Évaluation isocinétique du genou chez les patients atteints de polyarthrite rhumatoïdeIsokinetic evaluation of the knee in patients with rheumatoid arthritis.

Objectives. Rheumatoid arthritis is a chronic inflammatory disease with a clinical picture of arthritis, muscle hypotrophy, loss of range of motion, loss of strength and disability. The objective of this study was to evaluate knees of patients with rheumatoid arthritis using an isokinetic dynamometer. Methods. Fifty patients with a diagnosis of rheumatoid arthritis and 50 control subjects were evaluated using an isokinetic dynamometer (Cybex 6.000) regarding the following parameters: peak torque, peak torque angle, power, total work, peak torque acceleration time, set total work, torque acceleration energy (‘explosion’) and endurance. Comparisons between rheumatoid arthritis and the control group, left side versus right side, flexors and extensors and the proportion between flexors and extensors were made. The subjects were also evaluated through the Health Assessment Questionnaire, visual and analogical scale of pain, EPM-ROM and goniometry of the knee. Results. The results showed that patients with rheumatoid arthritis have less strength than the control group (P < 0,05); the extensors are stronger than the flexors (P < 0,05); no significant differences between the right and the left knee for rheumatoid arthritis and the control group were observed and the proportion between flexors and extensors is the same in both groups. We concluded that regarding the isokinetic parameters, the knees of subjects with rheumatoid arthritis are different from normal knees with decreased strength parameters, maintaining the proportion between flexors and extensors with a global loss of strength in the segment, excluding the high speeds in some of the parameters.     

Sympathetic nervous system as transmitter of mechanical loading in bone

Sympathetic innervation has been demonstrated in bone. Adrenergic stimulation is one of the transmitters of bone loss by uncoupling between decreased bone formation and increased bone resorption. OBJECTIVE: By using a non-specific antagonist of -adrenergic pathway (propranolol per os), we hypothesized that we could rescue the uncoupling induced mechanical unloading bone loss in the rat model of tail-suspension. MATERIALS AND METHODS: Twenty-two female Wistar rats, 12 week-old, have been divided into three groups: eight tail-suspended rats (SR), six tail-suspended rats treated by propranolol (SRP) and eight non-suspended rats (NSR) during 30 days. Bone mineral density (BMD, g/cm2) has been measured by DXA (Hologic QDR-4500A) at D0 and D30 of the study, in the distal femoral metaphysis (DFM), the femoral diaphysis (FD), the whole body (WB, g) and body composition. RESULTS: Between D0 and D30, in DFM a significant variation in BMD is observed between NSR and SR (% BMD change: NSR +15.6 +/- 3.1% vs SR -1.0 +/- 1.4%, P < 0.0001) and BMD rescue in SRP group (% BMD change SRP +5.3 +/- 1.5% vs SR -1.0 +/- 1.4%, P = 0.03). In FD, gain of BMD is significant in NSR compared to SR (+17.5 +/- 1.5% vs +8.2 +/- 2.8%, P = 0.007) and to SRP (+17.5 +/- 1.5% vs +10.1 +/- 2.4%, P = 0.046). Gain in SRP group is not significant compared to SR group (P = 0.6). In WB, SRP gain more BMD than NSR (+14.0 +/- 1.8% vs +5.4 +/- 0.7%, P = 0.0002) and than SR (+14.0 +/- 1.8% vs +7.8 +/- 1.4%, P = 0.0043). There is no difference between NSR and SR groups (P = 0.19). CONCLUSION: We demonstrate that -adrenergic pathway of sympathetic nervous system is a major transmitter pathway of mechanical loading in rat bone. A specific study is necessary to analyse a possible systemic effect of propranolol in rat bone. Propranolol could be used to prevent the induced mechanical unloading bone loss as weightlessness     

Évaluation de la reproductibilité et de la validité de construit d’une forme modifiée de l’indice algofonctionnel de Lequesne dans l’arthrose du genouAssessment of the test-retest reliability and construct validity of a modified Lequesne index in knee osteo-arthritis

Objectives. – To assess the test-retest reliability and the construct validity of a modified version of the Lequesne index.Methods. – Patients with symptomatic knee osteo-arthritis fulfilling the revised criteria of the american college of rheumatology completed the Lequesne index twice at a 3 h interval. Impairment outcome measures and patients’ perceived discomfort in walking and handicap were recorded. An item by item analysis was performed. Items having insufficient psychometric properties were excluded. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using Spearman rank correlation coefficient and a factor analysis was performed.Results. – Eighty-eight patients were included. One question assessing pain (question IE) had a weak reliability (Kappa = 0.39) and was excluded. The test-retest reliability of the modified questionnaire was excellent (ICC = 0.95). Expected convergent and divergent correlations were achieved excepted for Vas pain and Vas handicap (0.46 and 0.40 respectively), and the “a priori” double stratification was confirmed by factor analysis, explaining 48.7% of the variance.Conclusion. – The modified form of the Lequesne index has sufficient psychometric properties to be used to assess pain and function in knee osteo-arthritis in a french population.     

Les facteurs associés à l'évolution de la sciatique commune. À propos de 1092 cas

La sciatique commune constitue par sa fréquence et son retentissement socioprofessionnel un problème de santé publique.Méthode. – À travers une étude rétrospective de 1092 cas de sciatique commune, nous précisons les caractéristiques épidémiologiques, cliniques, radiologiques et thérapeutiques et nous cherchons les facteurs associés à une mauvaise évolution afin de mieux apprécier le pronostic de cette affection.Résultats. – L'âge moyen de nos patients est de 45,0 ± 13,3 ans avec une prédominance féminine (61,8 % des cas). Les antécédents de lombalgies sont notés dans 35,2 % des cas. La sciatique est mono-radiculaire dans 68 % des cas et touche essentiellement la racine L5. La cause de la sciatique est une hernie discale dans 58,4 % des cas. Le traitement médical initial est efficace dans 75 % des cas. À six mois, le résultat de tous les traitements confondus est satisfaisant dans 76,5 % des cas.Conclusion. – Pour l'ensemble de la série, et en étude multivariée, les facteurs associés à une mauvaise évolution à six mois de recul sont : le travail de force (p = 0,049, Odds ratio (OR) = 1,69 ; IC = [1,01–2,86]) et l'obésité (p = 0,05, OR = 1,5 ; IC = [1,01–2,47]).As an extremely common symptom and major source of lost productivity, mechanical sciatica places a heavy burden on public health.Methods. – We retrospectively reviewed 1092 medical records to determine the epidemiological, clinical, imaging study, and therapeutic characteristics of mechanical sciatica. We also looked for factors associated with adverse outcomes.Results. – Mean patient age was 45.0 ± 13.3 years, and 61.8% of patients were women. A history of low back pain was noted in 35.2% of cases. A single nerve root was involved in 68% of cases, and L5 was the most commonly affected root. Disk herniation was the cause in 58.4% of patients. First-line conservative treatment provided relief in 75% of cases, and the overall 6-month outcome was favorable in 76.5% of cases.Conclusion. – The multivariate analysis conducted in the overall patient population showed that factors associated with adverse 6-month outcomes were heavy labor (odds ratio [OR], 1.69; 95% confidence interval [95% CI], 1.01–2.86; P = 0.049) and obesity (OR, 1.5; 95% CI, 1.01–2.47; P = 0.05).     

Après une fracture périphérique survenant chez une femme ménopausée : comment est faite la prise en charge de l'ostéoporose et quel est l'impact de l'information donnée au médecin généraliste ?

A non-traumatic fracture that occurs in a postmenopausal woman should be suspected as osteoporotic and needs a specific intervention.Objectives. – To evaluate the effects of information given to physician on the rate of treatment for osteoporosis initiated after a non-vertebral fracture.Patients and methods. – Seventy-eight postmenopausal women (mean age 81,5 years old) admitted to surgery emergency department with a non-vertebral fracture were studied for seven months. A letter, which informs the physicians that the fracture was probably osteoporotic, and needed a treatment, was sent three months after the fracture occurred. At seven months, a questionnaire was sent to physicians when their patients remained not treated.Results. – Nine patients were receiving a therapy for osteoporosis before the fracture occured: one hormonal replacement therapy and eight calcium (Ca) ± vitamin D supplements. Eighty-five percent of the patients were hospitalised, and no treatment was initiated before discharge. At six months, seven treatments were initiated (Ca ± vitamin D). At seven months, the answers to questionnaires show that 11 other treatments have been initiated (5 bisphosphonates ± Ca/vitamin D et 6 Ca/vitamin D supplements). Management was similar when women where less than 80 years old or 80 and more.Conclusions. – Despite information given to physician, only 30.5% of these patients were offered a treatment for osteoporosis. Was the decision to introduce treatment influence by old age and comorbidities?     

Systemic effects of zoledronic acid in children with traumatic femoral head avascular necrosis and Legg–Calve–Perthes disease

Background: Intravenous bisphosphonate therapy is associated with preservation of femoral head sphericity and congruence in 77% of children with traumatic avascular necrosis. The aim was to describe the systemic effects of intravenous zoledronic acid (ZA) on bone and mineral metabolism in otherwise normal children and adolescents with femoral head AVN.Material and methods: 37 children (age 10.8 ± 2.76 years) diagnosed with avascular necrosis AVN (Slipped Capital Femoral Epiphysis (SCFE), N = 20 or Legg–Calve–Perthes disease (LCPD), N = 17) were treated with at least 12 months of ZA. Bone mineral density (BMD) by DXA, bone morphometry and mineral homeostasis were evaluated at baseline, 6, 12 and 18 months. Data was retrieved retrospectively.Results: All children maintained height SD during treatment. BMI SD increased in the SCFE subgroup during the first 12 month period. Bone age increased appropriately. Age adjusted total body BMD, lumbar spine BMD and lean tissue mass adjusted bone mineral content (BMC) Z-scores increased significantly over the 18 months of treatment. The LS.BMD increase was greater in LCPD than in SCFE leading to more individuals with LCPD having a LS.BMD_(age) Z-score over 2 SD at 12 months follow-up. Biochemical markers of bone turnover were decreased and PTH increased during the first 12 months of treatment and bone modeling was reduced. All markers stabilised over the next 6 months. There were no incidences of fracture, spondylolisthesis or osteonecrosis of the jaw.Conclusion: We here report that ZA in otherwise healthy children with femoral head AVN increases BMD – most pronounced in the LCPD group – and reduces bone modeling and turnover. Further efficacy and safety data are required before this therapy can be widely recommended.     

Anomalies de la densité minérale osseuse chez des patients suivis pour arthroseAltered bone metabolism in patients with osteoarthritis.

Objective. Investigation of the relationship between osteoarthritis (OA) and mineral density, and determination of any alteration in bone mineral, metabolism as assessed by biochemical markers of bone resorption and formation. Methods. Forty females and 20 males were included in the study. Spinal OA as well as knee OA were defined from radiographs and graded according to Lane and Spector scoring systems. Bone mineral density (BMD) of the lumbar spine was measured by osteo CT. Bone turnover rates were estimated by measuring biochemical markers of bone resorption (urinary deoxypyridinoline) and bone formation (bone-specific alkaline phosphatase). Forty females and 20 males of the same age were studied as a control group. Results. BMD was greater in women with spinal OA as compared to controls (P < 0.05). Also, males with OA had a non-significantly higher BMD than controls. The bone resorption markers were higher than normal values. However, they were lower than the control group. Similarly, the bone formation markers were lower as compared to the control group. Conclusion. Spinal OA is associated with higher BMD. This protective effect of spinal OA against osteoporosis may be mediated through decreased rate of bone turnover.     

Bone rigidity to neuromuscular performance ratio in young and elderly men

Given the adaptation of bone to prevalent loading, bone loss should follow, but lag behind, the decline in physical performance during aging. Furthermore, bone responsiveness to load-induced strains is believed to decrease with aging. However, the relationship between bone and lean body ( muscle) mass appears to remain rather constant throughout adulthood. The purpose of this study was to examine the association between age and bone to neuromuscular performance ratio. Young (N = 20, age 24 SD ± 2 years, body mass 77 ± 11 kg, height 178 ± 6 cm) and elderly (N = 25, 72 ± 4 years, 75 ± 9 kg, 172 ± 5 cm) men served as subjects. Bone structural traits were measured at the right distal tibia and tibial mid-shaft with peripheral quantitative computed tomography (pQCT). Maximal section modulus (Z_max50), total area (ToA_d), cortical area (CoA₅₀), total density (ToD_d) and cortical density (CoD₅₀) were determined from the pQCT images. Neuromuscular performance was measured by recording vertical ground reaction force (GRF) in maximal bilateral hopping. Load-induced strains were estimated by calculating appropriate indices for compressive and tensile loading that took into account both the bone structure and apparent biomechanics of the given bone site. Young subjects had significantly higher maximal GRF compared to older men (4260 ± 800 N vs. 3080 ± 600 N, P < 0.001). They also had smaller ToA_d (1100 ± 170 mm² vs. 1200 ± 100 mm², P = 0.028) while their ToD_d was higher (370 ± 46 g/cm³ vs. 330 ± 22 g/cm³, P = 0.002). The Z_max50 did not differ significantly between young (1660 ± 320 mm³) and elderly men (1750 ± 320 mm³) (P = 0.224). Compressive (0.484 ± 0.102 vs. 0.399 ± 0.078, P = 0.016) and tensile (0.107 ± 0.016 vs. 0.071 ± 0.018, P < 0.001) strain indices were significantly higher in the younger group. In conclusion, the difference in bone to loading ratio at the tibial mid-shaft is bigger than expected from the delay in bone adaptation alone. Potential candidates to explain this phenomenon include a decrease in mechanosensitivity with aging, inability of maximal physical performance to adequately represent the bone loading environment, or the need to maintain constant safety factors to functional strains.     

Association d’une pneumopathie à Chlamydia psittaci et d’une maladie de HortonA possible assocation between Chlamydiae psittaci infection and temporal arteritis.

Some arguments are in favor of the role of Chlamydia in the pathogenesis of atherosclerosis and some vasculitis. Illustrating this possible relation, we report the case of a patient developing consecutively a Chlamydia psittacci infection and a temporal arteritis. A 73-years-old woman, with no significant medical history, was hospitalized for constitutionnal symptoms. Three weeks before, she described fever and sore throat during 2 days. Since that, she remained exhausted and developped a mild intermittent limp of the jaws. Clinical examination was poor. A biological inflammatory syndrome was noticed. X-ray chest revealed bilateral interstitial opacities. The titer of anti-C. psittaci antibodies was significant (positive IgG at 1/ 2048). Soon after initiation of doxycyclin, a temporal arteritis biopsy performed, due to the persistance of clinical symptoms and high inflammatory syndrom, concluded to the diagnosis of temporal arteritis. Corticotherapy was added to antibiotherapy resulting in decreasing of inflammatory syndrom and improvement of general status of the patient. X-ray opacities decreased in 3 weeks. Serological control after 3 months showed a decrease of the titer of anti-C.psittacci antibodies to 1/256, confirming the initial diagnosis of Chlamydia pneumopathy. Our observation could constitute one more argument for the role of bacteria like Chlamydia in the pathogenesis of vascular diseases. Prospective seroepidemiologic and molecular biology studies could allow to clarify the association between Chlamydia infections and inflammatory vasculitis like temporal arteritis.     

Facteurs pronostiques du myélome utilisables en pratique courante : suivi sur dix ans de 148 malades âgés de plus de 55 ans

Objective. – The objective of this study was to identify prognostic factors in a uniform population of older patients with myeloma.Methods. – Thirty-one study centers in France included 148 patients who were older than 55 years at diagnosis and were followed up until death or for at least ten years. The following tests were available for all patients: blood cell counts; serum and urinary protein electrophoresis; and serum levels of creatinine, calcium, β2-microglobulin (β2-m), lactic dehydrogenase (LDH), and C-reactive protein (CRP).Results. – Mean age was 71.9 years, median survival was 34 months, and mean survival was 47 months. In the univariate analysis, factors significantly associated with higher mortality were male gender (odds ratio [OR], 1–2.12), age older than 70 years (OR, 1.10–2.28), serum albumin lower than 30 g/l (OR, 1.16–3.28), serum creatinine greater than 100 μmol/l (OR, 1.34–2.81), β2-m greater than 6 mg/l (OR, 1.78–4), CRP greater than 6 mg/l (OR, 1.44–3.06), hemoglobin lower than 10 g/dl (OR, 1.8–2.23). In the multivariate analysis, only two factors significantly predicted a higher risk of death: β2-m greater than 6 mg/l (OR =2.439 [1.59–3.76]) and CRP greater than 6 mg/l (OR =1.76 [1.18–2.63]). β2-m level was greater than 6 mg/l in 41 (27.7%) patients and CRP was greater than 6 mg/l in 61 (43.6%) patients. Other potential prognostic factors such as chromosome 13 deletion were not investigated because they were not available for all study patients.Conclusions. – The strength of this study is the ten-year follow-up in a uniform patient cohort. β2-m and CRP independently predicted the risk of death.     

Effets indésirables des morphiniques dans les douleurs aiguës non cancéreuses en rhumatologie. Étude observationnelle en milieu hospitalier

Objectif. – Évaluer la prévalence des effets secondaires de la morphine dans les douleurs aiguës d’origine ostéoarticulaire.Méthodes. – Étude prospective, observationnelle, monocentrique. Les patients hospitalisés dans un service de rhumatologie pour une affection douloureuse, non cancéreuse, évoluant depuis moins de trois mois, pour lesquels une indication de traitement morphinique de classe III OMS, ont été inclus. Les effets secondaires suivants ont été recherchés tous les jours : nausées et vomissements, constipation, prurit, dysurie, globe vésical, somnolence, confusion, hallucinations.Résultats. – Inclusion de 75 patients (46 femmes, 29 hommes ; âge moyen = 56,4 ans hospitalisés pour radiculalgie, tassement vertébral ostéoporotique, rhumatisme inflammatoire ou autre. Le traitement administré en première intention était du sulfate de morphine LP, à la posologie initiale moyenne de 55,2 mg/jour. La dose était majorée si besoin (dose maximale moyenne = 78,3 mg/jour). La durée moyenne du traitement était de 8,9 jours. Des effets secondaires étaient observés chez 73,3 % des patients. Ils étaient le plus souvent mineurs (constipation, nausées, prurit), ne nécessitant pas de modification thérapeutique. Huit patients ont présenté des troubles sérieux (confusion : 5, globe vésical : 3), régressifs sans modification dans deux cas, après réduction de la dose dans deux cas et après remplacement du sulfate de morphine par du fentanyl ou du chlorhydrate d’hydromorphone dans quatre cas. Aucun phénomène de sevrage n’a été observé à l’arrêt du traitement.Conclusions. – L’utilisation de morphine dans les douleurs aiguës rhumatologiques non cancéreuses s’accompagne de fréquents effets secondaires. Ceux-ci sont cependant le plus souvent modérés, et nécessitent exceptionnellement un arrêt du traitement morphinique.Objective. – To evaluate the prevalence of adverse effects of opioids used to treat acute nonmalignant musculoskeletal pain.Methods. – Prospective, single-center, observational study in patients admitted to a rheumatology department for a nonmalignant painful musculoskeletal condition with onset within the last three months and a need for WHO Class III analgesics. The following side effects were recorded daily: nausea and vomiting, constipation, pruritus, urinary retention, drowsiness, confusion, and hallucinations.Results. – The 75 study patients (46 women and 29 men with a mean age of 56.4 years) were admitted for nerve root pain, osteoporotic vertebral fracture, inflammatory joint disease, or other disorders. First-line treatment was sustained-release morphine sulfate in a mean starting dosage of 55.2 mg/day. The dosage was increased if needed (mean maximum dosage, 78.3 mg/day). Mean treatment duration was 8.9 days. Adverse effects were recorded in 73.3% of patients but were usually minor, requiring no change in the treatment regimen. Eight patients experienced serious adverse effects (confusion in 5 and urinary retention in 3) that resolved with no change in treatment in two patients, after dosage reduction in two patients and after substitution of fentanyl or hydromorphone hydrochloride in four patients. Treatment discontinuation was not associated with adverse effects.Conclusions. – Morphine is often responsible for adverse effects in patients with acute nonmalignant musculoskeletal pain. These effects are usually moderate and very rarely require discontinuation of the drug.     

Relationship among dietary estimates of net endogenous acid production, bone mineral density and biochemical markers of bone turnover in an Iranian general population

Chronic, low-grade metabolic acidosis due to Western diets may be a risk factor for osteoporosis. The severity can be determined in part by net endogenous acid production (NEAP). In a population-based study, a total of 1028 healthy men and women aged 20–72 years were evaluated for dietary intakes and NEAP estimates with a validated food frequency questionnaire. Dual-energy X-ray absorptiometry (DXA) was used to determine BMD of the lumbar spine (L2–L4), distal third of radius, and proximal femur. Serum CrossLaps, degradation products of the C-terminal telopeptides of type I collagen, and osteocalcin were measured by highly specific ELISA methods. Lower estimates of energy-adjusted rates of NEAP were associated with greater femoral neck BMD (p = 0.01) in premenopausal women and with greater BMDs at the distal radius (p = 0.001) and lumbar spine (p = 0.04) in postmenopausal women. Compared with women in the highest quartile of the estimates of the energy-adjusted rates of NEAP, pre- and postmenopausal women in the lowest quartile had significantly greater means of osteocalcin [9.12 (SD ± 1.62) vs. 5.24 (SD ± 1.41) ng/ml, p = 0.02 and 11.74 (SD ± 1.69) vs. 7.79 (SD ± 2.63) ng/ml, p = 0.002, respectively]. Analysis by quartiles of the estimates of energy-adjusted rates of NEAP did not reveal a relationship between BMD and bone turnover markers in men. In conclusion, we found that a high energy-adjusted rate of NEAP was associated with a significantly lower BMD in women but not in men and the energy-adjusted rate of NEAP had a negative relationship with bone formation.     

A novel protamine variant reversal of heparin anticoagulation in human blood in vitro

Purpose: Protamine reversal of heparin anticoagulation during cardiovascular surgery may cause severe hypotension and pulmonary hypertension. A novel protamine variant, [+18RGD], has been developed that effectively reverses heparin anticoagulation without toxicity in canine experiments. Heretofore, human studies have not been undertaken. This investigation hypothesized that [+18RGD] would effectively reverse heparin anticoagulation of human blood in vitro. Methods: Fifty patients who underwent anticoagulation therapy during vascular surgery had blood sampled at baseline and 30 minutes after receiving heparin (150 IU/kg). Activated clotting times were used to define specific quantities of [+18RGD] or protamine necessary to completely reverse heparin anticoagulation in the blood sample of each patient. These defined amounts of [+18RGD] or protamine were then administered to the heparinized blood samples, and percent reversals of activated partial thromboplastin time, thrombin clotting time, and antifactor Xa/IIa levels were determined. In addition, platelet aggregation assays, as well as platelet and white blood cell counts were performed. Results: [+18RGD] and protamine were equivalent in reversing heparin as assessed by thrombin clotting time, antifactor Xa, antifactor IIa levels, and white blood cell changes. [+18RGD], when compared with protamine, was superior in this regard, as assessed by activated partial thromboplastin time (94.5 ± 1.0 vs 86.5 ± 1.3%δ, respectively; p < 0.001) and platelet declines (–3.9 ± 2.9 vs –12.8 ± 3.4 per mm³, respectively; p = 0.048). Platelet aggregation was also decreased for [+18RGD] compared with protamine (23.6 ± 1.5 vs 28.5 ± 1.9%, respectively; p = 0.048). Conclusions: [+18RGD] was as effective as protamine for in vitro reversal of heparin anticoagulation by most coagulation assays, was statistically more effective at reversal than protamine by aPTT assay, and was associated with lesser platelet reductions than protamine. [+18RGD], if less toxic than protamine in human beings, would allow for effective clinical reversal of heparin anticoagulation. (J Vasc Surg 1997;26:1043-8.)     

Bone mass and metabolism in thalassemic children and adolescents treated with different iron-chelating drugs

We evaluated bone mineral density (BMD) and bone turnover in 22 homozygous prepubertal beta-thalassemic patients treated with desferrioxamine. Ten patients underwent treatment with desferrioxamine for the whole study period, while 12 patients stopped desferrioxamine and were then treated with deferiprone (L1). Lumbar and femoral BMD and bone metabolism markers were examined at baseline and after 1 and 3 years of follow up. All patients were prepubertal at baseline and they all became pubertal over the 3 years of follow up. At baseline, the mean lumbar Z score value was –2.048 SD ± 0.75; the Z score was less than –2 SD in 13 children, within –1 and –2 SD in 6, and within 0 and –1 SD in only 3 subjects. A significant BMD increase (P 0.0001) was observed at both the lumbar (+8.466%/year) and the femoral level (average of +3.46%/year at neck and +5.83%/year at the intertrochanteric region) after 3 years, without any significant difference being shown between patients treated with desferrioxamine and those treated with L1. The mean Z score SD values increased to –1.957 ± 0.975 at 1 year (not significantly different from baseline) and to –1.864 ± 1.221 at 3 year follow up (P 0.05 vs baseline); an increase in bone turnover was also observed. These findings show that low BMD, a hallmark of beta-thalassemia, improves significantly when puberty begins; this increase involves different skeletal sites, regardless of pharmacological treatment with different iron-chelating drugs.     

Beneficial treatment with risedronate in long-term survivors after allogeneic stem cell transplantation for hematological malignancies

In this prospective randomized study we evaluated the effect of risedronate, an aminobisphosphonate, on bone mass and turnover in patients who had undergone allogeneic stem cell transplant (SCT) for hematological malignancies. Thirty-four patients (18 females, 16 males, age 32±10 years) with bone mineral density (BMD) –1.5 SD as a T-score at least 6 months after SCT were treated with calcium 1 g/day and vitamin D 800 IU/day and randomized to receive (n=17, group 1) or not receive (n=17, group 2) oral risedronate 5 mg/day. The duration of treatment was 12 months. After 6 months, lumbar BMD increased by 4.4±1.6% in patients of group 1 and decreased by 4.3±1.5% in those of group 2 (P<0.05); at the femoral neck, BMD did not change significantly in patients of group 1 (+1.2±1.2%), while it decreased in those of group 2 (–4.3±2.1%; P<0.05). After 12 months, lumbar BMD further increased (+5.9±1.7%, P<0.05), compared to baseline in group 1 and slightly increased (+1.1±1.4%) in group 2. No further changes were observed at femoral neck in both groups. In conclusion, treatment with risedronate for 12 months increased BMD significantly at the lumbar spine and prevented further bone loss at the femoral neck in long-term survivors after allo-SCT.     

L’hypercalciurieHypercalciuria.

Hypercalciuria is a biological syndrome defined as excretion in the urine of more than 0.1 mmol/kg/24 hours of calcium in the absence of dietary restrictions. A number of endocrine, renal, and bone diseases can cause hypercalciuria. Urinary calcium excretion is substantially influenced by the intakes of calcium, sodium, protein, carbohydrates, alcohol, and potassium, so that a poorly balanced diet can result in hypercalciuria. Recently, there has been a burst of interest in molecular studies of rare lithiasis syndromes, all of which are due to mutations in the ClCN5 chlorine channel gene. Mutations affecting the calcium-sensitive receptor (CaSR) have been identified in other forms of hypercalciuria. Idiopathic hypercalciuria is defined as hypercalciuria that persists after correction of dietary imbalances and has no detectable cause. The classification suggested by Pak (class I, class II, class III, and “renal” hypercalciuria) is controversial and of little assistance in clinical practice. Three mechanisms can be incriminated in idiopathic hypercalciuria: increased intestinal absorption of calcium, defective reabsorption of calcium by the renal tubule, and increased bone resorption. Overexpression of the vitamin D receptor and a deficiency in renal tubule enzymes may be involved also. Bone mineral density is moderately decreased in idiopathic hypercalciuria, particularly of the renal type. The risk of vertebral fracture seems increased, however. Overproduction of calcitriol and of cytokines that stimulate bone resorption have been incriminated in the bone loss. Treatment of the cause is essential in secondary hypercalciuria (dietary advice, treatment of an underlying disease…). A diet low in sodium and meat and containing no more than 800 mg of calcium per day has been advocated in idiopathic hypercalciuria. Hydrochlorothiaide therapy is warranted in patients with osteopenia and an inadequate response to dietary therapy.     

Treatment of postmenopausal vertebral osteopenia with monofluorophospate: A long-term calcium-controlled study

The aim of the present study was to assess the effects of the new fluorine pro-drug monofluorophos-phate (MFP) in postmenopausal women with vertebral osteopenia and high bone turnover. We enrolled postmenopausal women (PMW, 43–59 years) who had had a natural menopause 2–5 years before the study, had vertebral bone mineral density (BMD) <13 SD from the premenopausal mean, and had at least one of the biochemical markers of bone remodeling >1 SD over the mean for premenopausal women. Patients were randomly divided into two treatment groups (group 1, 500 mg/day of oral calcium; group 2, MFP at the dose of 20 mg F-equivalents + 600 mg calcium/day) for 2 years (n=21 in each group). The lumbar vertebral (L2–4) BMD and total body bone mineral (TBBM) were measured by dual-energy X-ray absorptiometry (Lunar DPX, Lunar Corporation, USA). Urinary hydroxyproline excretion (OH-P/Cr), plasma bone Gla protein (BGP) and serum alkaline phosphatase (AP) were assayed. In group 1 the markers of bone turnover and vertebral BMD did not show any significant modification, while TBBM showed a significant (p<0.05) decrease after 24 months. In group 2 a significant (p<0.05) decrease in OH-P/Cr (–23.9±2.0%), and an increase in both BGP (+19.4±2.6%) and AP(+10.3±2.6%) levels were observed after 24 months of MFP administration. In this group, both vertebral BMD (+5.01±0.9%,p<0.01) and TBBM (+4.0±0.6%,p<0.05) showed a significant increase after 24 months. Present results suggest that, in osteopenic PMW, MFP administration induces a significant increase in vertebral BMD without impairment of cortical bone, with a reduction in bone resorption and an increase in bone formation rate.