; Risk Factors*

BACKGROUND: N-containing bisphosphonates (BPs), such as pamidronate and risedronate, can inhibit osteoclastic function and reduce osteoclast number by inducing apoptotic cell death in osteoclasts. The aim of this study is to demonstrate the effect of pamidronate, second generation nitrogen-containing BPs and to elucidate matrix metallo-proteinases (MMPs) mRNA expression under serum starvation and/or tumor necrosis factor alpha (TNF-α) stimulation on metabolism of intervertebral disc (IVD) cells in vitro. METHODS: Firstly, to test the effect of pamidronate on IVD cells in vitro, various concentrations (10⁻¹², 10⁻¹⁰, 10⁻⁸, and 10⁻⁶ M) of pamidronate were administered to IVD cells. Then DNA and proteoglycan synthesis were measured and messenger RNA (mRNA) expressions of type I collagen, type II collagen, and aggrecan were analyzed. Secondly, to elucidate the expression of MMPs mRNA in human IVD cells under the lower serum status, IVD cells were cultivated in full serum or 1% serum. Thirdly, to elucidate the expression of MMPs mRNA in IVD cells under the stimulation of 1% serum and TNF-α (10 ng/mL) In this study, IVD cells were cultivated in three dimensional alginate bead. RESULTS: Under the lower serum culture, IVD cells in alginate beads showed upregulation of MMP 2, 3, 9, 13 mRNA. The cells in lower serum and TNF-α also demonstrated upregulation of MMP-2, 3, 9, and 13 mRNA. The cells with various doses of pamidronate and lower serum and TNF-α were reveled partial down-regulation of MMPs. CONCLUSIONS: Pamidronate, N-containing second generation BPs, was safe in metabolism of IVD in vitro maintaining chondrogenic phenotype and matrix synthesis, and down-regulated TNF-α induced MMPs expression.
Aggrecans ; Cell Death ; Collagen ; Collagen Type I ; Collagen Type II ; Diphosphonates ; DNA ; Down-Regulation ; Humans* ; In Vitro Techniques ; Intervertebral Disc* ; Matrix Metalloproteinases* ; Metabolism ; Osteoclasts ; Phenotype ; Proteoglycans ; Risedronate Sodium ; RNA, Messenger ; Starvation ; Tumor Necrosis Factor-alpha* ; Up-Regulation

BACKGROUND: In this study, we examined the influence of exercise loading characteristics on bone metabolic responses and bone morphology in the growth phase and adulthood. METHODS: Running exercise (RUN) and jumping exercise (JUM) were used for the exercise loading in 28-day-old male Wistar rats. Bone metabolism was measured by blood osteocalcin (OC) and tartrate-resistant acid phosphatase (TRACP) levels. For bone morphology, the maximum bone length, bone weight, and bone strength of the femur and tibia were measured. RESULTS: A pre- and post-exercise loading comparison in the growth phase showed significantly increased OC levels in the RUN and JUM groups and significantly decreased TRACP levels in the JUM group. On the other hand, a pre- and post-exercise loading comparison in adulthood showed significantly decreased TRACP levels in the RUN and JUM groups. Femur lengths were significantly shorter in the RUN and JUM groups than in the control (CON) group, while bone weight was significantly greater in the JUM group than in the CON group. CONCLUSIONS: Exercise loading activates OC levels in the growth phase and suppresses TRACP levels in adulthood. On the other hand, these results suggest that excessive exercise loading may suppress bone length.
Acid Phosphatase ; Femur ; Hand ; Humans ; Male ; Metabolism* ; Osteoblasts ; Osteocalcin ; Osteoclasts ; Osteogenesis* ; Rats, Wistar ; Running ; Tibia

BACKGROUND: The practice of swimming in "hypogravity" conditions has potential to decrease bone formation because it decreases the time engaged in weight-bearing activities usually observed in the daily activities of adolescents. Therefore, adolescents competing in national levels would be more exposed to these deleterious effects, because they are engaged in long routines of training during most part of the year. To analyze the effect of swimming on bone mineral density (BMD) gain among adolescents engaged in national level competitions during a 9-month period. METHODS: Fifty-five adolescents; the control group contained 29 adolescents and the swimming group was composed of 26 athletes. During the cohort study, BMD, body fat (BF) and fat free mass (FFM) were assessed using a dual-energy x-ray absorptiometry scanner. Body weight was measured with an electronic scale, and height was assessed using a stadiometer. RESULTS: During the follow-up, swimmers presented higher gains in FFM (Control 2.35 kg vs. Swimming 5.14 kg; large effect size [eta-squared (ES-r)=0.168]) and BMD-Spine (Swimming 0.087 g/cm² vs. Control 0.049 g/cm²; large effect size [ES-r=0.167]) compared to control group. Male swimmers gained more FFM (Male 10.63% vs. Female 3.39%) and BMD-Spine (Male 8.47% vs. Female 4.32%) than females. Longer participation in swimming negatively affected gains in upper limbs among males (r=-0.438 [-0.693 to -0.085]), and in spine among females (r=-0.651 [-0.908 to -0.036]). CONCLUSIONS: Over a 9-month follow-up, BMD and FFM gains were more evident in male swimmers, while longer engagement in swimming negatively affected BMD gains, independently of sex.
Absorptiometry, Photon ; Adipose Tissue ; Adolescent* ; Athletes ; Body Weight ; Bone Density* ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Osteogenesis ; Spine ; Sports ; Swimming* ; Upper Extremity ; Weight-Bearing