Altered bone composition in children with vertebral fracture

Primary osteoporosis in children often leads to vertebral fractures, but it remains unknown whether these fractures associate with changes in bone composition. This study aimed to determine the differences in bone composition in fracture‐prone children with and without vertebral fractures, as assessed by Fourier transform infrared spectroscopic imaging (FTIRI) and bone histomorphometry. Iliac crest bone biopsies (n = 24) were obtained from children who were suspected of primary osteoporosis based on evidence from the fracture history and/or low bone mineral density (BMD) by dual‐energy X‐ray absorptiometry. Vertebral morphology was determined by radiography. Bone biopsies were analyzed using histomorphometry and FTIRI. Phosphate‐to‐amide I, carbonate‐to‐phosphate, carbonate‐to‐amide I, and cross‐link ratio (collagen maturity) were calculated. Children with (n = 14) and without (n = 10) vertebral fracture were compared. Low cancellous bone volume (BV/TV) was detected by histomorphometry in 36% of the children with vertebral fracture, and bone turnover rate was abnormal in 64% of them. Children with vertebral fractures had lower carbonate‐to‐phosphate ratios (p < .05) and higher collagen maturity (p < .05) than children without vertebral fracture. The children with low BV/TV in biopsy showed lower carbonate‐to‐amide I ratios (p < .05) than the children with normal bone volume. This study showed changes in bone composition among fracture‐prone children who had sustained a vertebral fracture. The observed changes in bone composition in these children may contribute to their greater propensity to sustain vertebral fractures. © 2011 American Society for Bone and Mineral Research     

The effect of body mass index on the spread of spinal block in patients with rheumatoid arthritis

Purpose  

Body mass index (BMI) has a significant effect on the spread of sensory spinal block in rheumatoid patients. We tried to achieve the same spread of spinal block for patients in three different BMI groups and, on the basis of the results from a preliminary study, used a simple method feasible for clinical practice. We hypothesized that BMI-related inverse dosing of plain bupivacaine according to low, normal, and high BMI would result in no difference in block extent.     

Apolipoprotein B is related to arterial pulse wave velocity in young adults: the Cardiovascular Risk in Young Finns Study

ObjectiveLimited data are available regarding the relationship of apolipoproteins B (ApoB) and A-1 (ApoA-1) with arterial stiffness. We conducted the present study to determine whether adulthood ApoB and ApoA-1 are related to arterial pulse wave velocity (PWV). Moreover, we examined whether ApoB and ApoA-1 measured in young adulthood are predictive of PWV assessed 6 years later.MethodsThe study population consisted of 1618 apparently healthy Finnish young adults (aged 30–45 years, 44.9% males) whose apolipoproteins, other cardiovascular risk factors and PWV were measured in 2007. In a sub-sample population, apolipoproteins and other cardiovascular risk factors had also been measured in 2001 (n = 1264). PWV measurements were performed using a whole-body impedance cardiography device.ResultsApoB (p < 0.001) and the ApoB/ApoA-1 ratio (p < 0.001) were directly associated with PWV. ApoB and the ApoB/ApoA-1 ratio measured in young adulthood were also predictive of PWV measured 6 later (p < 0.001 for both). These relations remained significant (p < 0.006) in models adjusted for non-lipid risk factors. The areas under the receiver-operating characteristic (ROC) curves (AUC) were similar for ApoB and non-HDL cholesterol (2001: p for AUC comparison = 0.15; 2007: p for AUC comparison = 0.07) in detecting subjects with increased PWV (PWV ≥ 90th percentile).ConclusionThe present study suggests that elevation of ApoB or non-HDL cholesterol is associated with increased arterial stiffness in young adults.     

Simplifying the treatment of acute bacterial bone and joint infections in children

The treatment of acute hematogenous bone and joint infections of children - osteomyelitis (OM), septic arthritis (SA) and OM-SA combination (OM+SA) - has simplified over the past years. The old approach included months-long antibiotic treatment, started intravenously for at least a week, followed by oral completion of the course. Recent prospective randomized trials show that most cases heal with a total course of 3 weeks (OM, OM+SA) or 2 weeks (SA) of an appropriate antibiotic, provided the clinical response is good and C-reactive protein level has normalized. If the prevalence of methicillin-resistant Staphylococcus aureus and Kingella kingae is low, clindamycin and a first-generation cephalosporin are safe, inexpensive and effective alternatives. They should be administered in large doses and four times a day. Clindamycin, vancomycin and expensive linezolid are options against methicillin-resistant Staphylococcus aureus. Extensive surgery beyond a diagnostic sample by aspiration is rarely needed in uncomplicated cases.