OBJECTIVE: To explore relationship between bone marrow edema(BME) and osteoporosis in patients with severe knee osteoarthritis. METHODS: Unmatched case-control study was conducted. Totally 160 patients with severe knee osteoarthritis who had undergone knee magnetic resonance imaging (MRI) and bone mineral density examination (BMD) from January 2020 to March 2021 were included. Eighty patients complicated with BME were included in BME group, and 80 patients without BME were selected as NBME group. In BME group, there were 12 males and 68 females, aged from 51 to 80 years old with an average of(66.58±8.10) years old;the courses of disease ranged from 5 to 40 months with an average of (15.61±9.25) months;body mass index(BMI) ranged from 21.81 to 34.70 with an average of (27.79±3.00) kg·m^-2;25 patients classified to grade Ⅲ and 55 patients grade Ⅳ according to Kellgren- Lawrence(K-L). In NBME group, there were 15 males and 65 females, aged from 50 to 80 years old with an average of(67.82±8.05) years old;the course of disease ranged from 6 to 37 months with an average of(15.75±8.18) months;BMI ranged from 21.39 to 34.46 with an average of (28.26±3.13) kg·m^-2;25 patients were K-L Ⅲ and 55 patients with K-L Ⅳ. The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score(WORMS). Osteoporosis was diagnosed and BMD was evaluated by DXA T value. To explore the relationship between bone marrow edema and osteoporosis by comparing prevalence rate of osteoporosis between two groups, and to further explore relationship between BME and BMD by Spearman correlation analysis of BME WORMS score and DXA T value in BME group. RESULTS: The complete case data were obtained on the first diagnosis, and there was no significant difference in sex, age, courses of disease and BMI between two groups (P>0.05). The proportion of K-L Ⅳ in BME group was significantly higher than that in NBME (P<0.05). The prevalence rate of osteoporosis in BME group was significantly higher than in NBME group with the same K-L grade (P<0.001), and there was a strong negative correlation between BME WORMS score and DXA BMD T value (r=-0.812, |r|=0.812 >0.8, P<0.001). CONCLUSION Osteoporosis is one of the risk factors of bone marrow edema in patients with severe knee osteoarthritis, and the lower the bone mineral density is, the easier it is to be complicated with bone marrow edema.
Male ; Female ; Humans ; Osteoarthritis, Knee/diagnostic imaging* ; Bone Marrow/pathology* ; Case-Control Studies ; Bone Marrow Diseases/etiology* ; Osteoporosis/complications* ; Edema/etiology* ; Magnetic Resonance Imaging/methods*

Renal Fanconi syndrome (RFS) is caused by generalized proximal tubular dysfunction and can be divided into hereditary and acquired form. Adult-onset RFS is usually associated with drug toxicity or systemic disorders, and modern molecular genetics may explain the etiology of previous idiopathic cases of RFS. Here, we report the case of a 52-year-old woman with RFS whose etiology could not be identified. She presented with features of phosphaturia, renal glucosuria, aminoaciduria, tubular proteinuria, and proximal renal tubular acidosis. Her family history was unremarkable, and previous medications were nonspecific. Her bone mineral density was compatible with osteoporosis, serum intact parathyroid hormone level was mildly elevated, and 25(OH) vitamin D level was insufficient. Her blood urea nitrogen and serum creatinine levels were 8.4 and 1.19 mg/dL, respectively (estimated glomerular filtration rate, 53 mL/min/1.73 m²). Percutaneous renal biopsy was performed but revealed no specific renal pathology, including mitochondrial morphology. No mutation was detected in EHHADH gene. We propose the possibility of involvement of other genes or molecules in this case of adult RFS.
Acidosis, Renal Tubular ; Adult ; Biopsy ; Blood Urea Nitrogen ; Bone Density ; Creatinine ; Drug-Related Side Effects and Adverse Reactions ; Fanconi Syndrome ; Female ; Glomerular Filtration Rate ; Glycosuria, Renal ; Humans ; Hypophosphatemia, Familial ; Middle Aged ; Molecular Biology ; Osteoporosis ; Parathyroid Hormone ; Pathology ; Proteinuria ; Vitamin D

STUDY DESIGN: Single-center, retrospective case series. PURPOSE: To investigate the effectiveness of posterior vertebrectomy and circumferential fusion in patients with advanced Kümmell disease with neurologic deficit. OVERVIEW OF LITERATURE: Various surgical options exist for the treatment of Kümmell disease, and determination of the appropriate treatment is based on the clinical and radiologic status of the patient. However, surgical intervention is required for patients with advanced Kümmell disease accompanied by neurologic deficit. METHODS: We retrospectively analyzed 22 neurologically compromised patients with advanced Kümmell disease who were treated surgically at Ewha Womans Hospital between January 2011 and January 2014. The surgical approach used by us was a posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation. The tissue from the corpectomy was histopathologically examined. Anterior vertebral height, kyphotic angle, visual analog scale (VAS) score, and the Frankel classification were used to evaluate the efficacy of the procedure. RESULTS: The mean follow-up period was 26 months (range, 13–40 months). VAS score, anterior vertebral height, kyphotic angle, and neurologic state were significantly improved immediately postoperatively and at the last follow-up compared with preoperatively (p<0.05). Most patients exhibited intravertebral clefts on imaging, and postoperative pathology revealed bone necrosis. CONCLUSIONS: Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective approach for treating patients with advanced Kümmell disease with neurologic deficit.
Classification ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Necrosis ; Neurologic Manifestations* ; Osteoporosis ; Pathology ; Pedicle Screws ; Retrospective Studies ; Visual Analog Scale

Osteoporosis is a bone pathology leading to increased fracture risk and challenging the quality of life. The aim of this study was to evaluate the effect of an anthraquinone glycoside, aloin, on osteogenic induction of MC3T3-E1 cells. Aloin increased alkaline phosphatase (ALP) activity, an early differentiation marker of osteoblasts. Aloin also increased the ALP activity in adult human adipose-derived stem cells (hADSC), indicating that the action of aloin was not cell-type specific. Alizarin red S staining revealed a significant amount of calcium deposition in cells treated with aloin. Aloin enhanced the expression of osteoblast differentiation genes, Bmp-2, Runx2 and collagen 1a, in a dose-dependent manner. Western blot analysis revealed that noggin and inhibitors of p38 MAPK and SAPK/JNK signals attenuated aloin-promoted expressions of Bmp-2 and Runx2 proteins. siRNA mediated blocking of Wnt-5a signaling pathway also annulled the influence of aloin, indicating Wnt-5a dependent activity. Inhibition of the different signal pathways abrogated the influence of aloin on ALP activity, confirming that aloin induced MC3T3-E1 cells into osteoblasts through MAPK mediated Wnt and Bmp signaling pathway.
Adult ; Alkaline Phosphatase ; Blotting, Western ; Calcium ; Collagen ; Core Binding Factor Alpha 1 Subunit ; Humans ; Osteoblasts ; Osteoporosis ; p38 Mitogen-Activated Protein Kinases ; Pathology ; Quality of Life ; RNA, Small Interfering ; Signal Transduction ; Stem Cells

The clinical effects of two different methods-high-viscosity cement percutaneous vertebroplasty (PVP) and low-viscosity cement percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs) were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups (P>0.05). Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP (P<0.05). Both groups showed significant improvements in pain relief and functional capacity status after surgery (P<0.05). It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.
Administration, Cutaneous ; Aged ; Bone Cements ; chemistry ; therapeutic use ; Female ; Follow-Up Studies ; Fractures, Compression ; pathology ; rehabilitation ; surgery ; Humans ; Kyphoplasty ; instrumentation ; methods ; Male ; Middle Aged ; Osteoporosis ; pathology ; rehabilitation ; surgery ; Pain ; diagnosis ; physiopathology ; Pain Measurement ; Recovery of Function ; physiology ; Spinal Fractures ; pathology ; rehabilitation ; surgery ; Spine ; pathology ; surgery ; Treatment Outcome ; Viscosity ; Visual Analog Scale

OBJECTIVETo evaluate the therapeutic effects of conservative treatment of refracture in cemented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients.

METHODSBetween January, 2012 and August, 2014, a total of 324 elderly patients (381 vertebrae) received percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Of these patients, 12 patients (14 vertebrae) complained of recurrence of back pain and were confirmed to have refracture in the cemented vertebrae by imaging examination. Seven of these 12 patients (9 vertebrae), who were all female with an average refracture time of 8±6.7 weeks (range 2-20 weeks), received conservative treatments with analgesics, osteoporosis medication, bracing and physical therapy, and their visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 7 days and 1, 3 and 12 months after the treatment were measured.

RESULTSThe 7 patients were followed up for 21.3±11.2 months (range 13-29 months) after conservative treatments. Their VAS score and ODI decreased significantly over time after the treatment (P<0.05) and showed significant differences between the measurements at 7 days, 1 and 3 months (P<0.05) but not between 3 and 12 months (P>0.05). The average VAS score and ODI before treatments were 8.3±0.8 and (88.3±3.2)%, 3.1±1.2 and (56.3±7.7)% at 1 month, and 0.8±0.7 and (5.9±2.8)% at 3 months during the follow-up, respectively.No such complications as phlebothrombosis of the leg, decubitus, or hypostatic pneumonia occurred in these cases.

CONCLUSIONThough with a relatively low incidence rate, refracture in the cemented vertebrae is one of the important causes of recurrence of back pain following percutaneous vertebroplasty. Conservative treatment is effective in relieving pain and improving the spine function in such cases without obvious complications.

Aged ; Analgesics ; therapeutic use ; Back Pain ; therapy ; Bone Cements ; Female ; Fractures, Compression ; surgery ; therapy ; Humans ; Osteoporosis ; surgery ; therapy ; Pain Management ; Pain Measurement ; Recurrence ; Spinal Fractures ; surgery ; therapy ; Spine ; pathology ; Treatment Outcome ; Vertebroplasty

BACKGROUNDOsteoporosis is a common complication of chronic obstructive pulmonary disease (COPD). Recent clinical and biological researches have increasingly delineated the biomolecular pathways of bone metabolism regulation in COPD. We extended this work by examining the specific association and potential contribution of the osteoprotegerin (OPG)/receptor activator of nuclear factor-κB ligand (RANKL) axis to the pathogenesis of osteoporosis in advanced COPD. The aim of this study was to assess the relationships of serum OPG, RANKL, and tumor necrosis factor-alpha (TNF-μ) with bone turnover in men with very severe COPD.

METHODSPulmonary function, T-score at the lumbar spine (LS) and femoral neck (FN), serum OPG, RANKL, soluble receptor of tumor necrosis factor-alpha-I and II (sTNFR-I, sTNFR-II), osteocalcin (OC), and β-CrossLaps (βCL) levels were measured in 45 men with very severe stage COPD and 36 male non-COPD volunteers. COPD patients and healthy controls were compared using an independent t-test and Mann-Whitney U-test. The Pearson coefficient was used to assess the relationships between variables.

RESULTSOPG and OC were lower in male COPD patients than in control subjects whereas RANKL, serum βCL, TNF-μ, and its receptors were higher. OPG directly correlated with forced expiratory volume in 1 s (FEV1) % predicted (r = 0.46, P < 0.005), OC (r = 0.34, P < 0.05), LS (r = 0.56, P < 0.001), and FN T-score (r = 0.47, P < 0.01). In contrast, serum RANKL inversely associated with LS and FN T-score (r = -0.62, P < 0.001 and r = -0.48, P < 0.001) but directly correlated with βCL (r = 0.48, P < 0.001). In addition, OPG was inversely correlated with RANKL (r = -0.39, P < 0.01), TNF-μ (r = -0.56, P < 0.001), and sTNFR-I (r = -0.40, P < 0.01).

CONCLUSIONOur results suggest that serum OPG and RANKL levels are inversely associated with bone loss in men with advanced stage COPD.

Bone Density ; physiology ; Cross-Sectional Studies ; Humans ; Male ; Middle Aged ; Osteoporosis ; metabolism ; pathology ; Osteoprotegerin ; metabolism ; Pulmonary Disease, Chronic Obstructive ; metabolism ; pathology ; RANK Ligand ; metabolism ; Respiratory Function Tests ; Tumor Necrosis Factor-alpha ; metabolism

STUDY DESIGN: Retrospective observational study. PURPOSE: To identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures. OVERVIEW OF LITERATURE: Vertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures. Therefore, histological confirmation is necessary for definitive diagnosis and to plan appropriate management for patient. METHODS: A retrospective observational study was conducted involving 84 patients who underwent percutaneous vertebral biopsy between 2010 and 2014. We performed C-arm guided percutaneous transpedicular core vertebral biopsy of vertebral compression fractures under combination of local anesthesia and intravenous conscious sedation. RESULTS: Sufficient biopsy material was obtained in 79 of the 84 cases. In the other five cases, biopsy material was not sufficient for reporting. Out of the 79 cases, osteoporotic pathology was detected in 69 patients, malignancy was detected in 8 patients and no pathology was found in 2 patients. Two patients with distant metastases to vertebra were identified. Primary spinal malignancy was detected in 6 patients (1 unsuspected plasmacytoma, 5 diagnosed malignancy preoperatively). So, the frequency of unsuspected malignancy of this study was 1.19% (1/84). None of the patients had any complications. CONCLUSIONS: C-arm guided percutaneous transpedicular vertebral biopsy is useful in obtaining definitive histopathological diagnosis of vertebral compression fractures, especially in differentiating malignant and non-malignant vertebral compression fractures and helping plan appropriate management of patients. The rate of unexpected malignancy in vertebral compression fracture was 1.19%.
Anesthesia, Local ; Biopsy* ; Biopsy, Needle ; Conscious Sedation ; Diagnosis* ; Fractures, Compression* ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Observational Study ; Osteoporosis ; Pathology* ; Plasmacytoma ; Retrospective Studies ; Spine

OBJECTIVE: To map the progression of osteoporosis following spinal cord injury in mice in specific areas and analyze changes in parathyroid hormone (PTH) and ion levels which could be responsible for overall bone loss. SUMMARY OF BACKGROUND DATA: Spinal cord injury rapidly induces severe bone loss compared to other conditions, yet the cause of this bone loss has not been identified. Studies suggest the bone loss after injury is not solely due to disuse. METHODS: To quantify bone loss we weighed individual bones and measured bone mineral density using dual energy X-ray absorptiometry at acute (1 week) and chronic (4 week) time points following a T9 contusion. An ELISA was used to measure blood PTH levels at 1 and 4 weeks after injury. Calcium and phosphate levels were also analyzed at 4 weeks following injury at the University of Miami pathology core. RESULTS: We observed a significant decrease in bone mineral density in hind limbs after an acute injury, and found this bone loss to progress over time. Furthermore, following chronic injury a decrease in bone mineral density is also observed in bones above the level of injury and in the total bone mineral density. We observed a significant decrease in parathyroid hormone levels in injured mice at the chronic time point, but not at the acute time point which suggests this could be involved in the global bone loss following injury. We also observed a significant increase in serum calcium levels following injury which could account for the imbalance of PTH levels.
Absorptiometry, Photon ; Animals ; Bone Density ; Calcium ; Contusions ; Enzyme-Linked Immunosorbent Assay ; Extremities ; Mice* ; Osteoporosis ; Parathyroid Hormone ; Pathology ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: The aim of the study was to assess and identify gender differences in factors associated with prevalence, awareness, and treatment of osteoporosis. METHODS: Data for 3,071 men and 3,635 women (age> or = 50) from the Korea National Health and Nutrition Examination Survey 2008~2011 were included. Osteoporosis was defined by World Health Organization T-score criteria. Impact factors and odds ratios were analysed by gender using multivariate logistic regression. RESULTS: Osteoporosis prevalence rates were 7.0% in men and 40.1% in women. Osteopenia rates were 45.5% and 46.0% respectively. Among respondents with osteoporosis, 7.6% men and 37.8% women were aware of their diagnosis. Also 5.7% men with osteoporosis and 22.8% women were treated. Higher prevalence was found among respondents who were older, at lower socioeconomic levels, with lower body mass index and shorter height in both genders, and among women with fracture history, and non-hormonal replacement therapy. Awareness and treatment rates for the risk groups were similar compared to the low risk controls for both genders. Fracture history increased awareness and treatment rates independently for both genders. Women with perceived poor health status and health screening had increased awareness and treatment rates, but not men. CONCLUSION: Results indicate that postmenopausal women have a higher prevalence of osteoporosis than men and awareness and treatment rates were higher than for men. Despite gender difference in prevalence, osteoporosis was underdiagnosed and undertreated for both genders. Specialized public education and routine health screenings according to gender could be effective strategies to increase osteoporosis awareness and treatment.
Aged ; Bone Density ; Female ; *Health Knowledge, Attitudes, Practice ; Humans ; Logistic Models ; Male ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; Osteoporosis/epidemiology/*pathology/therapy ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Social Class