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Asymptomatic Pulmonary Embolus Following Percutaneous Kyphoplasty: A Case Report

Chae Geun KIM ; Soo Uk CHAE ; Jong Yun KIM ; Gang Deuk KIM

Journal of Korean Society of Osteoporosis.2013;11(3):136-139.

Percutaneous vertebroplasty is a relatively recent procedure in the treatment of osteoporotic vertebral compression fractures. Bone cement embolism is a severe and potentially life-threatening complication of percutaneous vertebroplasty with cement. The risk for cement pulmonary embolism ranges between 3.5 and 23% for osteoporotic fractures. Bone cement leakage may be usually more frequent with vertebroplasty than with kyphoplasty. We experienced a 69-year-old female patient of an asymptomatic pulmonary embolus (length 8 cm) after kyphoplasty for an osteoporotic vertebral compression fracture
Aged ; Embolism ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporotic Fractures ; Pulmonary Embolism ; Vertebroplasty

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The Incidence of Osteoporosis and the Related Factors Among Injured Sites in Above 50 Year-old Patients with Fractures Caused by Low-energy Trauma

Youn Moo HEO ; Jin Woong YI ; Kwang Kyoun KIM ; Jung Bum LEE ; In Ho JO ; Jae Ik LEE

Journal of Korean Society of Osteoporosis.2013;11(3):126-135.

OBJECTIVES: To compare the incidence of osteoporosis and the related factors among fracture sites in above 50 year-old patients with fractures caused by low-energy trauma. MATERIALS AND METHODS: Seven hundred and fourteen patients with fracture from low energy trauma were evaluated retrospectively. By the Dual-energy x-ray absorptionmetry, we measured bone mineral density (BMD) at lumbar spine and proximal femur, and compared the incidence of osteoporosis, age, sex, body mass index (BMI), previous fracture history, past osteoporosis medication history according to each fracture sites. RESULTS: BMD was decreased according to increasing age with statistical significance (P<0.001). Sex has no significant difference according to fracture site (P=0.141). Average age of patients with osteoporotic fracture was 73.8, 72.8, 66.3, 73.4, 78.3 years old according to fracture site as T-spine, L-spine, distal radius, proximal humerus and proximal femur, respectively. There was significant difference among groups (P<0.001). Average BMI related with osteoporotic fracture site was 22.9 kg/m2, 22.7 kg/m2, 23.4 kg/m2, 23.0 kg/m2, 21.7 kg/m2, respectively and it showed significant difference among groups (P<0.001). Average bone mass and T-score related with osteoporotic fracture site was 0.587 g/cm2 (-3.5), 0.614 g/cm2 (-3.1), 0.647 g/cm2 (-2.6), 0.597 g/cm2 (-3.1), 0.554 g/cm2 (-3.5), with significant difference among groups (P<0.001). Previous fracture history had no significant difference among groups (P=0.078). Previous osteoporosis medication history had significant difference among the groups (P<0.001). CONCLUSIONS: In low-energy traumatic fracture, age, BMI and previous osteoporosis medication history are significantly related factors with BMD and osteoporotic fracture. Early diagnosis of osteoporosis and osteoporotic medication use is effective for decrease incidence of low-energy osteoporotic fracture.
Body Mass Index ; Bone Density ; Early Diagnosis ; Femur ; Humans ; Humerus ; Incidence ; Middle Aged ; Osteoporosis ; Osteoporotic Fractures ; Radius ; Retrospective Studies ; Spine

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Proximal Femur and Lumbar Spine's DXA T-score Concurrence in Diagnosis of Osteoporosis

Jin Young PARK ; Jong Myoung LEE ; Chul Min LIM ; Hee Seok YANG ; Tae Kyun KIM

Journal of Korean Society of Osteoporosis.2013;11(3):119-125.

OBJECTIVES: To evaluate the correlation between T-score of lumbar spine and that of proximal femur using dual energy x-ray absorptiometry (DXA) and the accuracy of the diagnosis of osteoporosis. MATERIAL AND METHODS: From December 2009 to January 2012, 300 female patients were selected who underwent bone mineral density (BMD) test using DXA. After measuring BMD of proximal femur and lumbar spine, the score of BMD in each age group was compared by two sites. Also, the concordance of the diagnosis of osteoporosis was evaluated. RESULTS: The result showed significantly lower T-score and BMD as it goes to the elderly group. As it goes for 60's age group and even more for 70's age group, lumbar spine showed lower BMD than proximal femur. In all age groups, lumbar spine and proximal femur T-score showed significant correlation; however, it showed the least states at 60's age group. Discordance rate of osteoporosis diagnosis was 33% and 47.3% each at lowest t-score and total t-score. 60's age group showed the highest discordance rate, and osteoporosis group showed the highest rate. CONCLUSIONS: When measuring BMD for diagnosis of osteoporosis, since it shows significant discordance between proximal femur and lumbar spine, it is necessary to measure BMD simultaneously on both parts.
Absorptiometry, Photon ; Aged ; Bone Density ; Diagnosis ; Female ; Femur ; Humans ; Osteoporosis ; Spine

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Efficacy of Once-Yearly Intravenous Zoledronic Acid for Osteopenia

Chang Ho SUNG ; Wan Sik SEO ; Ye Soo PARK

Journal of Korean Society of Osteoporosis.2013;11(3):114-118.

OBJECTIVES: To assess the clinical efficacy of once-yearly treatment with Zoledronic acid in patients with osteopenia. MATERIALS AND METHODS: From June 2009 to November 2011, patients diagnosed with osteopenia were applied to fracture risk assessment tool (FRAX). Among them, 40 patients who showed high possibility of osteoporotic fracture were selected and treated with intravenous zoledronic acid once-yearly. At the baseline and after one year of injection of zoledronate, we measured the changes in the bone mineral density (BMD) and bone turnover markers In addition, we analyzed the side effects and thereby assessed the drug safety.
Bone Density ; Bone Diseases, Metabolic ; Bone Resorption ; Hip ; Humans ; Osteocalcin ; Osteoporotic Fractures ; Risk Assessment

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Phytoestrogens and Bone Metabolism

Gyun Ho JEON ; Byung Moon KANG

Journal of Korean Society of Osteoporosis.2013;11(3):105-113.

Although most gynecologists had prescribed estrogen with or without progestin for their menopausal patients before the publication of Women's health Initiative (WHI) trial findings, only 35 to 40% of women ever started hormone therapy (HT) and many discontinued it, because of perceived side effects and discomfort. HT will not likely to be regularly prescribed in the future given the recommendations by several groups against long-term use for chronic diseases after the release of the findings of the WHI. Consequently, many postmenopausal women have turned to botanical dietary supplements containing phytoestrogen as an alternative to HT. Although there are numerous studies in the literature over the last decade trying to address the efficacy of phytoestrogens on bone health in animal models and in humans, the efficacy of phytoestrogens as bone-protective agents in vivo remains unclear. Differences in the bioactivities of individual phytoestrogens, differences in bioavailability and metabolism of phytoestrogens within different study populations, and imprecise reporting of the form and dose of phytoestrogens provided in intervention studies may have leaded to the disparity in study results. However, the preventive effect of phytoestrogens for bone loss is promising. This review discusses the effects of phytoestrogens on bone metabolism and their roles on the prevention and treatment of postmenopausal osteoporosis.
Biological Availability ; Chronic Disease ; Dietary Supplements ; Estrogens ; Female ; Humans ; Clinical Trial ; Metabolism ; Models, Animal ; Osteoporosis ; Osteoporosis, Postmenopausal ; Phytoestrogens ; Postmenopause ; Publications ; Women's Health

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Analysis of Adherence of Once-yearly Intravenous Zolendronic Acid for Osteoporosis

Jung Hwan LEE ; Jaewon LEE ; Wan Sik SEO ; Ye Soo PARK

Journal of Korean Society of Osteoporosis.2014;12(1):22-29.

OBJECTIVES: To analyze the adherence of once-yearly intravenous zolendronic acid for osteoporosis. MATERIALS AND METHODS: The subjects were 322 osteoporotic patients who received more than single infusion of zolendronic acid. On clinical assessment, we assessed adherence. The changes of bone mineral density (BMD) and bone turnover marker were measured before and after infusion. RESULTS: Reinfusion rate was 48.4% (109/225) at second infusion, and 51.3% (41/80) at third infusion. Adverse event at each time was 161 (42.1%) cases, 30 (27.5%) cases, and 8 (19.5%) cases, respectively. The measured mean BMD change was significantly increased (P-value<0.001). CONCLUSIONS: In this study, once-yearly intravenous zolendronic acid for 2 years was safe and efficacious in terms of BMD and bone turnover marker. The adherence was higher than most published studies of adherence to oral bisphosphonates, but lower than optimal. Physicians should fully explain to patients about medications and educate to improve their adherence.
Bone Density ; Diphosphonates ; Humans ; Osteoporosis

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Combined Treatment of Degenerative Spinal Stenosis and Osteoporotic Compression Fracture

Seungwook BAEK ; Cheol KIM ; Han CHANG ; Jongwoo CHAE

Journal of Korean Society of Osteoporosis.2014;12(1):15-21.

OBJECTIVES: To analyze the treatment results of combined treatment with percutaneous vertebroplasty and adhesiolysis in the patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. MATERIALS AND METHODS: A retrospective review was carried out on 38 patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. We performed percutaneous vertebroplasty for osteoporotic compression fractures and adhesiolysis for degenerative spinal stenosis after 4 weeks after vertebroplasty. Radiologic results were evaluated by progression of compression rate, fractures in adjacent segment and change of the BMD. Clinical results were evaluated with Denis pain scale for osteoporotic compression fractures and Katz satisfaction scale for degenerative spinal stenosis. RESULTS: The compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at 12 months postoperatively. There was no fracture in adjacent segment. Clinically, the Denis score were P3 in 13 and P4 in 25, preoperatively, P1 in 11 and P2 in 26, P3 in 1, postoperatively (P=0.03). In regard to degenerative diseases, the Kats scale were 38 to 5, 86.8% in low back pain (P=0.017) and 38 to 4, 89.4% in claudication (P=0.006). The overall Katz satisfaction scale was 81.5% at 12 months postoperatively. The BMD changes in patients who treated neuroplasty was not significant (P=0.175). CONCLUSIONS: The combined treatment with percutaneous vertebroplasty and adhesiolysis may be an effective treatment strategy for the osteoporotic compression fracture and spinal stenosis without surgical intervention in old age patients.
Fractures, Compression ; Humans ; Low Back Pain ; Retrospective Studies ; Spinal Stenosis ; Vertebroplasty

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Assessment of Fracture Risk by the FRAX Algorithm in Postmenopausal Korean Women with and without Type 2 Diabetes Mellitus: The Korea National Health and Nutrition Examination Survey 2008-2009

Yong Jun CHOI ; Dae Jung KIM ; Yoon Sok CHUNG

Journal of Korean Society of Osteoporosis.2014;12(1):7-14.

OBJECTIVES: The aim of this study was to compare the 10-year probability of hip fracture and a major osteoporotic fracture using the FRAX algorithm between postmenopausal Korean women with and without type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: We used data from the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. The measurements of anthropometric parameters and bone mass were obtained using dual energy X-ray absorptiometry (DXA) (Discovery-W, Hologic Inc., USA). Data was available for a total of 1,594 postmenopausal women (1,498 without T2DM and 96 with T2DM) aged 40 to 90 years old. The FRAX(R) 10-year probability was computed using the algorithm available online at http://www.shef.ac.uk/ FRAX (South Korea version). To compare the 10-year probability of osteoporotic fracture between the groups with and without adjustment for age and weight, a general linear model was used. RESULTS: Mean 10-year probabilities of fracture were similar between groups for major fractures [diabetic 9.0 (8.0, 10.0, 95% CI) versus non-diabetic 8.1 (7.8, 8.4, 95% CI), P=0.087] and hip fractures [diabetic 3.6 (2.8, 4.3, 95% CI) versus non-diabetic 2.9 (2.7, 3.1, 95% CI), P=0.099]. After adjustment for confounding factors (age and weight), there was also no significant difference between the diabetic and non-diabetic group [major osteoporotic fracture: 8.4 versus 8.1, P=0.563; hip fracture: 3.2 versus 2.9, P=0.320]. CONCLUSIONS: FRAX did not reflect higher major osteoporotic and hip fracture risk in Korean T2DM patients. T2DM might be considered for inclusion in future iterations of FRAX.
Absorptiometry, Photon ; Bone Density ; Diabetes Mellitus, Type 2 ; Female ; Hip ; Hip Fractures ; Humans ; Korea ; Linear Models ; Nutrition Surveys ; Osteoporotic Fractures

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Spinal Cord Injury and Osteoporosis

Jun Yeong PARK ; Seung Hyun LEE ; Jun Young YANG

Journal of Korean Society of Osteoporosis.2014;12(1):1-6.

Osteoporosis is one of the major complications in patients with SCI (spinal cord injury). The neurologic lesion and subsequent immobilization induce early and acute bone loss. During the first months post-injury, demineralization occurs exclusively in the sublesional areas and predominantly in weight-bearing sites. The high bone loss associated with modification in bone matrix composition is very likely at the origin of the pathologic fractures occurring spontaneously or in response to minor trauma. The pathogenesis of osteoporosis after SCI was generally considered disuse. But, the lack of mechanical factors alone cannot explain the considerable bone loss. Currently, the pathogenesis of SCI-induced bone loss is considered the result of high rate of bone turnover characterized by bone formation-resorption uncoupling. But, the duration and patterns of bone loss after SCI remain still unknown. In addition the question of whether alterations in qualitative bone properties are confined to the paralyzed limbs or affect the whole skeleton remains open.
Bone Matrix ; Extremities ; Fractures, Spontaneous ; Humans ; Immobilization ; Osteoporosis ; Skeleton ; Spinal Cord Injuries ; Weight-Bearing

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Isolated Posterior Malleolar Fracture of Ankle Occurring with Total Knee Arthroplasty in Severe Osteoporotic Patient

Kwang Kyoun KIM

Journal of Korean Society of Osteoporosis.2014;12(2):67-70.

There are numerous reports of fractures associated with total knee arthroplasty. But, to our knowledge, isolated posterior malleolus fracture associated with TKR has not previously been reported. Here, we report a case of isolated posterior malleolar fracture that occurred with total knee arthroplasty. The patient was informed that data concerning the case would be submitted for publication.
Ankle Fractures ; Ankle ; Arthroplasty ; Humans ; Knee ; Osteoporosis ; Publications

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