Parathyroid carcinoma is very rare in patients with primary hyperparathyroidism, only accounts for 1% to 2% of all cases. It is characterized by higher incidence of renal dysfunction, metabolic bone disease and gastrointestinal symptoms. Although the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma when compared to those with those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma without pathologic confirmation. To our knowledge, there have only been a few cases of hyperparathyroidism due to parathyroid carcinomas reported to date. Here, we report a case of 63-year-old woman developing osteoporosis, hypercalcemia and hypophosphatemia due to a parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively.
Adenoma ; Bone Diseases, Metabolic ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hypophosphatemia ; Incidence ; Middle Aged ; Osteoporosis ; Parathyroid Neoplasms

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients.
Calcium ; Female ; Gait ; Humans ; Hypercalcemia ; Male ; Osteogenesis ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Teriparatide ; United States ; Vitamin D

Parathyroid carcinoma is very rare in patients with primary hyperparathyroidism, only accounts for 1% to 2% of all cases. It is characterized by higher incidence of renal dysfunction, metabolic bone disease and gastrointestinal symptoms. Although the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma when compared to those with those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma without pathologic confirmation. To our knowledge, there have only been a few cases of hyperparathyroidism due to parathyroid carcinomas reported to date. Here, we report a case of 63-year-old woman developing osteoporosis, hypercalcemia and hypophosphatemia due to a parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively.
Adenoma ; Bone Diseases, Metabolic ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hypophosphatemia ; Incidence ; Middle Aged ; Osteoporosis ; Parathyroid Neoplasms

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.
Buttocks ; Female ; Fractures, Stress ; Humans ; Low Back Pain ; Osteoporosis ; Osteoporotic Fractures

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients.
Calcium ; Female ; Gait ; Humans ; Hypercalcemia ; Male ; Osteogenesis ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Teriparatide ; United States ; Vitamin D

OBJECTIVES: The purpose of this study is to identify whether the change of pH affects the proliferation and the differentiation of human bone marrow stem cells (hBMSCs) and what mechanism is underlied. METHODS: To achieve objective of this study, hBMSCs were cultivated in the conditioned media adjusted to potential of hydrogen (pH) ranging from 6.4 to 8.0 using addition of hydrochloric acid (HCl) and sodium hydroxide (NaOH). The ratio of proliferation of hBMSCs according to the change of pH was measured for 24 h, 48 h, and 72 h using water-soluble tetrazolium salt (WST)-8 method. To elucidate the mechanism involved, hBMSCs was subjected to blocking extracellular signal-regulated kinases (ERK) and calcium sensing receptor (CaSR) activation. The Osteogenic-related genes and alkaline phosphatase (ALP) activity were tested under the conditioned media. RESULTS: The proliferation of hBMSCs was promoted under extracellular alkali conditions (pH 7.6~8.0) via CaSR/ERK pathway. On the other hand, the differentiation was inhibited/delayed via decreased ALP activity besides gene expression at pH 8.0. CONCLUSION: Extracellular alkali or acidic surrounding according to pH alteration can play a crucial role in hBMSC behavior including the proliferation and the differentiation.
Alkalies ; Alkaline Phosphatase ; Bone Marrow ; Bone Marrow Cells ; Cell Differentiation ; Cell Proliferation ; Culture Media, Conditioned ; Extracellular Signal-Regulated MAP Kinases ; Gene Expression ; Hand ; Humans ; Hydrochloric Acid ; Hydrogen ; Hydrogen-Ion Concentration ; Hydroxides ; Receptors, Calcium-Sensing ; Sodium Hydroxide ; Stem Cells

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.
Buttocks ; Female ; Fractures, Stress ; Humans ; Low Back Pain ; Osteoporosis ; Osteoporotic Fractures

OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.
Bone Density ; Female ; Femoral Fractures ; Femur Neck ; Hip ; Humans ; Osteoporotic Fractures ; Retrospective Studies ; Risk Factors ; World Health Organization

OBJECTIVES: The purpose of this study is to identify whether the change of pH affects the proliferation and the differentiation of human bone marrow stem cells (hBMSCs) and what mechanism is underlied. METHODS: To achieve objective of this study, hBMSCs were cultivated in the conditioned media adjusted to potential of hydrogen (pH) ranging from 6.4 to 8.0 using addition of hydrochloric acid (HCl) and sodium hydroxide (NaOH). The ratio of proliferation of hBMSCs according to the change of pH was measured for 24 h, 48 h, and 72 h using water-soluble tetrazolium salt (WST)-8 method. To elucidate the mechanism involved, hBMSCs was subjected to blocking extracellular signal-regulated kinases (ERK) and calcium sensing receptor (CaSR) activation. The Osteogenic-related genes and alkaline phosphatase (ALP) activity were tested under the conditioned media. RESULTS: The proliferation of hBMSCs was promoted under extracellular alkali conditions (pH 7.6~8.0) via CaSR/ERK pathway. On the other hand, the differentiation was inhibited/delayed via decreased ALP activity besides gene expression at pH 8.0. CONCLUSION: Extracellular alkali or acidic surrounding according to pH alteration can play a crucial role in hBMSC behavior including the proliferation and the differentiation.
Alkalies ; Alkaline Phosphatase ; Bone Marrow ; Bone Marrow Cells ; Cell Differentiation ; Cell Proliferation ; Culture Media, Conditioned ; Extracellular Signal-Regulated MAP Kinases ; Gene Expression ; Hand ; Humans ; Hydrochloric Acid ; Hydrogen ; Hydrogen-Ion Concentration ; Hydroxides ; Receptors, Calcium-Sensing ; Sodium Hydroxide ; Stem Cells

OBJECTIVES: Osteoclasts (OCs) are bone-resorbing multinucleated cells derived from hematopoietic progenitors of the monocyte-macrophage lineage. OC precursors, such as bone marrow-derived macrophages (BMMs), are formed in the presence of macrophage colony-stimulating factor (M-CSF) and differentiate into OCs in response to M-CSF and receptor activator of nuclear factor kappaB ligand (RANKL). In this study, we investigated the role of mixed lineage kinases (MLKs)-c-Jun amino-terminal kinase (JNK) pathways in OC formation. METHODS: We performed an OC formation assay and reverse transcription polymerase chain reaction (RT-PCR) analysis. RESULTS: We first explored the role of JNK on osteoclst formation using mouse bone marrow (BM) culture system. We found that OC formation was impaired when the JNK inhibitor was added either in early or late stage, suggesting the requirement for JNK activation during OC formation. MLKs are serine/threonine kinases that regulate signaling by the JNK. Since the JNK activity is specifically required for osteoclastogenesis, we examined the messenger ribonucleic acid (mRNA) levels of MLKs in BMs, BMMs and OCs by RT-PCR. Among MLKs, the level of MLK3 mRNA expression is highest in BMs, BMMs and OCs. Moreover, we found that the mRNA expression of MLK2 and MLK3 is increased with the differentiation of BMs to BMMs, and is sustained in OCs. Finally we investigated the role of MLK3 in OC differentiation using gene knock-down techniques. The silencing of MLK3 in BMMs partly attenuated RANKL-induced OC differentiation. CONCLUSIONS: These data suggest that JNK and MLK3 may positively regulate OC formation.
Animals ; Bone Marrow ; Gene Knockdown Techniques ; Macrophage Colony-Stimulating Factor ; Macrophages ; Mice ; Osteoclasts ; Phosphotransferases ; Polymerase Chain Reaction ; RANK Ligand ; Reverse Transcription ; RNA ; RNA, Messenger