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Compression fracture due to horseback riding alone in osteopenic spine
S20
Abstracts
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The VINFORCE Study Group, St. Vincent Hospital, Vienna Austria Department of Radiology, Medical University of Vienna, Austria c Biomedica Group, Vienna, Austria d Central Laboratory St. Vincent Group, Vienna, Austria Abstract: Sclerostin is a secreted Wnt antagonist, almost exclusively produced by osteocytes, which have been identified to be responsible for mechanotransduction. Recent mice experiments showed a down regulation of SOST/Sclerostin pathway as a result of mechanical force. Currently there is less information available about the effect of physical load in humans on the production of Sclerostin. The aim of our study was to investigate the response of circulating plasma sclerostin levels to different types of physical exercise with high impact on musculoskeletal system in healthy young females. Group 1 consisted of competitive athletes of team handball (n = 8, Age: 22.1 +/− 2.3, BMI 21.8 +/− 2.6), who played handball for 60 min. Group 2 consisted of healthy young females of average physical fitness (n = 21, Age: 24.9 +/− 2.3, BMI 24.1 +/− 3.8) who underwent a single training unit of high intensity whole body vibration (Galileo Basic®, 20 Hz, 10 min). Blood samples of both groups were collected at baseline, directly after exercise and after 1 h rest. At baseline sclerostin levels (pmol/l) in both groups showed no significant difference (group 1 37.5 +/− 13.9, group 2 28.5 +/− 12.6, N.S.). After 1 h of resting following the physical activity, sclerostin levels in group 1 increased significantly (44.7 +/− 13.8, p = 0.016), in contrast group 2 showed no significant changes. Our data suggest that the different responses of circulating sclerostin levels depend on duration and type of exercise in healthy young females. Circulating sclerostin levels of competitive athletes with high sportive activity show a different response than young females on average fitness-level.
Department of Orthopaedic Surgery, Medical University Graz, Graz, Austria Department of Internal Medicine, Medical University Graz, Graz, Austria
Abstract: Childhood sarcoma patients still receive chemotherapy without consideration of their bone status. Especially high-dose methotrexate, used in osteosarcoma treatment, is suspected to have a negative long-term effect on bone development. We therefore wanted to evaluate possible bone mineral density deficits, laboratory alterations and skeletal related events after chemotherapy in our Ewing's and osteosarcoma patients, focusing on possible differences between the two tumor entities and potential further influencing factors. We performed lumbar and femoral dual-energy X-ray scans in addition to serum analysis in 43 bone sarcoma survivors (mean age, 27 ± 9 years), and evaluated the incidence of fractures after chemotherapy and patient life style. Mean follow-up was 7 ± 5 years. All patients had received chemotherapeutic treatment according to the protocols active at the time of enrollment. Osteodensitometry revealed lower bone mineral density for chronologic age in 58% of patients in at least one measured site. Seven patients of 43 suffered from non-trauma/tumor-associated fractures. Further our patients presented disturbances in bone metabolism combined with vitamin D deficiency in 88% and genetic predisposition for lactose intolerance in 37%. Results did not significantly vary between the two tumor subgroups. We would like to sensitize doctors of possible premature bone loss and consecutive pathologic fractures as a potential threat in young bone sarcoma survivors years after chemotherapeutic treatment. Vitamin D deficiency, calcium malnutrition, and lactose intolerance might additionally worsen the harmful effect of tumor therapy. Considering this in follow up provides a beneficial strategy for our young patients in prevention of premature osteoporosis.
doi:10.1016/j.bone.2012.08.065 doi:10.1016/j.bone.2012.08.063
P13 Bone remodelling biomarkers after whole body cryotherapy (WBC) in elite rugby players E. Gallieraa,c, G. Dogliottib, G. Melegatic,d, P. Cabitzab,e, M.M. Corsi Romanellib,e, G. Banfib,c a Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy b Dipartimento di Scienze Biomediche per la salute, Università degli Studi di Milano, Milan, Italy c Istituto Ortopedico R. Galeazzi IRCCS, Milan, Italy d Italian Rugby Federation, Italy e Policlinico San Donato IRCCS, San Donato Milanese , Italy Abstract: Whole body cryotherapy (WBC) consists of a brief exposure to extreme cold air (− 110 °C) in a controlled chamber and it is applied in sports medicine to improve recovery from musculoskeletal trauma. The aim of this study is to better define the beneficial effect of WCB on the musculoskeletal system of athletes, in particular on bone remodelling. Remodelling osteoimmunologic biomarkers OPG, RANKL and RANK were measured after WBC treatment in 10 male rugby players randomly selected from the Italian National team. OPG levels were increased significantly, supporting the view that WBC induces an osteogenic effect. Further studies evaluating the effect of WBC on bone metabolism are desirable.
doi:10.1016/j.bone.2012.08.064
P14 Bone mineral density reduction and alterations in bone metabolism after chemotherapy in young bone sarcoma survivors U. Pirker-Frühaufa, J. Friesenbichlera, W. Maurer-Ertla, B. Obermayer-Pietschb, A. Leithnera
P15 Compression fracture due to horseback riding alone in osteopenic spine M. Kang, J.I. Lee Department of Physical medicine and Rehabilitation, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea Abstract: Introduction: Osteoporosis is a common and important health problem that accounts for up to 2 million fractures per year in postmenopausal women and vertebral compression fractures are the most common type of osteoporotic fracture. To improve bone mineral density, exercises providing spinal axial loading are generally considered as an integral part of the management for osteoporosis. We present a case report of compression fracture due to horseback riding alone in osteopenic spine. Case report: A 49-year-old woman presented with upper back pain. There was no prior history of back pain and she denied history of falls even from a standing height or less and trauma such as motor vehicle accident. On regular check up including bone mineral density and thoracolumbar X-ray 2 months earlier, osteopenia of lumbar spine and femur was revealed, total Z-score was − 2.3, − 2.4 respectively. 1 month after she began to take vit D and calcium supplements, she started to learn horseback riding. 1 month later, vague pain at her upper back was developed. On physical examination, palpation of the entire spine revealed no tenderness at the thoracolumbar spine and no stepoffs or gaps between the spinous processes. Bone scan showed a hot uptake at the 6th thoracic spine. The lateral thoracic spine film identified a compression fracture of her 6th thoracic vertebra without any displacement of a bony fragment causing cord compression. Discussion: Despite ongoing pharmacotherapy including vit D and calcium for osteoporosis and the absence of significant back pain, this patient had a compression fracture. Though isolated compression fracture of the thoracolumbar vertebrae usually is considered stable, it, if left undiagnosed, could have progressed into a more serious condition during the training of horseback riding. An appropriate index of suspicion should be present. Exercise is generally considered as an integral part of the management for osteoporosis, but proper exercise program for strengthening the back extensors, improving the bone mineral density must be done along with instructions to avoid complications.
doi:10.1016/j.bone.2012.08.066
Abstracts
a
a
b
b
The VINFORCE Study Group, St. Vincent Hospital, Vienna Austria Department of Radiology, Medical University of Vienna, Austria c Biomedica Group, Vienna, Austria d Central Laboratory St. Vincent Group, Vienna, Austria Abstract: Sclerostin is a secreted Wnt antagonist, almost exclusively produced by osteocytes, which have been identified to be responsible for mechanotransduction. Recent mice experiments showed a down regulation of SOST/Sclerostin pathway as a result of mechanical force. Currently there is less information available about the effect of physical load in humans on the production of Sclerostin. The aim of our study was to investigate the response of circulating plasma sclerostin levels to different types of physical exercise with high impact on musculoskeletal system in healthy young females. Group 1 consisted of competitive athletes of team handball (n = 8, Age: 22.1 +/− 2.3, BMI 21.8 +/− 2.6), who played handball for 60 min. Group 2 consisted of healthy young females of average physical fitness (n = 21, Age: 24.9 +/− 2.3, BMI 24.1 +/− 3.8) who underwent a single training unit of high intensity whole body vibration (Galileo Basic®, 20 Hz, 10 min). Blood samples of both groups were collected at baseline, directly after exercise and after 1 h rest. At baseline sclerostin levels (pmol/l) in both groups showed no significant difference (group 1 37.5 +/− 13.9, group 2 28.5 +/− 12.6, N.S.). After 1 h of resting following the physical activity, sclerostin levels in group 1 increased significantly (44.7 +/− 13.8, p = 0.016), in contrast group 2 showed no significant changes. Our data suggest that the different responses of circulating sclerostin levels depend on duration and type of exercise in healthy young females. Circulating sclerostin levels of competitive athletes with high sportive activity show a different response than young females on average fitness-level.
Department of Orthopaedic Surgery, Medical University Graz, Graz, Austria Department of Internal Medicine, Medical University Graz, Graz, Austria
Abstract: Childhood sarcoma patients still receive chemotherapy without consideration of their bone status. Especially high-dose methotrexate, used in osteosarcoma treatment, is suspected to have a negative long-term effect on bone development. We therefore wanted to evaluate possible bone mineral density deficits, laboratory alterations and skeletal related events after chemotherapy in our Ewing's and osteosarcoma patients, focusing on possible differences between the two tumor entities and potential further influencing factors. We performed lumbar and femoral dual-energy X-ray scans in addition to serum analysis in 43 bone sarcoma survivors (mean age, 27 ± 9 years), and evaluated the incidence of fractures after chemotherapy and patient life style. Mean follow-up was 7 ± 5 years. All patients had received chemotherapeutic treatment according to the protocols active at the time of enrollment. Osteodensitometry revealed lower bone mineral density for chronologic age in 58% of patients in at least one measured site. Seven patients of 43 suffered from non-trauma/tumor-associated fractures. Further our patients presented disturbances in bone metabolism combined with vitamin D deficiency in 88% and genetic predisposition for lactose intolerance in 37%. Results did not significantly vary between the two tumor subgroups. We would like to sensitize doctors of possible premature bone loss and consecutive pathologic fractures as a potential threat in young bone sarcoma survivors years after chemotherapeutic treatment. Vitamin D deficiency, calcium malnutrition, and lactose intolerance might additionally worsen the harmful effect of tumor therapy. Considering this in follow up provides a beneficial strategy for our young patients in prevention of premature osteoporosis.
doi:10.1016/j.bone.2012.08.065 doi:10.1016/j.bone.2012.08.063
P13 Bone remodelling biomarkers after whole body cryotherapy (WBC) in elite rugby players E. Gallieraa,c, G. Dogliottib, G. Melegatic,d, P. Cabitzab,e, M.M. Corsi Romanellib,e, G. Banfib,c a Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy b Dipartimento di Scienze Biomediche per la salute, Università degli Studi di Milano, Milan, Italy c Istituto Ortopedico R. Galeazzi IRCCS, Milan, Italy d Italian Rugby Federation, Italy e Policlinico San Donato IRCCS, San Donato Milanese , Italy Abstract: Whole body cryotherapy (WBC) consists of a brief exposure to extreme cold air (− 110 °C) in a controlled chamber and it is applied in sports medicine to improve recovery from musculoskeletal trauma. The aim of this study is to better define the beneficial effect of WCB on the musculoskeletal system of athletes, in particular on bone remodelling. Remodelling osteoimmunologic biomarkers OPG, RANKL and RANK were measured after WBC treatment in 10 male rugby players randomly selected from the Italian National team. OPG levels were increased significantly, supporting the view that WBC induces an osteogenic effect. Further studies evaluating the effect of WBC on bone metabolism are desirable.
doi:10.1016/j.bone.2012.08.064
P14 Bone mineral density reduction and alterations in bone metabolism after chemotherapy in young bone sarcoma survivors U. Pirker-Frühaufa, J. Friesenbichlera, W. Maurer-Ertla, B. Obermayer-Pietschb, A. Leithnera
P15 Compression fracture due to horseback riding alone in osteopenic spine M. Kang, J.I. Lee Department of Physical medicine and Rehabilitation, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea Abstract: Introduction: Osteoporosis is a common and important health problem that accounts for up to 2 million fractures per year in postmenopausal women and vertebral compression fractures are the most common type of osteoporotic fracture. To improve bone mineral density, exercises providing spinal axial loading are generally considered as an integral part of the management for osteoporosis. We present a case report of compression fracture due to horseback riding alone in osteopenic spine. Case report: A 49-year-old woman presented with upper back pain. There was no prior history of back pain and she denied history of falls even from a standing height or less and trauma such as motor vehicle accident. On regular check up including bone mineral density and thoracolumbar X-ray 2 months earlier, osteopenia of lumbar spine and femur was revealed, total Z-score was − 2.3, − 2.4 respectively. 1 month after she began to take vit D and calcium supplements, she started to learn horseback riding. 1 month later, vague pain at her upper back was developed. On physical examination, palpation of the entire spine revealed no tenderness at the thoracolumbar spine and no stepoffs or gaps between the spinous processes. Bone scan showed a hot uptake at the 6th thoracic spine. The lateral thoracic spine film identified a compression fracture of her 6th thoracic vertebra without any displacement of a bony fragment causing cord compression. Discussion: Despite ongoing pharmacotherapy including vit D and calcium for osteoporosis and the absence of significant back pain, this patient had a compression fracture. Though isolated compression fracture of the thoracolumbar vertebrae usually is considered stable, it, if left undiagnosed, could have progressed into a more serious condition during the training of horseback riding. An appropriate index of suspicion should be present. Exercise is generally considered as an integral part of the management for osteoporosis, but proper exercise program for strengthening the back extensors, improving the bone mineral density must be done along with instructions to avoid complications.
doi:10.1016/j.bone.2012.08.066